Hospital-acquired pressure injuries (HAPIs) — tissue damage from sustained pressure, shear, or friction over bony prominences — affect 2.5 million patients annually in the US, costing $9.1–11.6 billion in hospital expenditures and contributing to >60,000 deaths. CMS eliminated reimbursement for hospital-acquired pressure ulcers (Stage 3 and above) in 2008 — making pressure injury prevention both a patient safety and financial imperative for hospital systems.
NPIAP Staging and Recognition
National Pressure Injury Advisory Panel (NPIAP) 2016 staging: Stage 1 — non-blanchable erythema of intact skin. Stage 2 — partial-thickness skin loss with exposed dermis (blister or shallow ulcer). Stage 3 — full-thickness skin loss with visible adipose tissue. Stage 4 — full-thickness tissue loss with exposed bone, tendon, or cartilage. Unstageable — full-thickness loss with slough or eschar obscuring wound base. Deep tissue pressure injury (DTPI) — persistent non-blanchable deep red/maroon/purple discoloration; may evolve rapidly to deep wound. Medical device-related pressure injury (MDRPI): 34% of hospital HAPIs are device-related (endotracheal tubes, oxygen masks, nasogastric tubes, sequential compression devices). Clinical importance: recognizing DTPI and MDRPI as distinct entities guides prevention strategies — rotating device placement and using protective dressings under medical devices are effective MDRPI prevention strategies.
Evidence-Based Prevention Interventions
Braden Scale risk assessment: validated 6-domain risk assessment tool (sensory perception, moisture, activity, mobility, nutrition, friction/shear) with validated cutoffs (≤18 = at risk in most studies). Higher risk patients require more intensive prevention protocols. Repositioning: 2-hourly repositioning in bed-bound patients significantly reduces sacral pressure injury incidence — the 30-degree tilt position (lateral tilted 30°, not full 90° side-lying) preferred over 90-degree lateral positioning for hip pressure distribution. Pressure-redistributing mattresses: foam and air mattresses significantly reduce pressure injury incidence versus standard hospital mattresses (Cochrane review: RR 0.40 for foam; RR 0.21 for alternating pressure). Mattress upgrade is cost-effective even at purchase cost. Nutrition: targeted nutritional support with protein supplementation (1.25–1.5g/kg/day) and zinc + vitamin C supplementation in deficient patients reduces pressure injury risk and improves healing. Skin moisture management: moisture-associated skin damage from urinary/fecal incontinence is a significant pressure injury risk factor — structured skin care protocols (cleansing + moisturizing + barrier protection) reduce both moisture damage and pressure injury rates. Our wound care catalog includes pressure injury dressings, foam dressings, silicone borders, and skin barrier products, and our skin care section includes clinical barrier creams and moisture management products essential for pressure injury prevention programs.
