PI treatment is challenging and involves pressure relief, skin protection, and adequate wound debridement, cleansing, and dressing. Advanced PIs may require surgical debridement, reconstruction, and treatment, such as negative pressure wound therapy.
Despite optimal management, PIs remain a major cause of serious complications (e.g., sepsis, malignant transformation, anemia, osteomyelitis) and mortality in long-term care settings. Improved PI prevention care remains an unmet medical need and is a critical component of care for at-risk patients.
Patient risk factors include advanced age, smoking, impaired mobility, poor dietary intake of protein, dehydration, hypotension, hemodynamic instability, history of PIs, comorbidities (i.e., paralysis, neurologic disorders, diabetes, heart and vascular disorders, psychiatric disorders), impaired sensation, anemia, steroid use, and infection. Patients in intensive care units and those in nursing homes often have major risk factors for PI.
Clinicians often use several management strategies for at-risk patients, including increasing patient mobility, improving nutrition, performing specialized skin care, using advanced wound dressings, and using therapeutic support surfaces. Here are three strategies that are supported by clinical evidence:
Therapeutic Support Surfaces
Therapeutic support surfaces reduce the risk of developing PIs by minimizing the effects of pressure, friction, shear, moisture, and heat on patients' skin. These surfaces include air-fluidized beds, low air-loss beds and mattress systems, foam or gel mattress systems, and alternating-pressure mattress systems. ECRI's Clinical Evidence Assessment, Therapeutic Surfaces for Preventing Pressure Injury, found:
Advanced Wound Dressings
Some advanced wound care dressings provide protection when placed over bony prominences where PIs are most likely to develop. Foam dressings have two layers—a hydrophilic silicone or polyurethane-based foam inner layer and a hydrophobic, gas-permeable outer layer. The foam collects exudate, and the outer layer prevents leakage and bacterial contamination. Hydrocolloid dressings contain gel-forming agents attached to a polyurethane film. The colloid portion absorbs exudate to form a gel and create a moist wound environment. ECRI's Clinical Evidence Assessment, Wound Dressings for Preventing Pressure Injuries, found:
Oral Nutrition Supplements
Oral nutrition supplements can help decrease the risk of developing PIs in wheelchair- or bed-bound patients. They contain macronutrients (protein and/or energy) and micronutrients (vitamins and minerals) at varying concentrations and are available in different styles (i.e., juice, yogurt, milkshakes), formats (e.g., liquid, powder, pudding), types (high protein, fiber-containing, low volume), energy densities (1.0 to 2.4 Kcal/mL), and flavors. ECRI's Clinical Evidence Assessment, Oral Nutrition Supplements for Preventing Pressure Injuries, found:
Impact
The direct and indirect costs of PIs are enormous. The Agency for Health Care and Quality (AHRQ) estimates that treating hospitalized patients who have PIs costs the U.S. healthcare industry between $9.1 billion and $11.6 billion per year.
Learn how ECRI’s Clinical Evidence Assessment service supports clinicians by researching evidence-based strategies that help improve care quality and reduce costs across all care settings.