About Pressure Ulcers

What are Pressure Ulcers?

Pressure ulcers (PUs) are a common medical problem that can lead to pain, disfigurement, infection and death.1 Also known as bedsores or pressure sores, PUs are an area of localised damage to the skin and underlying tissue – usually over and around an area of bony prominence (e.g., sacrum, coccyx, heels, hips) – as a result of pressure with shear and/or friction.2 Bedsores can develop quickly and are often difficult to treat.

An Urgent Yet Preventable Problem

Map: Pressure Ulcer Prevalence in Europe by CountryPrevalence:

In Europe, the prevalence of PUs ranges between 18 -23% in nursing homes and hospitals and can be as high as 57% in critical care units. In the US, they affect an estimated 2.5 million patients in acute care facilities

Complications:

PUs also can cause complications such as serious infections (sepsis, cellulitis, MRSA) and cancer. In the US, 60,000 patients die each year due to pressure ulcers.

Prevention:

With early detection, approximately 80% of PUs can be prevented. Primary methods of prevention include repositioning the body to redistribute pressure, balanced diet, hydration and keeping the skin free from exposure to moisture.

Clinical Challenges With Today's Standard of Care

The current standard of care in pressure ulcer prevention is based on risk assessment and visual assessment of skin in areas prone to PUs. This approach has several significant challenges:

  1. Risk assessment tools are limited

    • Low sensitivity (57%)
    • Specificity (67%)
  2. By the time damage is visually evident, significant tissue damage has already occurred, this is particularly important for:

    • Dark-skinned patients
    • Deep tissue injury patients
  3. Visual skin assessment is subjective and unreliable as it depends on the clinician's experience and expertise.

    These assessments cannot reliably determine which patients are at risk or which patients have existing damage.

Current practice misses opportunities for early detection and early intervention that can prevent PUs. As a result, expensive treatments are often offered to patients who don't need them, and conversely, not offered to those who do need them.

1Montroy RE, Eltorai I. Complications of Pressure Sore Neglect. In: Spinal Cord Medicine: Principles and Practice. Lin VW, Cardenas DD, Cutter NC, et al., (Eds.). New York: Demos Medical Publishing; 2003.

2National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Haesler E, editor. Osborne Park, Western Australia: Cambridge Media; 2014.

3Lyder CH, Ayello AE. Chapter 12. Pressure Ulcers: A Patient Safety Issue. In: Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Hughes RG (Ed). Rockville: Agency for Healthcare Research and Quality; 2008.

FaLang translation system by Faboba