From the Guidelines
Pressure injuries are primarily caused by prolonged pressure on the skin that restricts blood flow to tissues, leading to tissue damage and death, as supported by the most recent evidence from 2023 1. These injuries develop when soft tissue is compressed between a bony prominence and an external surface for extended periods. Several factors increase the risk of pressure injuries, including:
- Immobility
- Poor nutrition
- Moisture (from incontinence or perspiration)
- Decreased sensation
- Advanced age
- Certain medical conditions like diabetes or vascular disease Shearing forces, which occur when skin sticks to a surface while underlying tissues move, and friction from rubbing against surfaces can worsen damage.
Key Factors
Pressure injuries typically develop in areas with little padding between skin and bone, such as:
- The sacrum
- Heels
- Elbows
- Back of the head Prevention involves:
- Regular repositioning (every 2 hours)
- Using pressure-redistributing surfaces like specialized mattresses, as recommended by the American College of Physicians in 2015 1
- Maintaining good skin hygiene
- Optimizing nutrition
- Managing moisture Early intervention is crucial as pressure injuries can progress rapidly from mild redness to deep tissue damage, potentially leading to serious complications including infection and sepsis.
Prevention Strategies
The use of advanced static mattresses or advanced static overlays is recommended for patients at increased risk of developing pressure ulcers, as stated in the 2015 guideline from the American College of Physicians 1. In contrast, the use of alternating-air mattresses or alternating-air overlays is not recommended for patients at increased risk of developing pressure ulcers, according to the same guideline 1. Understanding the barriers and facilitators to implementing pressure injury prevention and management guidelines is essential for improving patient outcomes, as highlighted in the 2023 systematic review 1.
From the Research
Causes of Pressure Injuries
The causes of pressure injuries can be categorized into two main factors: extrinsic and intrinsic factors.
- Extrinsic factors include:
- Pressure
- Shear
- Friction
- Moisture 2
- Intrinsic factors include:
- Nutritional status
- Spasticity
- Decreased sensation
- Vascular disease 2
Role of Nutrition in Pressure Injury Prevention and Healing
Nutrition plays a crucial role in the prevention and treatment of pressure injuries.
- Macro- and micronutrients are required by each organ system in specific amounts to promote the growth, development, maintenance, and repair of body tissues 3
- Malnutrition can lead to longer hospital stays, altered immune function, and impaired skin integrity and wound healing 4
- Strategies such as early identification and management of malnutrition, provision of specially-formulated oral nutritional interventions, and optimization of electronic health record systems can improve outcomes 4
Prevention and Management of Pressure Injuries
Prevention of pressure injuries focuses on assessing and optimizing nutritional status, repositioning the patient, and providing appropriate support surfaces 5
- Treatment involves pressure off-loading, nutritional optimization, appropriate bandage selection, and wound site management 5
- Comprehensive skin assessments are crucial for evaluating pressure injuries, and staging of pressure injuries should follow the updated staging system of the National Pressure Injury Advisory Panel 5