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Prevention of pressure ulcers

Author
Dan Berlowitz, MD, MPH
Section Editors
Kenneth E Schmader, MD
Hilary Sanfey, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS

INTRODUCTION

Pressure ulcers are among the most common conditions encountered in hospitalized patients or those requiring long-term institutional care [1]. Ulcer prevention is a cost-effective approach that positively impacts health status [2-6]. As of October 2008, guidelines from the Center for Medicare and Medicaid Services (CMS) in the United States state that hospitals will no longer receive additional payments when patients develop stage 3 or 4 pressure ulcers (table 1) [7]. Failure to provide appropriate pressure ulcer prevention and care may also expose providers to liability [8].

The prevention of pressure ulcers will be reviewed here. The treatment, epidemiology, pathogenesis, clinical manifestations, and staging are discussed separately. (See "Epidemiology, pathogenesis and risk assessment of pressure ulcers" and "Clinical staging and management of pressure-induced injury".)

RISK ASSESSMENT

Risk assessment, which includes a comprehensive history and physical examination, should identify patients at risk for pressure ulcers who will benefit from preventive measures, as well as factors that are potentially correctable [9]. The pathogenesis of pressure ulcers, risk factors for pressure ulcers, and risk prediction tools are discussed in detail separately. (See "Epidemiology, pathogenesis and risk assessment of pressure ulcers", section on 'Risk factors' and "Epidemiology, pathogenesis and risk assessment of pressure ulcers", section on 'Risk prediction'.)

PRESSURE REDISTRIBUTION

Pressure redistribution is the most important factor in preventing pressure ulcers and may be accomplished in two ways: appropriate use of pressure-reducing devices and surfaces, and proper patient positioning [9-11].

Support surfaces — Many pressure-reducing support surfaces and products are available. These products are classified as follows by the National Pressure Ulcer Advisory Panel Support Surface Standards Initiative [12]:  

                 

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Literature review current through: Nov 2016. | This topic last updated: Wed May 25 00:00:00 GMT+00:00 2016.
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