Pressure Injury

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 the quality of care of a facility, 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 those patients at risk for their development, and preventive measures can be aimed toward these patients. As treatments for pressure injuries have been characterized and evaluated with variable degrees of completeness, there remains uncertainty regarding the best options for management.

The superficial skin layer is less prone to be affected by 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 bed-ridden 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 system updates, the term "pressure injury" instead of "pressure ulcer" is preferred. The former recognizes that minimal skin damage due to pressure may not necessarily be associated with ulceration and is categorized as stage 1. Moreover, deep tissue pressure injury might occur without prominent overlying skin ulceration.