Pressure Ulcer - Basic Facts and Prevention

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What is Pressure Ulcer?

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Any lesion caused by unrelieved pressure resulting in damage of underlying tissue. Pressure ulcers are usually over bony prominences and are graded or staged to classify the degree of tissue damage observed. The staging of pressure ulcers recommended for use by this panel is consistent with the recommendations of the National Pressure Ulcer Advisory Panel (NPUAP, 1989) as derived from previous staging systems proposed by Shea (1975) and the International Association for Enterostomal Therapy (IAET, 1988). The staging is as follows:

How are Pressure Ulcers Staged?

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Stage I: Non blanchable erythema of intact skin; the heralding lesion of skin ulceration. Note: Reactive hyperemia can normally be expected to be present for one-half to three-fourths as long as the pressure occluded blood flow to the area (Lewis and Grant, 1925). This should not be confused with a Stage I pressure ulcer.

Stage II: Partial thickness skin loss involving epidermis and/or dermis. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater.

Stage III: Full thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue.

Stage IV: Full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (for example, tendon or joint capsule). Note: Undermining and sinus tracts may also be associated with Stage IV pressure ulcers.

Staging definitions recognize the following limitations:

Assessment of Stage I pressure ulcers may be difficult in patients with darkly pigmented skin.
When eschar is present, accurate staging of the pressure ulcer is not possible until the eschar has sloughed or the wound has been debrided.

What are Risk Factors and How to Prevent?

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Risk Factor	Preventive Actions
Inability to Move Bed or Chair Confinement Inspect skin at least once a day. Bathe when needed for comfort or cleanliness. Prevent dry skin. For a person in a chair who is able to shift his or her own weight: change position at least every 15 minutes use pillows or wedges to keep knees or ankles from touching each other.	For a person in bed: 1. Change position at least every 2 hours. 2. Use a special mattress that contains foam, air, gel, or water. 3. Raise the head of bed as little and for as short a time as possible.	For a person in a chair: 1. Change position every hour. 2. Use foam, gel, or air cushion to relieve pressure. Reduce friction by: Lifting rather than dragging when repositioning. 1. Using corn starch on skin. 2. Avoid use of donut-shaped cushions. Participate in a rehab program.
Loss of Bowel or Bladder Control	Clean skin as soon as soiled. Assess and treat urine leaks. If moisture cannot be controlled: 1. Use absorbent pads and/or briefs with a quick-drying surface. 2. Protect skin with a cream or ointment.
Poor Nutrition	Eat a balanced diet. If a normal diet is not possible, talk to health care provider about nutritional supplements.
Lowered Mental Awareness	Choose preventive actions that apply to the person with lowered mental awareness. For example, if the person is chair-bound, refer to the specific preventive actions outlined in Risk Factor 1.