Understanding Pressure Ulcers: Symptoms, Prevention, Staging & Treatment
What are pressure ulcers?
Pressure ulcers, also known as bedsores or decubitus ulcers, are wounds that develop once a pressure injury causes blood circulation to be cut off from particular areas of the body. They range from closed to open wounds and are classified into four stages based on the depth of the wound.
Bedsores usually occur when a person sits or lies in one position for prolonged periods. The immobility cuts off blood circulation to specific body parts, damaging surrounding tissues. Therefore, pressure ulcers are more common among the elderly, people with limited mobility, and people who are bedridden from illness or other conditions. They form mainly on any skin that covers bony areas of the body. Common locations for bedsores to develop include: the butt, tailbone, heels, ankles, hips, back, elbows, shoulder blades, and the back of the head.
Though treatable, pressure ulcers can cause a number of complications like infection and the need for surgery/amputation. Moreover, they can take years to heal if not diagnosed and treated early.
Prevalence & Statistics
- Global prevalence of 12.8%, with a hospital-acquired pressure injury (HAPI) incidence of 8.4%.
- Prevalence in India : Prevalence in hospitalized patients in India ranges from 10% to 30%, depending on the healthcare setting and patient population.
- Elderly Population: Especially those in long-term care facilities, the prevalence can be higher, often reported to be around 20% to 40%.
- Specific Patient Populations: Certain groups, such as patients with spinal cord injuries, show even higher rates of pressure ulcers, potentially exceeding 50%.
Pressure Ulcer Symptoms
The symptoms of pressure ulcers vary as per stage and severity.
Early Symptoms (Stage 1)
- Red or discoloured skin that doesn’t turn white when pressed
- Skin possibly feels warmer or cooler than surrounding areas
- Pain, itching, or tenderness
Progressing Symptoms (Stages 2-4)
- Stage 2: A blister, open wound, blister, or superficial sore with skin loss
- Stage 3: Deep wound that exposes fat layers, possible foul odour
- Stage 4: Severe wound exposing muscle, bone, or tendons, high risk of infection
What Are the Top Causes of Pressure Ulcers?
Prolonged pressure is the primary cause of a pressure ulcer. Lying on a certain part of the body for long intervals causes the skin to break down.
Other factors that increase the risks of developing pressure ulcers include:
- Poor circulation
- Excessive moisture
- Skin irritants like urine and feces
- Friction, for example when a person who is bed-ridden and has sheets dragged from under them
Risk Factors For Pressure Ulcers:
|
Medical condition |
Circumstances |
Patient factors |
|
1. Diabetes – Poor circulation and neuropathy can increase the risk of skin breakdown 2. Vascular Disease – Conditions that affect blood flow can impair tissue oxygenation and healing 3. Neurological Disorders – Conditions like stroke or spinal cord injury can lead to reduced mobility and sensation 4. Incontinence -Urinary or fecal incontinence can lead to skin moisture and irritation, increasing the risk 5. Obesity-Excess weight can lead to increased pressure on certain body areas, particularly in those who are immobile 6. Malnutrition-Deficiencies in protein and other nutrients can impaired skin integrity and healing process 7. Chronic Illnesses -Conditions such as cancer, COPD, or kidney disease can impact mobility and overall health, raising risk levels |
1. Immobility: Extended periods of inactivity due to hospitalization, surgery, or physical disabilities. 2. Age: Older adults may have thinner skin and comorbidities that increase susceptibility. 3. Medical Devices: Devices like casts or braces, ventilators that create pressure points can lead to ulcers 4. Inadequate Support Surfaces: Use of non-specialized mattresses or cushions that do not redistribute pressure effectively. 5. Bed ridden 6. Cognitive Impairment |
1.Nutritional factors 2. Lifestyle Factors |
Pressure Ulcer Prevention using SSKIN
Once the pressure ulcer risk assessment has been undertaken the preventative care plan can be developed using SSKIN
- S = Support surface needed for pressure relief
- S = Skin inspection, condition and care
- K = Keep moving and identifying repositioning regimes
- I = Incontinence monitoring and prevention of moisture damage
- N = Nutrition and hydration
Key strategies include:
- Regular Repositioning:
○ Reposition patients at least every 2 hours to relieve pressure on bony prominences, particularly for bedridden or wheelchair-bound individuals.
