Prevention of pressure ulcers

Pressure ulcers (also known as bedsores) are the result of prolonged pressure or shear forces on the skin and underlying tissue-typically in areas where bones are close to the skin and there is little fat padding.

Pressure occurs when a person’s body weight presses against a surface. Whether lying down, sitting, or standing, the pressure is transferred to the underlying tissue, compressing it between the bone and the surface. Muscle tissue tolerates less pressure than skin, so damage often begins near the bone and may not become visible on the skin until 1–2 weeks after the pressure has occurred.

Shear occurs when tissue layers slide against each other, causing twisting and stretching that damage tissue and blood vessels. This reduces blood flow and means that less pressure is needed to cause tissue injury. Therefore, tissue exposed to shear is more likely to develop a pressure ulcer more quickly.
Pressure can develop from a lack of repositioning or from external pressure caused by medical devices such as oxygen tubes or catheters.

Shear typically occurs when the body moves without being lifted off the surface—for example, when a person is sitting with the head of the bed elevated and gradually slides downward.

Pressure is reduced when it is distributed over a larger surface area. This can be achieved with high-quality foam mattresses, frequent repositioning, and the use of cushions or mattresses with static air. Levabo offers such solutions, and our range of pressure-relieving products can help you prevent and treat pressure ulcers effectively and gently.

The Most Pressure-Prone Areas of the Body

The os sacrum (lower back) is the most common site, followed by the sitting bones and heels.

Overweight individuals often develop pressure ulcers on the heels due to the increased weight of the legs.
Underweight individuals are more likely to develop pressure ulcers on the os sacrum due to a lack of subcutaneous fat padding.

Pressure ulcers can also occur on:

Upper body: elbows, shoulders, spine, and shoulder blades
Trunk: hips, tailbone, and buttocks
Lower body: knees, backs of knees, calves, and ankles
Extremities and head: toes, back of the head, ears, and nose

The Four Categories of Pressure Ulcers

Category 1: Intact skin with redness.

The skin remains intact but shows redness that does not fade when pressed with a finger (indicating impaired capillary response). The area is often painful and typically located over a bony prominence.

Kategori 2: Delvist hudtab

Delvist hudtab der viser sig som et overfladisk sår med en rød sårbund uden dødt væv. Kan også forekomme som intakt eller bristet vabel. Smertefuldt.

Category 2: Partial Thickness Skin Loss

Partial loss of skin presenting as a shallow open ulcer with a red wound bed and no dead tissue. It may also appear as an intact or ruptured blister. Painful.

Category 4: Deep Tissue Injury

Full-thickness tissue loss with exposed or palpable tendon, bone, or muscle. Necrotic (dead) tissue or scar tissue may be visible in the wound bed. Typically not painful.

Guidelines for Repositioning

The national clinical guidelines for the prevention of pressure ulcers recommend the following key measures related to repositioning and positioning:

The frequency of repositioning should be determined based on observation of the skin condition, the patient’s nutritional status, circulation, sensory perception, ability to reposition independently, and the type of mattress used.

The more risk factors present, the more frequent repositioning should be.

The frequency can be adjusted based on changes in the skin’s condition — if pressure signs are observed, repositioning should be performed more frequently; if no pressure signs are seen, the frequency may be reduced.

Use a 30-degree side-lying position.

Ensure positioning that provides the largest possible weight-bearing surface, with materials supporting the entire body surface for stability and a neutral posture.

Repositioning can include frequent micro-movements.

Involving the patient at risk and providing education about prevention should occur as early as possible and throughout all phases of the prevention process, including during the development of a positioning plan.

Factors such as sleep disturbance, pain, patient preferences, and overall treatment goals are crucial when selecting positioning methods and determining repositioning frequency.