Pressure injury describes damage to the skin and the tissue underneath that is caused by constant pressure or friction. These can happen in people with reduced mobility. People with severe and complex physical disabilities are at high risk of pressure injuries.The impact on overall health and life from a pressure injury cannot be underestimated. It is essential that everyone supporting people with complex disabilities understand prevention and management of pressure injury.

Forces from pressure, friction and shearing can all cause pressure injury.

• Pressure areas can happen around bony areas like heels, elbows, ears, back of the head, tailbone or hip bones. The constant pressure on a bony area causes lack of blood flow leading to skin break down.
• Friction is when the body constantly moves over something else.
• Shearing is when the body is moved over a surface while gravity is pushing the body against the surface.

Causes of pressure injury:

• Long term sitting, for example sitting in a wheelchair or toilet chair
• Bunched up clothing
• Incorrect use of equipment
• Heel constantly rubbing over a bed sheet
• Sliding in bed or chair
• Being pulled across the bed or chair against standard bed sheets
• Being restless or having muscles spasms

Levels of pressure injury:

• Grade 1 – skin discolouration
• Grade 2 – some skin loss or damage to the top layers of the skin
• Grade 3 –necrosis (death) or damage the deeper skin layers
• Grade 4 – necrosis (death) or damage to skin layers and underlying structures, such as tendons or bone

Warning signs:

• Redness
• Skin discolouration
• Broken or swollen skin

Prevention of pressure injury:

• Check skin daily to look for early warning signs
• Maintain good blood circulation by reducing the amount of time that pressure is applied to the skin
• Use good quality equipment prescribed and as directed by therapists
• Develop a plan to ensure frequent position changes happen during the day and night - liaise with physiotherapists and occupational therapists
• Maintain daily skin care routines to ensure the skin is well moisturized

Some examples for how to reposition a person include:

• Using the recline and tilt in space function on wheelchairs
• A two person lift to reposition (if recommended)
• Being stood up to walk
• Being hoisted out of the chair and resting in bed, a fallout chair or recliner chair

Treatment of pressure injury

If a pressure injury develops, it must be managed medically, seek support from doctors and community nursing teams for overarching support. Healing can be promoted by:

• Changing position regularly
• Use of pressure relieving aids
• Review of equipment
• Wound care
• Use of barrier creams or prescribed medications
• Maintaining a healthy lifestyle and a nutritious diet

Where to get help:

Doctors, community nursing services and allied health teams can assess and develop plans to prevent and manage pressure injury concerns.

To learn more:

Online: https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/pressure-sores