A pressure ulcer is localized injury to the skin and/or underlying tissue usually
over a bony prominence, as a result of pressure, or pressure in combination with
shear and / or friction. Because muscle and subcutaneous tissue are more susceptible
to pressure-induced injury than skin, pressure ulcers are often worse than their
initial appearance. Pressure ulcers are staged to guide clinical description of
the ulcers.
In 2007, the national Pressure Ulcer Advisory Board updated pressure ulcer staging,
adding two stages to create a total of six (6) pressure ulcer stages. These added
stages include Suspected Deep Tissue injury (STDI) and Unstageable (see Table of
Skin Integrity Stages). Although pressure ulcers are preventable in most every case,
the prevalence of pressure ulcers in health care facilities is increasing. Pressure
ulcer incidence rates vary considerably by clinical setting—ranging from 0.4% to
38% in acute care, from 2.2% to 23.9% in long-term care, and from 0% to 17% in home
care (Lyder, 2003).
Pressure ulcers cause considerable harm to patients, hindering functional recovery,
frequently causing pain and the development of serious infections. Pressure ulcers
have also been associated with an extended length of stay, sepsis, and mortality.
In fact, nearly 60,000 US hospital patients are estimated to die each year from
complications due to hospital-acquired pressure ulcers. The estimated cost of managing
a single full-thickness pressure ulcer is as high as $70,000, and the total cost
for treatment of pressure ulcers in the US is estimated at $11 billion per year.
For this reason, preventing pressure ulcers is very important.
The steps to preventing pressure ulcers require a team approach and accurate reporting
to track the stages of pressure ulcers. Patient and families must be informed of
measures they can take to prevent pressure ulcers. These steps include:
- Skin Inspection and Risk Assessment (Assess and reassess)
- Keep Pressure Off (Turn or reposition patients every two hours or more often if
needed)
- Incontinence/Moisture Skin Protection (Protect skin from moisture)
- Nutrition that is Optimal (Assess and monitor patient’s calorie intake)
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PA-PSRS Definitions – Skin Integrity Stages
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SUSPECTED DEEP TISSUE INJURY
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A localized area of discolored (purple or maroon) intact skin or blood-filled blister.
The area may be painful, firm, mushy, boggy, warmer or cooler compared to adjacent
tissue.
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STAGE I
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A reddened area on the skin that, when pressed, in “nonblanchable” (does
not t urn white). This indicates that a pressure ulcer is starting to develop.
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STAGE II
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The skin blisters or forms an open sore. The area around the sore may be red and
irritated.
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STAGE III
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The skin breakdown now looks like a crater where there is damage to the tissue below
the skin.
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STAGE IV
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The pressure ulcer has become so deep that there is damage to the muscle and bone,
and sometimes tendons and joints.
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UNSTAGEABLE
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Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow,
tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.
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Source: National Pressure Ulcer Advisory Panel. Pressure ulcer stages revised by
NPUAP [online]. 2007 Feb [cited 2008 Dec 4]. Available from
www.npuap.org/pr2.htm.
References: Preventing Pressure Ulcers
- Black J, Baharestani MM, Cuddigan J, et al. National Pressure Ulcer Advisory Panel’s
updated pressure ulcer staging system. Adv Skin Wound Care. 2007;20(5):270-274.
- 5 Million Lives Campaign. Getting Started Kit: Prevent Pressure Ulcers How-to
Guide. Cambridge, MA: Institute for Healthcare Improvement; 2008. (Available
at www.ihi.org)
- Lyder CH. Pressure ulcer prevention and management. JAMA. 2003;289(2):223-226.
- Redelings MD, Lee NE, Sorvillo F. Pressure ulcers: More lethal than we thought?
Advances in Skin & Wound Care. 2005.18(7):367-372.
- Reddy M, Gill SS, Rochon PA. Preventing pressure ulcers: A systematic review.
JAMA. 2006;296:974-984.
- Russo C, Steiner C, Spector W. Hospitalizations Related to Pressure Ulcers among
Adults 18 Years and Older, 2006.Statistical Brief #64. AHRQ. Retrieved
April 10, 2011 from www.hcup-us.ahrq.gov.
- SAFE SKIN: Road Map to a Comprehensive Skin Safety Program. Patient Safety Call
to Action. Minnesota Hospital Association. 2007.
