How can pressure sores be prevented?

What are pressure sores?

Pressure sores, also called pressure ulcers or pressure injuries, are areas of damage to the skin and the tissue beneath it caused by prolonged pressure, often combined with friction or shearing. They usually develop over bony areas such as the heels, lower back, buttocks, hips and elbows.

Pressure sores range from red, unbroken skin that does not fade when pressed to deep wounds that expose muscle or bone. They can be painful, slow to heal and lead to infection.

Who is at risk?

People with limited mobility are at highest risk, including those who are bedbound, use a wheelchair, have had a stroke or spinal cord injury, or are recovering from surgery or serious illness. Reduced sensation, poor nutrition, incontinence, older age, diabetes and poor circulation also increase risk.

International guidelines on pressure ulcer prevention recommend structured risk assessment and regular skin assessment for people at risk 1.

How often should people be repositioned?

Changing position regularly relieves pressure on vulnerable areas. The frequency is individualised, based on the person's risk, skin condition, comfort and the support surface they are using 1. Many care plans involve repositioning people in bed every few hours and prompting wheelchair users to shift their weight more frequently.

Lying at a 30-degree tilt rather than directly on the hip, keeping heels free of pressure using pillows or heel protectors, and avoiding dragging the person across sheets reduce friction and shearing 1.

Do special mattresses and cushions help?

A Cochrane review of 59 trials found that higher-specification foam mattresses reduced the incidence of pressure ulcers compared with standard hospital foam mattresses in people at risk (risk ratio 0.40) 2. Medical sheepskins also appeared to prevent pressure ulcers (risk ratio 0.56) 2.

The relative benefits of different alternating-pressure and constant low-pressure surfaces were unclear 2. The choice of mattress or cushion is based on the person's level of risk and needs, and does not replace repositioning.

How should the skin be cared for?

Check the skin every day, especially over bony areas, looking for redness, warmth, swelling, hardness or broken skin. In darker skin, discolouration may appear purple or bluish rather than red, and changes in warmth or firmness are important signs.

Keep the skin clean and dry, use a pH-balanced cleanser, manage incontinence promptly and use barrier products when needed. Avoid vigorous rubbing of reddened areas.

Why do nutrition and hydration matter?

Poor nutrition and dehydration make skin more fragile and slow healing. Guidelines recommend nutritional screening and support for people at risk of pressure injuries, including adequate energy, protein and fluids 1.

A dietitian can help when someone is losing weight, eating poorly or has a wound that is slow to heal.

How can wheelchair users protect their skin?

People who sit for long periods, especially those with reduced sensation, are at risk of pressure sores on the buttocks and lower back. A properly fitted wheelchair and pressure-relieving cushion, chosen after assessment, spread pressure more evenly.

Regular weight shifts, such as leaning forward or to each side, or tilting the chair if possible, relieve pressure. Checking the skin daily, keeping clothing free of thick seams in sitting areas and reviewing the cushion regularly help prevent damage.

When should a pressure sore be checked by a healthcare professional?

Report any area of skin that stays red or discoloured after pressure is removed, blisters, open wounds or new pain over a bony area.

Seek prompt medical attention for a wound that smells, produces pus, has spreading redness or is accompanied by fever or confusion, as these may indicate infection.

Frequently asked questions