Pressure Injuries(Archived)

Excerpt

Pressure injuries are localized damage to the skin and underlying soft tissue, usually occurring over a bony prominence or related to medical devices. They result from prolonged or severe pressure with contributions from shear and friction forces. These skin and soft tissue injuries remain a significant problem within hospitals and long-term care facilities and result in decreased quality of life, high costs for the patient and our health care system, and increased morbidity and mortality. As pressure injuries may be considered an indicator of a facility's quality of care, inadequate steps in prevention or treatment can lead to litigation. Awareness of factors that may contribute to the pathogenesis of pressure injuries enables the identification of patients at risk for their development, and preventive measures can be targeted to these patients. As treatments for pressure injuries have been characterized and evaluated with varying degrees of completeness, uncertainty remains regarding the best options for management.

The superficial skin layer is less prone to pressure injury; the overall physical examination may underestimate the extent of the damage.[1] The underlying history of immobility (including but not limited to patients with bedridden status or chair-bound individuals) is usually present. However, poorly fitting casts, other medical equipment, devices, and implants also play a role. Medical devices may induce mucosal pressure injury.

Skin and soft tissue pressure-induced injuries are identified as localized skin with and without underlying tissue involvement. However, they usually occur over a bony prominence. The inciting factors are pressure or pressure accompanied by shear stress. The sacrum, calcaneus, and ischium are the most common bony prominences. Significantly, superficial moisture-induced lesions, skin tears, tape burns, perineal dermatitis, or excoriation should be differentiated from pressure injury-induced lesions.

According to the National Pressure Injury Advisory Panel, the term "pressure injury" is preferred over "pressure ulcer". The former recognizes that minimal skin damage from pressure may not be associated with ulceration and is categorized as stage 1. Moreover, deep-tissue pressure injury may occur without a prominent overlying skin ulceration.