A pressure ulcer / injury can be defined as:
‘Localised damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as
intact skin or an open ulcer and may be painful. Then injury occurs because of intense and/or prolonged pressure or pressure in combination with shear. The
tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, comorbidities, and condition of the soft tissue’. EUPAP 2019

The main causes of pressure ulceration are:

  • Shear
  • Friction
  • Microclimate
  • Unrelieved pressure
  • Reduced mobility
  • Poor nutrition
  • Underlying health issues
  • Extremes of age
  • Incontinence, both urinary and faecal
  • Perfusion, circulation and oxygenation factors (Ousey, 2011, EUPAP 2019)

It is essential to acknowledge that some individual groups will have a higher, specific pressure injury-related risk and requirements related to their clinical condition, age, or care setting, including the following:

  • Individuals with spinal cord injury
  • Individuals receiving palliative care
  • Individuals with obesity
  • Neonates and children
  • Individuals in community, aged care and rehabilitation settings
  • Individuals in transit.

Norton et al 2018, EUPAP2019

These intrinsic or extrinsic factors will increase a patient’s risk of pressure ulcer development.

Malnutrition Caused by chronic disease, major surgery, nil by mouth status and neglect
Immobility Sedation, anaesthesia, paralysis, pain, major trauma and chronic diseases
Age Loss of sensation
Medical condition Congestive cardiac failure, chronic respiratory disease, diabetes, anaemia and neurological disease
Dehydration Slows down the body’s metabolism, reduces skin rigidity, more vulnerable to new wounds
Poor blood supply If the person has a compromised blood supply and or underlying vascular disease any addition of pressure will cause the skin to break down quicker
Pressure Compression of tissue between bone and hard surface
Shear Shear forces initiated when part of the body tries to move but the surface remains motionless against the support surface
Friction Friction forces occur when the shearing force increases sufficiently to overcome the body’s resistance to being moved, the area of tissue in contact with the support surface will then begin to slide
Moisture Can be caused by incontinence, sweating, high temperature and wound exudate. The patients skin can adhere to the damp surface and exacerbate damage