Pressure injury – Is it preventable?

Article written by :
Dr. Koustubh Chakraborty
MD (P.M.&R.), DNB (P.M.&R.), ECFMG (USA),
Consultant Physical Medicine & Rehabilitation

A pressure injury, formerly known as a Pressure Ulcer or Bedsore, occurs when different kinds of forces are applied to the body, resulting from prolonged pressure on the skin & underlying tissues. They are mostly formed in the regions which have bony structures below the skin, like – hips, buttocks, head, ankle and heel. People who are mostly at risk are the ones who have limited ability of movement. We often say, that a pressure injury is life threatening. However, this is largely preventable.

What are the main causes of pressure injuries?

• Pressure: Constant pressure on the skin resulting from remaining in the same position for a prolonged period of time, compromising blood circulation to that area.
• Shear: Shear damage or a dragging force can occur when the head of the bed is raised and the body slides down. The skin sticks to the sheets, but internal structures move and are damaged.
• Moisture: Fluids (sweat, urine, fecal matter) that remains on the skin can cause the skin to become overly wet, which increases the risk for pressure injury development.

There are mainly four stages of pressure injury divided according to the severity of the wound.

• Stage 1: In this stage, a discolouration of the skin occurs. The skin appears red in the places where there is lighter tone and blue or purple in the places with darker tone.
• Stage 2: This stage involves superficial damage of the skin. The top layer of skin is lost. It may also look like a blister. At this stage, the top layer of skin can repair itself.
• Stage 3: In this stage a deeper wound occurs. The wound is open, extending to the fatty layer of the skin. in this stage muscles and bone are not showing.
• Stage 4: This stage is the most severe. The wound extends down to the bone. The muscles and bone are prone to infection, which can be life-threatening.
• In addition, two other categories are – Unstageable and suspected deep tissue injury

Who are at risk of developing pressure injuries?

Pressure injuries occur mostly in people with limited ability of movement or complete inability. It may also occur in people who have splints or prosthetic limbs, as the skin at those areas get irritated due to which a pressure injury occurs. Mostly elderly or aged people are at risk of developing these injuries as their skin become thinner with age.

What are the preventable measures?

• Changing position of the patient in every two hours when in lying position and every 20 minutes when in sitting position
• There should not be any wrinkles in the bed sheet / molysheet on which the person is lying down. As wrinkles can be a cause of pressure injury.
• Ensure that no body part of the patient crosses one another.
• Ensure that the catheter or oxygen tube (if needed for the person who is immobile), doesn’t come underneath any body part of the person.
• Ensure proper nutrition & fluid intake.
• Minimise urine or stool staying in contact with skin for prolonged periods in immobile patients.

We strongly believe that prevention is better than cure. Following the precautionary measures can – “Stop development of pressure ulcers and save people from developing life threatening situations”. However, if they do happen despite of our best efforts, various types of treatment options are available depending upon the stage and area involved.