- Skin Assessment:
○ Perform regular skin assessments to identify early signs of pressure damage, including redness or skin breakdown.
○ Pay special attention to high-risk areas like heels, sacrum, and elbows.
- Moisture Management:
○ Keep the skin dry and clean by managing incontinence or perspiration effectively to prevent skin breakdown.
○ Use moisture-wicking clothing and barriers to protect skin from prolonged moisture exposure.
- Nutrition and Hydration:
○ Ensure proper nutrition, including adequate protein intake, hydration to support skin health and healing.
- Use of Pressure-Relieving Devices:
○ Employ pressure-relieving devices such as foam, air, or gel cushions and mattresses to distribute weight evenly and reduce pressure on vulnerable areas.
- Education and Training:
○ Educate caregivers, and patients about the importance of repositioning, skin care, and early detection of pressure ulcers.
○ Training should include proper techniques for lifting and turning patients to avoid friction and shear.
- Pain Management:
○ Manage pain effectively to promote mobility, which can prevent prolonged pressure on specific areas of the body.
- Improving Mobility:
○ Encourage and assist with movement, even if it’s limited, to reduce the time spent in one position.
○ Regular exercise, where possible, helps in improving circulation and reducing the risk of pressure ulcers.
Stages of Pressure Ulcers
Stage 1
|
 |
Stage 2
|
 |
Stage 3
|
 |
Stage 4
|
 |
Deep Tissue Injury (DTI)
|
 |
Unstageable Ulcers
|
 |
Images source: https://www.healthline.com/health/stages-of-pressure-ulcers
Importance of Timely & Effective Management of Pressure Ulcers
Timely and effective management of pressure ulcers is crucial for several reasons:
- Prevents Infection: Early treatment reduces the risk of infection and severe complications like sepsis.
- Promotes Faster Healing: Proper care accelerates healing, shortening wound duration and minimizing pain.
- Minimizes Pain: Effective management alleviates discomfort, enhancing the patient’s quality of life.
- Reduces Healthcare Costs: Early intervention avoids costly treatments and long-term care.
- Prevents Further Damage: Timely care stops ulcers from worsening into complex wounds.
- Enhances Mobility: Effective management restores mobility and independence, especially for immobile patients.
- Reduces Long-term Complications: Prevents scarring, loss of function, and permanent disability.
- Improves Outcomes: Timely management benefits both healing and overall patient well-being.
Pressure Ulcer Management and Treatment Approaches
Stage 1 Pressure Ulcer
Treatment
The primary approach to treating a stage 1 pressure ulcer is to relieve pressure from the affected area. Excess pressure can cause the ulcer to worsen and break through the skin’s surface. If you are lying down, adjust your position or use pillows and blankets for added support.
It is also crucial to keep the area clean and dry to prevent further tissue damage.
Hydration and a nutrient-rich diet—including calcium, protein, and iron—are essential for promoting skin health and recovery.
Recovery
When treated promptly, stage 1 pressure ulcers can typically heal within 3 to 4 days.
Stage 2 Pressure Ulcer
Treatment
Similar to stage 1, treatment for a stage 2 pressure ulcer involves reducing pressure on the affected area. However, medical attention is necessary to ensure proper wound care.
A healthcare provider may recommend specialized wound dressings to keep the ulcer dry and free from contaminants, reducing the risk of worsening or infection.
After cleaning the wound, consult a doctor on the appropriate method for bandaging. Keep a close watch for signs of infection, such as increased pain, pus, redness, or fever.
Recovery
Healing at this stage typically takes between 3 days and 3 weeks.
Stage 3 Pressure Ulcer
Treatment
If a stage 3 pressure ulcer develops, immediate medical intervention is necessary, as these wounds require specialized care.
