In April of 2016, the National Pressure Ulcer Advisory Panel announced a change in terminology from “pressure ulcer” to “pressure injury” to better reflect the description of pressure injuries to both intact and ulcerated skin. The changes eliminated confusion surrounding the subject and the stages of injury.

The existing stages of pressure injury were also updated and changed to Arabic numbers from Roman numerals. Over four hundred professionals attended a meeting about the terminology change from “pressure ulcer” to “pressure injury” as well as the changes to the stages of pressure injuries. A consensus confirmed the change.

What Is a Pressure Injury?

Pressure injuries, more commonly known as bedsores, are wounds caused by “unrelieved pressure of tissue compressed between a bony prominence and an external surface.” These levels are classified by the extent of tissue damage. Unrelieved pressure causes the network of vascular and lymph vessels to be constricted, keeping oxygen and other nutrients from reaching the area.

Bedsore and pressure injuries are most common in people who are immobile or bedridden. About ten percent of hospital patients develop a pressure injury during their stay, and the most commonly affected group of people is the elderly.

Factors determining if a pressure injury will develop include the duration and intensity of pressure, as well as tissue tolerance or the ability of the tissue to resist pressure. Shear, friction forces, and moisture also play a part in the development of pressure injuries. Incontinence is also a contributing factor. The most common areas to develop pressure injuries include the tailbone, heel, buttocks, and hip.

Revised Stages of Pressure Injuries

Doctors categorized pressure injuries as a way to stage the wound to better determine the extent of damage and the level of treatment required to allow it to heal completely. These stages include:

• Stage 1 is a non–blanchable erythema of intact skin. The skin has observable changes and is characterized by areas of persistent redness.

• Stage 2 is partial-thickness skin loss with exposed dermis. The wound is moist and pink or red in color. It may appear as an intact or ruptured blister. Fat and deep tissues are not visible.

• Stage 3 is full-thickness skin loss. Fat is visible and rolled wound edges are often present. Tunneling and undermining may occur. The depth of tissue damage varies by the injury location on the body.

• Stage 4 is full-thickness skin and tissue loss. This is characterized by exposed or directly palpable fascia (thin tissue enclosing a muscle or organ), tendon, cartilage, muscle, ligament, or bone in the ulcer. Rolled edges, undermining and tunneling often occur.

• Unstageable pressure injury is obscured full-thickness skin and tissue loss. A pressure injury is considered unstageable if the extent of tissue damage cannot be determined.

Finally, a deep tissue pressure injury is persistent non-blanchable deep red, maroon, or purple discoloration. A dark wound bed or blood-filled blister is often present.

Additional Pressure Injury Definitions

A medical device-related pressure injury results from the use of devices applied and designed for therapeutic or diagnostic purposes. The injury usually conforms to the shape of the device. This type of injury is often difficult to classify and is considered an unstageable pressure injury.

A mucosal membrane pressure injury is found on mucous membranes with a history of a medical device in the area of the injury. This type of pressure injury is usually classified as a Stage 3 or Stage 4.

Preventing Bedsores

Normally, treatment of pressure injuries consists of the immediate and continued reduction of pressure and shear forces, management of any exudate coming from the wound, prevention of any contamination that would lead to infection, creation of a moist wound environment, and minimizing dressing changes if possible.

Prevention is the best method to ensure the health and well-being of the resident. However, prevention requires constant monitoring of nursing home residents who are mobility challenged including repositioning their body at least one time every 1 to 2 hours. In addition, the nursing staff can use pressure reducing devices and routinely change urinary and fecal incontinence pads to keep the skin dry.

Nursing staff can also use specialized bandages and medication that has been proven to be effective at minimizing the potential for the development of infections to the bone (osteomyelitis) and blood (sepsis).

Seeking Compensation After Developing Bedsores

Bedsores, or pressure injuries, are a common cause of claims filed against hospitals or various forms of care facilities such as nursing homes. This is because nearly every type of bedsore is preventable and if caught in its early stages results in only minimal damage to skin and underlying tissue.