2019 World Wide Pressure Injury Prevention Day

Thursday, November 21, 2019

Pressure Injury Prevention DayBringing attention to pressure injury prevention may keep many people from ever experiencing a pressure injury or perhaps lead to early detection and treatment.  Each year, more than 2.5 million people in the United States develop pressure injuries in acute-care facilities and 60,000 die from their complications1.  These skin lesions bring:

  • pain
  • risk for serious infection
  • increased use of health care resources


While we are most familiar with the term, pressure ulcer, the National Pressure Ulcer Advisory Panel (NPUAP) changed the term from pressure ulcer to pressure injury in 2016 to reflect injuries to both intact and ulcerated skin.

What is pressure injury?

The NPUAP definition is “localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful. The injury results from intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, comorbidities and condition of soft tissue.”2 Pressure injuries are staged to indicate the extent of damage.

What could increase the risk of pressure injury?

  • Sitting or lying too long in one place
  • Sitting in wet clothing or a wet bed
  • Poor nutrition and/or hydration
  • Poor health
  • Having many chronic conditions at one time, especially diabetes and vascular disease
  • Using multiple medications that cause drowsiness, confusion or loss of appetite
  • Having surgery that might last longer than 3 hours
  • History of a previous pressure injury
  • Having fragile skin, skin tears or chronic skin problems
  • Being elderly
  • Having loss of feeling or sensation to a body part
  • Having weight loss, especially during a prolonged illness
  • Being immobile or have limited mobility
  • Having excessively dry or moist skin
  • Having bowel or urinary incontinence
  • Medical devices – e.g., catheters, masks, tubing


What can be done to prevent pressure injury?

Know the risks and take steps to eliminate or lessen them.  Watch for any sign of changes to the skin or reports/feelings of pain.  Create a plan that includes these Joint Commission Standards:

  • Skin inspection, skin cleansing, care for dry skin, use of moisture barriers and massage (as prescribed by a health care professional)
  • Nutritional support based on an individualized nutritional needs assessment
  • Avoidance of skin injury from friction or shear forces through the use of positioning, transferring and turning techniques
  • A plan to maintain and, when appropriate, to increase mobility and activity level
  • Use of repositioning devices, and support surfaces to reduce skin injury caused by friction or shear force
  • Staff educational programs on assessment, prevention, and treatment
  • Communication between all caregivers should include relevant information about the person's risk of developing a pressure ulcer, or the treatment and status of any existing pressure ulcers

1https://www.jointcommission.org/high_reliability_healthcare/identifying_root_causes_and_solutions_for_hospital_acquired_pressure_injuries/, accessed November 5, 2019

2https://cdn.ymaws.com/npuap.site-ym.com/resource/resmgr/npuap_pressure_injury_stages.pdf

Resources

Office of Developmental Programs (ODP) and Health Care Quality Unit (HCQU) Resources:

  • Pressure Injury Prevention developed by the Western PA HCQU:

https://milestonepa.org/download/docs/29

  • Health Care Alert developed by Dr. Cherpes, MD, Medical Director of ODP

https://www.pchc.org/images/PDFs/Advocacy/ODP/Alerts/2018/FINAL_Maintaining_Skin_Integrity_Preventing_Pressure_Injuries_Health_Alert_111318.pdf