---
title: Pressure Injury Prevention
description: A clinical reference on the assessment, prevention, and management of pressure injuries.
keywords: [pressure ulcer, decubitus ulcer, skin integrity, risk assessment, repositioning]
category: clinical
---

## Introduction

Pressure injuries, also known as pressure ulcers or decubitus ulcers, are localized areas of skin and underlying tissue damage caused by unrelieved pressure, shear, friction, or a combination of these factors. These injuries can range from superficial reddening of the skin to deep tissue damage and can lead to significant morbidity, extended hospital stays, and increased healthcare costs. Effective pressure injury prevention is essential for optimizing patient outcomes and reducing the burden on the healthcare system.

## Risk Assessment

The first step in pressure injury prevention is conducting a comprehensive risk assessment. Several validated risk assessment tools are available, including the Braden Scale, Norton Scale, and Waterlow Score. These tools evaluate factors such as sensory perception, moisture, activity, mobility, nutrition, and friction/shear to determine a patient's risk level. Patients identified as high-risk should be prioritized for preventive interventions.

In addition to using a standardized risk assessment tool, clinicians should also perform a thorough skin inspection, paying close attention to bony prominences and areas subjected to increased pressure, such as the sacrum, heels, elbows, and occiput. Any signs of erythema, warmth, edema, or skin breakdown should be promptly addressed.

## Preventive Interventions

Once a patient's risk has been established, the next step is to implement appropriate preventive measures. These interventions can be divided into two main categories: support surface selection and repositioning/mobilization.

### Support Surface Selection
The use of specialized support surfaces, such as mattresses, overlays, and cushions, is a crucial component of pressure injury prevention. These surfaces are designed to redistribute pressure, reduce shear, and maintain skin integrity. Common options include:

- Air-fluidized beds: These beds use a circulation of warm air to provide a "fluidized" support surface that conforms to the patient's body contours.
- Low-air-loss beds: These beds use a series of air chambers that inflate and deflate to continuously redistribute pressure.
- Foam mattresses: High-density, viscoelastic foam mattresses can provide effective pressure redistribution.
- Alternating pressure mattresses: These mattresses have air-filled cells that inflate and deflate in a cyclic pattern to relieve pressure on different areas of the body.

The selection of the appropriate support surface should be based on the patient's risk level, body habitus, and mobility, as well as the specific features and capabilities of the available options.

### Repositioning and Mobilization
Frequent repositioning and mobilization are essential for preventing pressure injuries. Patients should be repositioned at least every 2 hours, with the goal of relieving pressure on bony prominences and promoting blood flow to the skin and underlying tissues. When repositioning, clinicians should avoid placing patients directly on their bony prominences and use pillows, wedges, or other devices to offload pressure.

In addition to repositioning, early mobilization and ambulation should be encouraged whenever possible to improve circulation and reduce the duration of unrelieved pressure.

## Skin Care and Moisture Management
Maintaining optimal skin health is another crucial aspect of pressure injury prevention. Clinicians should ensure that the patient's skin is kept clean and dry, and that any incontinence is promptly managed. Barrier creams or ointments may be used to protect the skin from moisture and friction.

## Nutritional Support
Adequate nutrition is essential for wound healing and skin integrity. Patients at risk for pressure injuries should be assessed for nutritional deficiencies, and appropriate nutritional interventions, such as high-calorie, high-protein supplements, should be implemented as needed.

## Monitoring and Documentation
Ongoing monitoring and documentation of pressure injury risk, preventive interventions, and skin condition are essential for ensuring the effectiveness of the pressure injury prevention program. Clinicians should regularly document the patient's risk assessment score, any identified pressure injuries, and the specific preventive measures in place.

## Conclusion
Pressure injury prevention is a multifaceted and critical aspect of patient care. By conducting comprehensive risk assessments, implementing appropriate preventive interventions, and closely monitoring patient outcomes, clinicians can effectively reduce the incidence and severity of pressure injuries, improve patient outcomes, and minimize the burden on the healthcare system.