Pressure Injury Stages and Prevention

Pressure injuries, commonly referred to as bedsores or pressure ulcers, are not only painful but can also lead to serious health complications if not properly treated. These injuries arise from sustained pressure on the skin, which impedes blood flow and results in damage to the underlying tissue. They are most prevalent among individuals with limited mobility, such as those who are bedridden or wheelchair-bound.

This guide aims to shed light on the stages of pressure injuries, equip you with knowledge on pressure injury treatments, and share vital prevention strategies to mitigate the risk of developing these painful sores.

A pressure injury is localised damage to the skin and underneath tissue that typically occurs over a bony prominence as a result of pressure, or pressure in combination with shear and/or friction. Common pressure areas develop around the tailbone, heels, elbows, and the back of the head.

Whilst bed sores and pressure injury are terms used interchangeably however there is a slight difference. Bed sores are like a specific type of pressure injury. They happen when there's too much pressure on the skin and underlying tissue, especially for people with limited mobility. For example pressure sores on buttocks from sitting. Pressure injuries, are a big umbrella term that covers more ground. It includes damage not just from pressure but also from shear and friction. 

Untreated bed sores can lead to a cascade of complications. Initially, they might seem like minor issues, but over time, they can become quite serious.  

There are four primary stages for a pressure injury.

Stage 1 Pressure Injury 
In the initial stage of a pressure injury, the skin is still intact, but you might notice redness or discoloured skin around the pressure area. The persistent area of skin redness that does not lighten when touched. Some telltale signs include pain or itching in the area, which indicates potential tissue damage beneath the surface. It can be considered a minor wound, and it can be healed quickly.

Stage 2 Pressure Injury 
In the second stage, the skin shows partial thickness damage, which can look like abrasions or blisters due to sustained pressure. The wound bed is typically red or pink and moist and may also present as an intact or ruptured blister. This stage is characterised by pain and the potential for infection as the skin barrier has been broken. 

Stage 3 Pressure Injury 
At this stage, the skin and tissue damage become more severe, exposing underlying tissue beneath the skin surface. The pressure wound or pressure ulcer can appear like a deeper sore or even look like a crater—appropriate treatment can speed up the healing process and curtail further tissue damage. 

Stage 4 Pressure Injury 
The final stage involves full thickness loss of both skin and underlying muscle and bone. The deep wound may further reveal tendon or joint caps. Stage 4 injuries are quite severe as they are susceptible to infection and can be life-threatening if left untreated. 

1. Pressure on skin
Injuries can occur when prolonged pressure suffocates the skin’s ability to breathe and flourish, leaving behind wounds as a stark testimony to its fragility. Imagine your skin, the body's most expansive organ, suppressed against the hard surfaces of beds or chairs for extended periods—this skin pressure interrupts the crucial flow of blood, starving tissues of oxygen and nourishment.

2. Friction
Pressure injuries inflicted by friction are a testament to what happens when skin meets an opposing rough force, a scenario all too common when someone is confined to a single position for too long. This friction results from the skin dragging across surfaces, much like delicate fabric snagging on a rough edge. Enter shear force the invisible foe—it's the strain that occurs deep in the tissue, as the skin is pulled one way while the bone moves another, stretching and distorting the delicate architecture beneath the surface. This interplay between friction and shear can lead to the skin becoming vulnerable to damage, eventually breaking down and resulting in painful, open wounds.

3. Wetness
Too much dampness on your skin can lead to sores and damage, especially in sticky, sweaty conditions. Just like spending too long in the bath can make your fingers go all wrinkly, staying wet for a long time weakens your skin and makes it easier to get hurt. Think of moisture as something that can slowly break down the skin’s shield. If you hang around in wet clothes or stay in a place with a lot of humidity for too long, your skin starts to give in, which can lead to really sore spots. 

• People with a loss of mobility, unable to move easily or change positions.
• Individuals living with a disability that limits their movement or activity.
• Those experiencing a loss of skin sensitivity, who can’t feel pressure or pain in certain areas.
• Patients coping with a chronic injury that keeps them bedridden or in a chair for long periods.
• Elderly persons of old age, whose skin is more fragile and prone to injury

• Skin loss where the skin has worn away, possibly revealing layers underneath.
• Skin swelling, often around a tender area that's been under pressure.
• Skin colour changes, with the skin turning red, blue, purple, or black.
• Pus coming from an open skin area, indicating an infection.
• Blisters formed on the skin, filled with fluid, where pressure has been applied.

By following simple guidelines, you can quickly protect your skin and reduce the risk of developing pressure sores. Here are six tips to prevent pressure injuries:

1. Change Positions Frequently – If you are bedridden, change positions every two hours or so to relieve pressure on any one area.
2. Invest in a comfortable mattress – Investing in a good mattress and pillows or other pressure-relieving devices can help alleviate some or all of the pressure experienced by people who cannot change positions regularly, e.g., elderly people.
3. Constant Movement – Mild exercises or even stretches can help improve circulation and reduce the risk of injuries. Active muscles and limbs support healthy blood flow to wounded tissues.
4. Good Nutrition – Adequate nutrition is integral to tissue growth and healing. Ensure that you consume the right blend of nutrients, including vitamins and minerals, to prevent pressure injuries.
5. Constant monitoring – for elderly persons or persons on disability support it is important to continually monitor all high risk areas for the formation of any pressure injuries
6. Maintain Clean, Dry Skin – Pressure injury-prone areas should be kept habitual clean and dry: use a gentle soap blend or other hygiene products to help keep the skin supple and moisture-free.

Treating pressure injuries demands a blend of meticulous care and the appropriate use of medical supplies to promote healing and prevent further damage. Begin by gently cleaning the wound to clear away any debris or bacteria, maintaining a pristine environment for the skin to recover. A clean wound is the foundation of effective treatment. Next, consider the application of a water-based gel, which provides a moist healing environment that can be vital for tissue repair. This gel can keep the wound hydrated, which is crucial for the natural healing process. Lastly, secure the area with a foam dressing, which not only cushions the wound, providing relief from continuous pressure, but also absorbs excess moisture, keeping the healing space stable. This combination of thorough cleaning, hydration, and protective cushioning creates the optimal conditions for a pressure injury to heal.