Pressure Ulcer-Injury Prevention for Caregivers


A pressure ulcer is an injury to the skin and underlying tissue that is typically caused by unrelieved pressure. Pressure ulcers, commonly known as bedsores, range in severity from moderate (light skin reddening) to severe (deep craters extending into muscle and bone). Unrelieved pressure on the skin constricts the small blood vessels that deliver nutrition and oxygen to the skin. When the skin is starved of nutrients and oxygen for an extended period of time, the tissue dies and a pressure ulcer develops. Skin reddening that resolves when pressure is removed is normal and does not indicate the presence of a pressure ulcer. Other variables also contribute to the development of pressure ulcers. When a person sinks into a bed or chair, blood vessels may stretch or bend, resulting in pressure ulcers. Minor pressure ulcers can be caused by very slight rubbing or friction on the skin.


Who is At-Risk for Pressure Ulcers?

Confinement to bed or a chair, inability to move, lack of bowel or bladder control, inadequate nutrition, and decreased mental awareness are all significant risk factors for pressure ulcers.


  • Lack of mobility. You are in grave danger if you are unable to change positions without assistance. People who are in a coma, paralyzed, or have a hip fracture are more vulnerable. When people can walk on their own, their chances of developing pressure ulcers are lower.
  • Inability to control one’s bowels or bladder. You are at greater risk if you are unable to keep your skin clean of urine, faeces, or perspiration. These moisture sources may irritate the skin.
  • Poor nutrition. If you are unable to consume a well-balanced diet, your skin may suffer as a result. When the skin is unhealthy, pressure ulcers are more likely to occur. 


Where Can You Develop a Pressure Ulcer?

People get pressure ulcers when their bones put a lot of pressure on their skin and tissue and push them against a surface outside of their bodies. Bony parts of the body may touch other parts of the body, a mattress, or a chair. This can happen when you are sitting or lying down. The sacrum, hip bone (trochanter), and heel are the places where most pressure ulcers happen in people who have to stay in bed. If a person is sitting in a chair or in a wheelchair, the exact spot where pressure ulcers form depends on how the person is sitting. A person can also get a pressure ulcer on his or her knees. The ulcer can also spread to the ankles, shoulders, back of the head, and spine, as well.


Nerves generally signal the body when to move in order to relieve pressure on the skin. People who are unable to move in bed may develop pressure ulcers in as little as 1-2 hours.

Because the strain on the skin is stronger in those who sit in chairs and are unable to move, pressure ulcers can develop in even less time.


How You Can Prevent Pressure Ulcers

These evidence-based steps can help prevent the progression of pressure ulcers. Consult a nurse or doctor to determine the best course of action for you.


Daily Skin Examination

At the very least once a day, your skin should be examined. Use good lighting. Pay careful attention to any red areas that persist despite changing positions and relieving pressure. This inspection can be carried out either by you or a caregiver. A mirror might be beneficial for inspecting difficult-to-see places. 


Keep Skin Clean

Your skin should be kept clean. If frequent bathing or showering is desired or necessary, more precautions should be taken to avoid irritation and dry skin. When bathing or showering, use only warm (not hot) water and a light soap.


Pressure Ulcer-Injury Prevention Tips

  • Moisturize your skin with lotions or oils.


  •  Minimize moisture loss by urine or stool, perspiration, or wound drainage.


  • Use pads or briefs that absorb urine and have a quick-drying surface that keeps moisture away from the skin.


  •  A cream or ointment that protects the skin from urine, stool, or wound drainage may also be beneficial.


  • Avoid massaging skin over bony parts of the body.  This may lead to more skin injury or damage. 


  • Limit pressure over bony areas.  Turn and reposition every 2 hours and as needed.


  • Reduce friction (rubbing) with lifting vs. dragging across the sheets.  This will cause skin injury.


  • Avoid using donut-shaped cushions.  These add pressure.  


  • Use pillows or foam wedges between knees or to elevate heels off of the bed.


  • Avoid lying directly on the trochanter (hip bone).


  • To alleviate pressure, foam, gel, or air cushions should be used. Consult your health care professional to determine which is the best option for you. 



The ideal pressure ulcer prevention program will take into account what you desire and be tailored to your specific situation. Make sure you ask your health care professional questions and describe your requirements, desires, and concerns. The majority of pressure ulcers can be avoided. The extra effort may result in improved health.



The views and opinions stated in this blog are exclusively those of the author and do not reflect those of iWound, its affiliates, or partner companies.


Further Reading and References


National Pressure Injury Advisory Panel (NPUAP)

A non-profit professional organization dedicated to the prevention and management of pressure ulcers through public policy, education, and research. 


Agency for Healthcare Research and Quality (AHRQ)

The federal agency that conducts research on health care quality issues, health care cost, and patient safety. Their mission includes translating research into better patient care.


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