Pressure Injury

Pressure injuries are an injury to the skin and/or underlying tissue resulting from pressure, or pressure in combination with other factors. Usually, it is the pressure of a person’s own body weight against the substrate that causes pressure sores. The amount of pressure, how long the pressure is maintained and how sensitive an individual is to pressure affect the risk of developing pressure injury. Bony prominences are particularly sensitive because the pressure there is particularly high.

Pressure injuries can be of varying severity and fall into the following categories:

• Category 1: Skin redness that does not fade with pressure—intact skin with redness.

• Category 2: Partial skin lesion—superficial open wound or blister.

• Category 3: Full skin lesion—damage throughout the skin layer, down to the subcutaneous fat.

• Category 4: Deep full-thickness injury—deep injury down to the bone, tendon or muscle.

• Non-classifiable pressure injury: wound depth unknown—full-thickness wound where the wound bed is covered by dead tissue and/or scab.

• Suspected deep skin lesion: wound depth unknown—discolored purple or reddish-brown area with intact skin.

Current methods of assessing the risk of pressure injuries, usually in the form of so-called rating scales, are entirely subjective and based only on external factors related to the individual being assessed. Current methods do not assess at all what happens physiologically to an individual when the skin is exposed to pressure, even though this is a key factor in the risk of developing pressure injuries. Half of all pressure injuries today occur in individuals who have not been assessed as being at increased risk of pressure injuries.

Pressure injuries are mainly prevented by reducing the stress on the skin. This is particularly important in individuals with weakened skin microcirculation associated with pressure on the skin.

Pressure is often reduced by using specially adapted mattresses, such as active alternating mattresses. Positioning and repositioning are other ways to reduce skin stress. Positioning cushions can be used to vary position and to relieve pressure on specific parts of the body.

Preventive skin care is about keeping the skin dry, soft and clean. In some cases, pressure-preventing dressings are also used to complement it.

Effective prevention of pressure injuries requires a systematic approach throughout the care chain. Therefore, an objective structured risk assessment is very important for providing the right conditions. It is also important that the individual’s pressure injuries risk is communicated to the next actor in the care chain.

The most important way to treat pressure injuries is to relieve the pressure where the injury is. Pressure injuries are treated differently depending on their severity, but cleansing and rebandaging with an appropriate dressing is the basic treatment in addition to pressure relief. In severe cases, antibiotics or surgical treatment may be required.