Pressure injuries and risk prevention

In this section, you’ll learn about:

• how to protect the skin 
• how to use dressings to prevent pressure injuries 
• how to use repositioning to prevent pressure injuries 
• how to prevent pressure injuries in the heel 

Maintaining skin integrity is the key to protecting the skin against pressure injuries. This is especially important in patients with incontinence. When urine and/or stool gets on the skin, it can increase the risk of a pressure injury developing.¹

If you have a patient with incontinence, you should follow this three-step routine after each incontinence episode:

Step 1: Cleanse

Cleanse the skin with a pH-balanced cleanser. This will maintain the skin’s acid mantle.

Step 2: Moisturise

Consider using a skin moisturiser to hydrate the skin.

Step 3: Protect

Use a moisture barrier to protect the skin from urine, stool and excessive moisture.²

TIP: Use low-friction textiles

Studies show that silk-like fabrics reduce shear stress, minimise skin irritation and dry more quickly than cotton or cotton-blend fabrics. Patients placed on silk-like fabric sheets also have fewer pressure injuries than ones on standard cotton sheets.¹

Studiesshow that using a multi-layer silicone foam dressing can protect the skin and prevent pressure injuries.

To choose the right dressing, ask yourself the following questions:

• Is it the right size and design?
• Does it manage the skin’s microclimate, e.g. moisture?
• Is it easy to put on and take off?
• Will it stay in place?
• Does it allow me to regularly assess the skin underneath the dressing?
• Is it comfortable and hypo-allergenic?
• Is it cost-effective and easy-to-access?

If you decide to use a protective dressing, you should:

• continue to reposition your patient regularly;
• assess the skin beneath the dressing at least once a day;
• change the dressing if it is dirty or excessively moist, or if it loosens or gets out of place.

Patients who can’t move on their own are more likely to develop pressure injuries. When the body lies or sits in one position for an extended period of time, this places pressure on certain parts of the body. If a person doesn’t change position regularly, this pressure can damage the skin and underlying tissues, forming a pressure injury.¹

For this reason, an important part of preventing pressure injuries is repositioning or mobilising your patient.^1,3

The goal of repositioning is to:

• reduce the amount of pressure placed on vulnerable areas of your patient’s body, and
• reduce the length of time pressure is placed on these areas.

Tips for repositioning

When you’re choosing a position for your patient, be sure to assess whether the position actually relieves pressure on vulnerable areas.

Watch this video to see the correct way to reposition.

Guidelines recommend using a 30-degree side-lying position, as shown in this image

If your patient is in a wheelchair, keep the following in mind:

• Try to limit the time the patient spends sitting to 60 minutes or less
• Try to shift the patient from time to time. For example, by tilting them forward or using a lift-off
• Choose a reclined seated position where the legs are elevated
• Make sure your patient’s feet are well-supported so they don’t slide when the patient is sitting upright in a chair or wheelchair

How often should I reposition?

To find out how often you should reposition a patient, you need to start with a pressure injury risk assessment. Pay particular attention to how active and mobile your patient is. This is important because the less active and mobile a person is, the greater the risk of a pressure injury.¹

Consider the following factors when planning your repositioning schedule:

• What is the condition of the patient’s skin?
• How tolerant is the skin and tissue (i.e. how well can they cope with pressure)?
• What is the patient’s overall medical condition?
• What are my overall treatment objectives?¹

Keep in mind that you should reposition your patient throughout the day. Be sure to clearly document each time you do it.³

TIP: Try a 2-hour schedule as a starting point.³

If your assessment shows that your patient is at risk of a heel pressure injury, you should elevate the heel. To do so, use a heel suspension device or a pillow or foam cushion. The device or cushion should be specifically designed for the heel.

The suspension device will help to distribute the leg’s weight along the calf, without placing pressure on the Achilles tendon.

Make sure that:

• the heels are free from the bed surface;
• the knees are slightly flexed (5-10 degrees); and
• pressure is distributed along the full length of the calves.

Almost 80% of all Stage 4 pressure injuries are located on the heel and sacrum.