Treatment may involve antibiotic therapy and the removal of dead tissue to facilitate healing and reduce infection risk.
For individuals with limited mobility, doctors may suggest a specialized mattress or bed to alleviate pressure on affected areas.
Recovery
Stage 3 ulcers generally require a healing period of 1 to 4 months.
Stage 4 Pressure Ulcer
Treatment
Patients with stage 4 pressure ulcers typically require hospitalization. Surgical intervention is often recommended by healthcare providers.
Recovery
Full recovery from a stage 4 ulcer can take anywhere from 3 months to 2 years, depending on the severity and individual response to treatment.
Unstageable Pressure Ulcer
Treatment
To accurately assess the severity of an unstageable ulcer, a doctor may need to remove eschar or slough. Additional imaging or surgical evaluation may also be necessary to determine the extent of the wound.
Advanced Wound Dressing Solutions as a Part of Modern Care
Advanced wound dressing solutions play an important role in modern wound care by providing enhanced healing environments for various types of wounds, including pressure ulcers.
These dressings are designed to maintain moisture, promote oxygenation, and manage exudate while protecting against infection.
Some advanced options include hydrocolloid, hydrofiber, foam, and silver-based dressings which offer antimicrobial properties and reduce the risk of infection.
These dressings help accelerate healing, reduce pain, and improve patient outcomes by offering better protection and comfort compared to traditional dressings
Criteria to select a wound dressing for pressure ulcers
- Ulcer size, depth, and location
- Nature and volume of wound exudate
- State of the tissue in the wound bed
- Condition of peri-wound skin
- Presence of tunneling and/or undermining
- Ulcer assessment
- Treatment objectives
- Previous positive effect of dressing
- Patient preference
Why is Seriderm an Ideal Wound Dressing for Pressure Ulcers?
Seriderm is a non-adherent, absorbent wound dressing with 100% silk protein in the wound contact layer to promote faster and efficient healing of complex wounds like pressure ulcers. This innovative wound dressing offers better healing of pressure ulcers through the following mechanisms:
- Reduces Inflammation for Faster Healing – Seriderm accelerates wound recovery by minimizing inflammation, creating a conducive environment for healing.
- Promotes Tissue Regeneration – By stimulating collagen deposition and angiogenesis (new blood vessel formation), Seriderm actively supports the regeneration of damaged tissue.
- Optimizes Moisture Balance – Choosing a dressing with the appropriate exudate absorption capacity is essential for managing wound moisture and promoting optimal healing. With an ideal Moisture Vapor Transmission Rate (MVTR), Seriderm efficiently absorbs exudate (~10-15 ml per day) while maintaining the perfect moisture level for wound healing.
- Gentle, Non-Adherent Application – Engineered for non-adherence, Seriderm ensures painless dressing changes without disrupting the wound bed.
- Infection Control: Seriderm Ag offers the added advantage of antimicrobial protection. Its sustained release of silver ions at the wound site for up to 7 days prevents and controls infections in pressure ulcers.
With the above characteristics, Seriderm accelerates the healing of pressure ulcers, prevents infections and severe complications, while maintaining patient’s comfort with its painless application and removal. Therefore, Seriderm is an ideal wound dressing for the effective management & treatment of pressure ulcers.
Conclusion
Pressure ulcers are preventable with proper care and timely intervention. Effective prevention includes regular repositioning, good skin care, pressure relief devices, and proper nutrition. If pressure ulcers develop, staging and appropriate treatment are crucial to minimize complications.
Choosing the right dressing, tailored to the wound’s needs, ensures optimal healing while reducing the risk of infection. Using Seriderm wound dressings can significantly aid in faster recovery and better patient comfort.
References
- Global prevalence and incidence of pressure injuries in hospitalised adult patients: A systematic review and meta-analysis – ScienceDirect White, C. H., & Baker, S. (2019). “Global Prevalence of Pressure Injuries and Incidence of Hospital-Acquired Pressure Injuries (HAPI).” Wound Care Journal
- Author manuscript; available in PMC: 2024 Sep 16. Published in final edited form as: Wound Repair Regen. 2023 Dec 20;32(1):6–33. doi: 10.1111/wrr.13130
- Medline, PubMed, Embase, Cochrane Library, CINAHL and ProQuest databases from January 2008 to December 2018.
