What is a pressure injury?

A pressure injury is damage to the skin and the tissue under it. It happens when steady pressure cuts off blood flow to an area, often where bone is close to the skin. You may also hear it called a bedsore, pressure sore or pressure ulcer.

People who spend most of the day in a bed or chair are at the highest risk. This includes people who are weak, recovering from surgery, living with a stroke or spinal cord injury, or who have trouble feeling pain. Poor nutrition, bladder or bowel leaks, and thin, fragile skin raise the risk even more.

Where to look

Pressure injuries usually form over bony spots. Check these areas every day, ideally when helping with bathing or changing clothes:

  • Tailbone, buttocks and hips
  • Heels and ankles
  • Shoulder blades, spine and elbows
  • Back of the head and the ears
  • Knees, especially if the person lies on their side
  • Any spot where tubes, braces or oxygen tubing touch the skin

Early warning signs

Catching a problem early makes a big difference. Look and feel for skin that stays red after pressure is taken off, or that does not lighten when you press on it gently. On darker skin, the area may look purple, bluish or darker than the skin around it rather than red.

Other early signs include a spot that feels warmer or cooler, firmer or softer, or more painful than nearby skin. Blisters, open skin or a dark, bruised-looking area need to be checked by a clinician soon. If you see any of these, keep pressure off that spot and call your care team.

Move, shift and cushion

Moving often is the most important way to prevent pressure injuries. Ask your clinician for a turning schedule that fits the person you care for. Common advice is to change position in bed about every 1 to 2 hours, and for people in a wheelchair to shift their weight every 15 to 20 minutes if they can.

  • Use pillows or foam wedges between the knees and ankles when lying on the side.
  • Float the heels off the bed by placing a pillow under the calves, not under the knees.
  • Keep the head of the bed as low as is safe and comfortable to reduce sliding, unless the care plan says otherwise.
  • Lift, don’t drag, when moving someone in bed. A draw sheet helps prevent rubbing and skin tears.
  • Ask your care team whether a pressure-relieving mattress or chair cushion is right. Avoid donut-shaped cushions, which can cut off blood flow.

Protect the skin

  • Keep skin clean and dry. Clean gently with a mild cleanser and pat dry; do not scrub.
  • Change wet or soiled pads and briefs as soon as possible, and use a barrier cream if the care team recommends one.
  • Use a gentle moisturizer on dry skin.
  • Do not massage red areas over bones, which can cause more damage.
  • Keep sheets smooth and free of crumbs and wrinkles.
  • Help the person eat balanced meals and drink enough fluids, as their doctor or dietitian advises.

When to get help

Call your doctor or wound care team if you see skin that stays red or discolored, a blister, or an open area. Call the same day if a sore gets bigger, smells bad, drains pus, or the skin around it becomes red, warm or swollen.

Call 911 if the person has a fever with confusion, trouble breathing, a racing heart, or is very hard to wake. These can be signs of a serious infection. If a pressure injury is already being treated, follow the care plan and dressing orders from your own clinician.

This guide is general education, not medical advice. Follow the care plan from your own clinician. For a medical emergency, call 911.