Pressure injuries (formerly called pressure ulcers or bedsores) affect over 2.5 million Americans annually and cost the U.S. healthcare system an estimated $26 billion in treatment costs. Beyond the financial burden, pressure injuries cause significant patient suffering, increase infection risk, and extend hospital and SNF stays. Since 2008, CMS has not reimbursed hospitals for hospital-acquired pressure injuries (HAPIs) at Stages 3–4, making prevention not only a quality imperative but a direct financial one.
Understanding Pressure Injury Staging
The National Pressure Injury Advisory Panel (NPIAP) staging system classifies pressure injuries by tissue depth:
- Stage 1: Non-blanchable erythema of intact skin
- Stage 2: Partial-thickness skin loss — shallow open ulcer or intact blister
- Stage 3: Full-thickness skin loss — subcutaneous tissue visible but no bone, tendon, or muscle
- Stage 4: Full-thickness skin and tissue loss with exposed bone, tendon, or muscle
- Unstageable: Full-thickness loss, depth obscured by slough or eschar
- Deep Tissue Injury (DTI): Persistent non-blanchable deep red, maroon, or purple discoloration
Pressure Redistribution Surfaces
Specialty mattresses and overlays are the cornerstone of pressure redistribution. Product selection should match patient risk level (Braden Scale score) and care setting:
- Foam mattresses and overlays (reactive): Appropriate for low-to-moderate Braden scores. Visco-elastic (memory) foam provides better pressure redistribution than standard polyurethane.
- Alternating pressure overlays (active): Motor-driven air cells alternately inflate and deflate, cyclically redistributing pressure. Indicated for moderate-to-high risk patients.
- Low air loss mattress systems: For high-risk and Stage 3–4 patients, low air loss surfaces simultaneously redistribute pressure and manage moisture through air permeation.
- Bariatric support surfaces: Rated for 500–1,000+ lb, with wider sleeping surfaces and enhanced pressure redistribution.
Heel Protection
Heels are the second most common pressure injury location after the sacrum. The heel's anatomy — a small bony prominence with minimal overlying soft tissue — makes it uniquely vulnerable. Heel protectors that completely offload the heel (elevating it fully off the bed surface) are the evidence-based standard. Suspension-style boot protectors (DermaGel, Heelift) are preferred over simple padding, which does not achieve full offloading.
Positioning and Repositioning Aids
Manual repositioning every 2 hours remains a standard of care for immobile patients. Positioning aids that maintain proper body alignment and prevent pressure concentration include: foam positioning wedges, bolsters, abductor pillows, and lateral positioning devices. Incontinence management is also a positioning concern — moisture-associated skin damage (MASD) significantly increases pressure injury risk.
Skin Protection and Barrier Products
Skin protectant and moisture barrier creams containing zinc oxide, dimethicone, or petrolatum protect at-risk skin from moisture damage caused by incontinence, perspiration, and wound drainage. Liquid skin sealants (protective films) protect Stage 1 areas and peri-wound skin. These are the front-line prevention supplies used at every routine skin assessment.
Building a Pressure Injury Prevention Program
A complete prevention program combines risk assessment (Braden Scale on admission and weekly), appropriate support surface selection, repositioning schedules, heel protection, moisture management, and nutritional optimization. On the supply side, facilities need a tiered inventory of support surfaces, adequate heel protectors for all at-risk patients, and skin protection supplies at every bedside. Healix stocks the full spectrum of prevention supplies — call (888) 585-6510 or browse our skin care catalog.