- Effectiveness of interventions to prevent pressure injury in adults admitted to intensive care settings: A systematic review and meta-analysis of randomised controlled trials – PubMed
- Stages of Pressure Ulcers: Stages, Treatments, and More
- http://www.msktc.org/sci/factsheets/skincare/Recognizing-and-Treating-Pressure-Sores
Author Bio – Keiretliu Chawang, a Registered Nurse, serves as a clinical educator at Serigen Mediproducts. She earned her nursing degree from the Nightingale Nursing Institute and brings 16 years of professional clinical experience across various specialties.
What are pressure ulcers?
Pressure ulcers, also known as bedsores or decubitus ulcers, are wounds that develop once a pressure injury causes blood circulation to be cut off from particular areas of the body. They range from closed to open wounds and are classified into four stages based on the depth of the wound.
Bedsores usually occur when a person sits or lies in one position for prolonged periods. The immobility cuts off blood circulation to specific body parts, damaging surrounding tissues. Therefore, pressure ulcers are more common among the elderly, people with limited mobility, and people who are bedridden from illness or other conditions. They form mainly on any skin that covers bony areas of the body. Common locations for bedsores to develop include: the butt, tailbone, heels, ankles, hips, back, elbows, shoulder blades, and the back of the head.
Though treatable, pressure ulcers can cause a number of complications like infection and the need for surgery/amputation. Moreover, they can take years to heal if not diagnosed and treated early.
Prevalence & Statistics
- Global prevalence of 12.8%, with a hospital-acquired pressure injury (HAPI) incidence of 8.4%.
- Prevalence in India : Prevalence in hospitalized patients in India ranges from 10% to 30%, depending on the healthcare setting and patient population.
- Elderly Population: Especially those in long-term care facilities, the prevalence can be higher, often reported to be around 20% to 40%.
- Specific Patient Populations: Certain groups, such as patients with spinal cord injuries, show even higher rates of pressure ulcers, potentially exceeding 50%.
Pressure Ulcer Symptoms
The symptoms of pressure ulcers vary as per stage and severity.
Early Symptoms (Stage 1)
- Red or discoloured skin that doesn’t turn white when pressed
- Skin possibly feels warmer or cooler than surrounding areas
- Pain, itching, or tenderness
Progressing Symptoms (Stages 2-4)
- Stage 2: A blister, open wound, blister, or superficial sore with skin loss
- Stage 3: Deep wound that exposes fat layers, possible foul odour
- Stage 4: Severe wound exposing muscle, bone, or tendons, high risk of infection
What Are the Top Causes of Pressure Ulcers?
Prolonged pressure is the primary cause of a pressure ulcer. Lying on a certain part of the body for long intervals causes the skin to break down.
Other factors that increase the risks of developing pressure ulcers include:
- Poor circulation
- Excessive moisture
- Skin irritants like urine and feces
- Friction, for example when a person who is bed-ridden and has sheets dragged from under them
Risk Factors For Pressure Ulcers:
Pressure Ulcer Prevention using SSKIN
Once the pressure ulcer risk assessment has been undertaken the preventative care plan can be developed using SSKIN
- S = Support surface needed for pressure relief
- S = Skin inspection, condition and care
- K = Keep moving and identifying repositioning regimes
- I = Incontinence monitoring and prevention of moisture damage
- N = Nutrition and hydration
Key strategies include:
- Regular Repositioning:
○ Reposition patients at least every 2 hours to relieve pressure on bony prominences, particularly for bedridden or wheelchair-bound individuals.
- Skin Assessment:
○ Perform regular skin assessments to identify early signs of pressure damage, including redness or skin breakdown.
○ Pay special attention to high-risk areas like heels, sacrum, and elbows.
- Moisture Management:
○ Keep the skin dry and clean by managing incontinence or perspiration effectively to prevent skin breakdown.
