Pressure Ulcers: The Hidden Bedside Threat You Need to Know About

Pressure Ulcer Awareness – Part 1  

Correct understanding, effective prevention, and scientific care are the keys to staying healthy.

Pressure ulcers, also known as bedsores or decubitus ulcers, are areas of damaged skin and underlying tissue caused by prolonged pressure that impairs local blood circulation. This leads to ischaemia, hypoxia, and malnutrition of the skin and subcutaneous tissue, eventually resulting in tissue breakdown and necrosis.

How common are they?

A meta‑analysis published in Chinese Nursing Management (July 2018) reported that the prevalence of pressure ulcers (PU) among hospitalised patients in China was 1.67%, while hospital‑acquired pressure ulcers (HAPU) accounted for 0.68%.

For comparison, the overall PU prevalence in Germany between 2001 and 2007 was 10.2%. In the United States, data from 2006 to 2015 across various care settings showed PU prevalence ranging from 9.3% to 13.5%, with HAPU rates between 3.1% and 6.2%.

Globally, according to the Merck Manual, pressure ulcers contributed to 24,400 deaths in 2019 alone.

These figures underline that pressure ulcers are far from rare – and they are a serious concern for both patients and caregivers.

Where do pressure ulcers come from?

The old saying “prolonged lying on a mattress breeds sores” holds true. Pressure ulcers most often develop in people with limited mobility – those who are bedridden or use wheelchairs, especially older adults. The most common sites are the sacrum, heels, buttocks, and back.

The fundamental cause is sustained pressure that obstructs blood flow, depriving tissues of oxygen and nutrients, which leads to ischaemic damage and necrosis.

It is worth noting that about 80% of all pressure ulcers occur over the sacrum and the heels.

Pressure ulcers are closer than you think

Although they are typically associated with long‑term immobility, younger people are by no means immune. In clinical practice, we see patients who develop pressure ulcers after only a short period of bed rest due to fractures, stroke, heart failure, or poor peripheral circulation.

Young patients with traumatic spinal cord injuries from accidents or vehicle collisions are also at high risk. In addition, ill‑fitting casts, splints, or other orthopaedic devices can cause device‑related pressure ulcers.

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Recognising the stages – early detection and prevention

According to the National Pressure Ulcer Advisory Panel (NPUAP) staging system, pressure ulcers are classified into six categories: Stage I, Stage II, Stage III, Stage IV, Unstageable, and Suspected Deep Tissue Injury.

Stage I – Non‑blanchable erythema

The skin is intact but appears red in lighter‑skinned individuals; the redness does not blanch when pressed. The area may be painful, firm, soft, warmer, or cooler compared with adjacent tissue.

Stage II – Partial‑thickness skin loss

The epidermis is broken, and the wound bed is pink or red, possibly with an intact or ruptured blister. There may be a clear fluid exudate.

Stage III – Full‑thickness skin loss (superficial ulcer)

The ulcer extends through the full thickness of the skin, exposing subcutaneous fat, but without involvement of deeper structures (muscle, bone, or tendon). Slough may be present. The depth varies by anatomical location.

Stage IV – Full‑thickness tissue loss (necrotic ulcer)

There is extensive destruction with exposed bone, tendon, or muscle. Slough or eschar may be present on some parts of the wound bed, and sinus tracts or undermining are often observed.

Unstageable – Depth unknown

Full‑thickness tissue loss is present, but the base of the wound is covered by slough and/or eschar. The true depth cannot be determined until enough of this devitalised tissue is removed to expose the wound base.

Suspected Deep Tissue Injury – Depth unknown

The skin appears purple or maroon, and the area may be painful, firm, mushy, warmer, or cooler. Even with optimal treatment, deep tissue breakdown often occurs rapidly.

Why awareness matters

As the population ages, the incidence of pressure ulcers continues to rise. Moreover, even short‑term immobilisation or improper use of orthotic devices – combined with inadequate care – can lead to these wounds, severely reducing patients’ quality of life. Therefore, a correct understanding of pressure ulcers is becoming increasingly important.

If you or a loved one notice any suspicious skin changes, seek medical advice promptly. A healthcare professional can provide a personalised prevention and treatment plan tailored to your needs.

Coming up in Part 2 – We will explore the underlying causes of pressure ulcer formation in more depth.