Definition & Historical Significance of Pressure Injuries
Greetings to all of my colleagues. As a nursing professional with a focus on wound healing, I aim to share my insights on pressure injury prevention and treatment. This series of brief blogs will cover topics such as the definition, classification, skin assessment, risk assessment and the burden of pressure injuries. To those of you who may not be so familiar with this topic, I hope that you find this information interesting and of value.
Pressure injuries, also known globally as pressure ulcers, are localized damage to the skin and underlying soft tissue. Historically referred to as bed sores or decubitus ulcers, these wounds occur as a result of prolonged or intense pressure or pressure often in combination with shear force, typically over bony prominences such as the heels, elbows, hips, and sacrum. The mechanical force of pressure impedes blood flow to the affected area, deforming the soft tissue and depriving tissues of oxygen and nutrients, leading to cellular death or necrosis.
An example of a pressure injury caused by a combination of pressure and shear is when an individual positioned with the head of the bed elevated, slides down towards the foot of the bed. This results in internal pulling taut and twisting of the soft tissue between the spine and the outer surface of the skin, which may remain adhered to the support surface.
Friction versus Shear
The mechanical force of friction is often discussed in the context of pressure injuries. There is a differential diagnosis of soft tissue injury sourced from friction (Berke, 2015). Friction causes damage from the external surface of the skin inward, usually when the skin is dragged across another surface. An example is an individual being pulled up in bed without a proper lifting device or assistance.
Classification of Pressure Injuries
Pressure injuries can take on a variety of appearances and evolve over time, depending upon their trajectory of wound deterioration or healing. For example, a pressure injury may have overlying intact skin or there may be a break in the skin integrity. In my next blog I will share information on the classification of pressure injury based on severity, called staging, which is determined by the anatomical layers of the skin and degree of soft tissue affected.
Avoidable versus Unavoidable?
There is an ongoing debate about whether pressure injuries are avoidable or unavoidable. Both the National Pressure Injury Advisory Panel (NPIAP) and the Wound Ostomy Continence Nurse Society (WOCN) have examined this issue. Unavoidable pressure injuries may develop despite best practices for prevention, particularly in cases involving cardiopulmonary status, hemodynamic stability, spinal cord injury, terminal illness, and nutrition.
Role of the National Pressure Injury Advisory Panel (NPIAP)
The National Pressure Injury Advisory Panel (NPIAP), first convened in 1987, is an independent non-profit professional organization, founded by Dr. Thomas Stewart. Meeting biannually, the expert Panel works within a structural framework of committees and task forces, to address and provide leadership to a variety of interprofessional healthcare organizations and the community of individuals at risk and their significant others. The NPIAP has published a number of excellent resources, many of which are available for educational purposes. I would advise that you check them out. The Pressure Injury Fact Sheet is a great place to start.
Risk Profile
Pressure injuries are often associated with the elderly, while in reality, they may occur in any individuals who have degrees of immobility and physical limitations. The characteristics that may cause an individual to develop a pressure injury are called risk factors. Future blog posts will address risk factors and profiles.
Impact and Cost
The national cost of treating pressure injuries can be as high as $22 billion, with individual treatment costs ranging from $75,000 to $150,000 (Padula and Delarmente, 2019). The burden on individuals includes pain, suffering, and reduced quality of life. Both prevention and treatment resources are crucial. Consideration across the spectrum of care is vital, since environment factors may weigh heavily into the development of pressure injuries, with consideration of resources for both prevention and treatment.
Prevalence and Incidence
The terms prevalence and incidence are often used to quantify the problem of pressure injuries. Prevalence refers to the number of pressure injuries in a population at a given time, while incidence refers to the number of new pressure injuries in a population over time. Monitoring these metrics helps track trends and evaluate care quality.
This introductory blog aims to provide a basic understanding about the problem of pressure injuries. Future topics will cover risk factors, prevention strategies, and treatment options. I hope you find this information insightful and continue to visit my blog for more detailed discussions on this important topic.
Reference List
Berke, C.T. (2015). Pathology and Clinical Presentation of Friction Injuries: Case Series and Literature.
Edsberg, Laura E., Diane Langemo, Mona Mylene Baharestani, Mary Ellen Posthauer, and Margaret Goldberg. “Unavoidable Pressure Injury: State of the Science and Consensus Outcomes.” Journal of Wound, Ostomy & Continence Nursing 41, no. 4 (July 2014): 313–34. https://doi.org/10.1097/WON.0000000000000050.
Padula, William V., and Benjo A. Delarmente. “The National Cost of Hospital‐acquired Pressure Injuries in the United States.” International Wound Journal 16, no. 3 (June 2019): 634–40. https://doi.org/10.1111/iwj.13071.
Schmitt, Shawneen, Marti K. Andries, Patti M. Ashmore, Glenda Brunette, Kathleen Judge, and Phyllis A. Bonham. “WOCN Society Position Paper: Avoidable Versus Unavoidable Pressure Ulcers/Injuries.” Journal of Wound, Ostomy & Continence Nursing 44, no. 5 (September 2017): 458–68. https://doi.org/10.1097/WON.0000000000000361.
Position Statements – National Pressure Ulcer Advisory Panel (npiap.com)
Resources – National Pressure Ulcer Advisory Panel (npiap.com)