○ Use moisture-wicking clothing and barriers to protect skin from prolonged moisture exposure.
- Nutrition and Hydration:
○ Ensure proper nutrition, including adequate protein intake, hydration to support skin health and healing.
- Use of Pressure-Relieving Devices:
○ Employ pressure-relieving devices such as foam, air, or gel cushions and mattresses to distribute weight evenly and reduce pressure on vulnerable areas.
- Education and Training:
○ Educate caregivers, and patients about the importance of repositioning, skin care, and early detection of pressure ulcers.
○ Training should include proper techniques for lifting and turning patients to avoid friction and shear.
- Pain Management:
○ Manage pain effectively to promote mobility, which can prevent prolonged pressure on specific areas of the body.
- Improving Mobility:
○ Encourage and assist with movement, even if it’s limited, to reduce the time spent in one position.
○ Regular exercise, where possible, helps in improving circulation and reducing the risk of pressure ulcers.
Stages of Pressure Ulcers
Images source: https://www.healthline.com/health/stages-of-pressure-ulcers
Importance of Timely & Effective Management of Pressure Ulcers
Timely and effective management of pressure ulcers is crucial for several reasons:
- Prevents Infection: Early treatment reduces the risk of infection and severe complications like sepsis.
- Promotes Faster Healing: Proper care accelerates healing, shortening wound duration and minimizing pain.
- Minimizes Pain: Effective management alleviates discomfort, enhancing the patient’s quality of life.
- Reduces Healthcare Costs: Early intervention avoids costly treatments and long-term care.
- Prevents Further Damage: Timely care stops ulcers from worsening into complex wounds.
- Enhances Mobility: Effective management restores mobility and independence, especially for immobile patients.
- Reduces Long-term Complications: Prevents scarring, loss of function, and permanent disability.
- Improves Outcomes: Timely management benefits both healing and overall patient well-being.
Pressure Ulcer Management and Treatment Approaches
Stage 1 Pressure Ulcer
Treatment
The primary approach to treating a stage 1 pressure ulcer is to relieve pressure from the affected area. Excess pressure can cause the ulcer to worsen and break through the skin’s surface. If you are lying down, adjust your position or use pillows and blankets for added support.
It is also crucial to keep the area clean and dry to prevent further tissue damage.
Hydration and a nutrient-rich diet—including calcium, protein, and iron—are essential for promoting skin health and recovery.
Recovery
When treated promptly, stage 1 pressure ulcers can typically heal within 3 to 4 days.
Stage 2 Pressure Ulcer
Treatment
Similar to stage 1, treatment for a stage 2 pressure ulcer involves reducing pressure on the affected area. However, medical attention is necessary to ensure proper wound care.
A healthcare provider may recommend specialized wound dressings to keep the ulcer dry and free from contaminants, reducing the risk of worsening or infection.
After cleaning the wound, consult a doctor on the appropriate method for bandaging. Keep a close watch for signs of infection, such as increased pain, pus, redness, or fever.
Recovery
Healing at this stage typically takes between 3 days and 3 weeks.
Stage 3 Pressure Ulcer
Treatment
If a stage 3 pressure ulcer develops, immediate medical intervention is necessary, as these wounds require specialized care.
Treatment may involve antibiotic therapy and the removal of dead tissue to facilitate healing and reduce infection risk.
For individuals with limited mobility, doctors may suggest a specialized mattress or bed to alleviate pressure on affected areas.
Recovery
Stage 3 ulcers generally require a healing period of 1 to 4 months.
Stage 4 Pressure Ulcer
Treatment
Patients with stage 4 pressure ulcers typically require hospitalization. Surgical intervention is often recommended by healthcare providers.
Recovery
Full recovery from a stage 4 ulcer can take anywhere from 3 months to 2 years, depending on the severity and individual response to treatment.
Unstageable Pressure Ulcer
Treatment
To accurately assess the severity of an unstageable ulcer, a doctor may need to remove eschar or slough. Additional imaging or surgical evaluation may also be necessary to determine the extent of the wound.
