Pressure Ulcer

Pressure ulcers, also known as decubitus ulcers or bedsores, are localized injuries to the skin and/or underlying tissue that usually occur over a bony prominence as a result of pressure in combination with shear, friction, and/or excessive skin moisture and temperature .

Stage 1

Intact skin with non-blancable redness of a localised area usually over a bony prominence.

Stage 2

Partial thickness of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough.

Stage 3

Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed.

Stage 4

Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, grey, green or brown) and/or eschar (tan, brown or black) in the wound bed.

How They Develop

People with normal mobility do not develop pressure ulcers, as their body automatically makes hundreds of regular movements that prevent pressure building up on any part of their body.

For example, while you are asleep you may think you are lying still, but you may shift position up to 20 times a night. Pressure ulcers can develop when a large amount of pressure is applied to an area of skin over a short period of time. They can also occur when less pressure is applied over a longer period of time. The extra pressure disrupts the flow of blood through the skin. Without a blood supply, the affected skin becomes starved of oxygen and nutrients and begins to break down, leading to an ulcer forming.

The lack of blood supply also means that the skin no longer receives infection-­fighting white blood cells. Once an ulcer has developed, it can become infected by bacteria. Conditions that affect the flow of blood through the body, such as type 2 diabetes, can also make a person more vulnerable to pressure ulcers.

Pressure ulcers can be caused by:

  • Pressure from a hard surface, such as a bed or wheelchair.
  • Pressure that is placed on the skin through involuntary muscle movements, such as muscle spasms.
  • Moisture, which can break down the outer layer of the skin (epidermis).

Pressure Risk Areas

The time it takes for a pressure ulcer to form will depend on:

  • the amount of pressure.
  • how vulnerable a person’s skin is to damage.

Grade three or four pressure ulcers can develop over short time periods. For example, in susceptible people, a full-thickness pressure ulcer can sometimes develop in just one or two  hours.

However, in some cases the damage will only become apparent a few days after the injury has occurred.

The Wider Impact

  • 412,000 individuals develop a new pressure ulcer annually in the UK. (Bennett et al., 2004)
  • Stage 1 pressure ulcers cost £1,214 rising to £14,108 for a stage 4 pressure ulcer. (Dealey, 2012)
  • Total cost of pressure ulcers to the NHS are £1.4-2.1 Billion, 4% of the total NHS budget (based on data from 2000)
  • Nursing time accounts for almost 90% of the overall cost of pressure ulcer treatment (Bennett, 2004)

NHS Institute estimated in 2010

  • 4-10% of hospital admissions will suffer from a new pressure ulcer
  • 30% of patients in the community may suffer a pressure ulcer
  • 20% of those in nursing and residential homes may be affected

How they are prevented

  • Keeping Moving
  • Self-Care
  • Mattresses and Cushions
  • A Good Diet
  • Skin Assessment