Pressure injuries — previously termed pressure ulcers or bedsores — remain one of the most prevalent, costly, and potentially preventable complications in long-term care. CMS designates hospital-acquired pressure injuries (HAPIs) as "never events," eliminating Medicare reimbursement for treatment of stage III, IV, and unstageable injuries developed during hospitalization. For SNFs, pressure injuries are a key quality indicator tracked in the Five-Star Quality Rating System. Effective prevention requires a systematic approach combining risk assessment, repositioning protocols, skin care, nutritional optimization, and the right supply infrastructure — all available through Healix Medical Supply.
Risk Stratification: The Braden Scale
The Braden Scale for Predicting Pressure Sore Risk remains the gold standard risk assessment tool validated in long-term care settings. It scores six subscales: sensory perception, moisture, activity, mobility, nutrition, and friction/shear — each on a 1–4 scale. Total scores ≤18 indicate at-risk status: mild risk (15–18), moderate risk (13–14), high risk (10–12), very high risk (≤9). CMS requires Braden assessment on admission, weekly for the first 4 weeks, quarterly thereafter, and after any significant clinical change.
Repositioning: The Non-Negotiable Foundation
For bedbound patients, the 2-hour repositioning protocol (turning every 2 hours using the 30-degree lateral tilt, not 90-degree side-lying which maximizes trochanteric pressure) remains standard. For chair-bound patients, weight shifts every 15–30 minutes or pressure-relieving seat cushions are required. Positioning aids — foam wedges, pillows, and heel protectors — are essential supplies. Our patient care catalog includes heel protection boots, positioning wedges, and turning sheets from leading manufacturers.
Pressure-Redistributing Surfaces
Support surface selection is a clinical decision based on risk level and existing injury stage. Reactive support surfaces (foam overlays, static air mattresses) are appropriate for moderate-risk patients. Active alternating-pressure mattresses and low-air-loss systems are indicated for high-risk patients and those with existing stage II–III injuries. Heel suspension — elevating heels completely off the mattress surface using commercially available heel protection devices — is separately required, as even reactive mattresses provide insufficient heel pressure relief for high-risk patients. Our patient care section includes full support surface options.
Skin Care: Moisture Management
Incontinence-associated dermatitis (IAD) is a major pressure injury risk factor — moisture weakens the skin barrier and increases friction coefficient. Structured skin care protocols using moisture barriers (dimethicone or petroleum-based) applied after each incontinent episode significantly reduce IAD prevalence and associated pressure injury risk. pH-balanced cleansers, barrier creams, and containment devices (briefs, pads, external urinary catheters) are all components of an effective moisture management program. Browse our incontinence product catalog and skin care supplies for complete formulary options.
Nutrition: The Often-Overlooked Pillar
Malnutrition is an independent risk factor for pressure injury development and impaired healing. NPUAP guidelines recommend 30–35 kcal/kg/day and 1.25–1.5 g protein/kg/day for pressure injury prevention in at-risk individuals, with increased protein targets (1.5–2.0 g/kg/day) for active wound healing. Oral nutritional supplements including arginine-enriched formulas (e.g., Nestlé Impact, Abbott Juven) have demonstrated accelerated wound healing in RCTs. Dietitian assessment and medical nutrition therapy are essential components of a CMS-compliant pressure injury prevention program. Our clinical nutrition catalog includes a full range of oral supplements and enteral feeding products.