Advanced wound dressings as a part of modern care
Advanced wound dressing solutions play an important role in modern wound care by providing enhanced healing environments for various types of wounds, including pressure ulcers.
These dressings are designed to maintain moisture, promote oxygenation, and manage exudate while protecting against infection.
Some advanced options include hydrocolloid, hydrofiber, foam, and silver-based dressings which offer antimicrobial properties and reduce the risk of infection.
These dressings help accelerate healing, reduce pain, and improve patient outcomes by offering better protection and comfort compared to traditional dressings
Criteria to select a wound dressing for pressure ulcers
- Ulcer size, depth, and location
- Nature and volume of wound exudate
- State of the tissue in the wound bed
- Condition of peri-wound skin
- Presence of tunneling and/or undermining
- Ulcer assessment
- Treatment objectives
- Previous positive effect of dressing
- Patient preference
Why is Seriderm an Ideal Wound Dressing for Pressure Ulcers?
Seriderm is a non-adherent, absorbent wound dressing with 100% silk protein in the wound contact layer to promote faster and efficient healing of complex wounds like pressure ulcers. This innovative wound dressing offers better healing of pressure ulcers through the following mechanisms:
- Reduces Inflammation for Faster Healing – Seriderm accelerates wound recovery by minimizing inflammation, creating a conducive environment for healing.
- Promotes Tissue Regeneration – By stimulating collagen deposition and angiogenesis (new blood vessel formation), Seriderm actively supports the regeneration of damaged tissue.
- Optimizes Moisture Balance – Choosing a dressing with the appropriate exudate absorption capacity is essential for managing wound moisture and promoting optimal healing. With an ideal Moisture Vapor Transmission Rate (MVTR), Seriderm efficiently absorbs exudate (~10-15 ml per day) while maintaining the perfect moisture level for wound healing.
- Gentle, Non-Adherent Application – Engineered for non-adherence, Seriderm ensures painless dressing changes without disrupting the wound bed.
- Infection Control: Seriderm Ag offers the added advantage of antimicrobial protection. Its sustained release of silver ions at the wound site for up to 7 days prevents and controls infections in pressure ulcers.
With the above characteristics, Seriderm accelerates the healing of pressure ulcers, prevents infections and severe complications, while maintaining patient’s comfort with its painless application and removal. Therefore, Seriderm is an ideal wound dressing for the effective management & treatment of pressure ulcers.
Conclusion
Pressure ulcers are preventable with proper care and timely intervention. Effective prevention includes regular repositioning, good skin care, pressure relief devices, and proper nutrition. If pressure ulcers develop, staging and appropriate treatment are crucial to minimize complications.
Choosing the right dressing, tailored to the wound’s needs, ensures optimal healing while reducing the risk of infection. Using Seriderm wound dressings can significantly aid in faster recovery and better patient comfort.
References
- Global prevalence and incidence of pressure injuries in hospitalised adult patients: A systematic review and meta-analysis – ScienceDirect White, C. H., & Baker, S. (2019). “Global Prevalence of Pressure Injuries and Incidence of Hospital-Acquired Pressure Injuries (HAPI).” Wound Care Journal
- Author manuscript; available in PMC: 2024 Sep 16. Published in final edited form as: Wound Repair Regen. 2023 Dec 20;32(1):6–33. doi: 10.1111/wrr.13130
- Medline, PubMed, Embase, Cochrane Library, CINAHL and ProQuest databases from January 2008 to December 2018.
- Effectiveness of interventions to prevent pressure injury in adults admitted to intensive care settings: A systematic review and meta-analysis of randomised controlled trials – PubMed
- Stages of Pressure Ulcers: Stages, Treatments, and More
- http://www.msktc.org/sci/factsheets/skincare/Recognizing-and-Treating-Pressure-Sores
Author Bio – Keiretliu Chawang, a Registered Nurse, serves as a clinical educator at Serigen Mediproducts. She earned her nursing degree from the Nightingale Nursing Institute and brings 16 years of professional clinical experience across various specialties.
