close -up of clinician applying sacral silicone foam bandage

Pressure Ulcers/Injuries Prevention Programs

Prevention starts with understanding where, how and why pressure ulcers/injuries occur.


Data shows: pressure ulcer/injuries as a growing healthcare concern1

In fact, a 2019 report revealed it is the only hospital-acquired condition that increased in incidence rates (+6%) from 2014-2017, while other hospital-acquired conditions saw a decrease.2 Pressure ulcer/injuries prevention strategies have been shown to shorten patients’ hospital stays and reduce their readmission rates1. It’s our goal to pursue patient-centered science that can support your commitment to proactive care and potentially improve lives.

When prevention isn’t possible: Explore pressure ulcer/injuries management options

Every pressure ulcer/injury prevented is money saved

Annually, more than 2.5 million people in the U.S. alone develop pressure ulcers/injuries.3
Taking extra care to prevent pressure ulcers/injuries shouldn’t overburden staff or inflate care costs. In fact, putting the right plan in place should ultimately help reduce costs for your facility. Discover more economic impacts of prevention (PDF 2.6 MB)

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    Pressure ulcers/injuries can develop in as little as 6 hours4

    When skin is exposed to friction and gravity, pressure ulcers/injuries can develop in as little as six hours.

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    Pressure ulcer/injury related complications result in 60,000 deaths annually5

    It’s estimated that 60,000 patients die each year as a direct result of pressure ulcer/injury related complications.

  • icon of an patient at an ICU

    Up to 41% of ICU patients may develop a pressure ulcer/injury6

    From 2013-2019 Hospital Acquired Pressure Ulcers / Injuries (HAPIs) have shown an upward trend, 2.5% to 3.2% in all inpatient care units and an upward trend of 5.6% to 6.4% in critical care units.7,8

Understanding what causes pressure ulcers/injuries

Pressure ulcers/injuries develop through mechanical forces – pressure, friction, and shear. These, along with moisture, set the stage for ulcer/injury development.

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    A pressure ulcer/injury may affect only the epidermis, or there may be an injury to the underlying tissue (like dermis, adipose, or muscle). ​Pressure ulcer/injury typically develop over boney prominences or may be related to medical devices such as tubes and braces. Tissue damage occurs due to intense or prolonged exposure, or a combination of these two, to sustained tissue deformation and pressure.

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    Friction and shear9

    Pressure alone can cause pressure ulcer/injury but are more likely in combination with shear or friction. Shear is when two unaligned forces move part of the body in one direction and the other in opposite direction at the interface of the skin and the bony surface prominence, causing damage to tissue deep within the skin. Friction occurs when two surfaces rub against one another, affecting the skin's surface.

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    Skin microclimate, the temperature, humidity, and airflow next to the skin's surface- and moisture play an important role in skin integrity. An excess of moisture which may include sweat, urine, faeces, or excessive exudate, makes the stratum corneum more suspectable to damage. And when combined with the friction from linen and bed sheets, this potential damage is exacerbated.

Watch this series of five-minute education videos to learn more.

  • different extrinsic and intrinsic risks for pressure injuries

    Chapter 1: Definition

    In part 1 of the 5 part video series on pressure ulcer/injury, this video focuses on defining pressure ulcers/injuries and outlining their risks and impact.

    Video 4:49 min

  • locations where shear and friction can cause pressure injuries

    Chapter 2: Cause

    In part 2 of the 5 part video series on pressure ulcer/injury, this video focuses on how pressure ulcers/injuries develop.

    Video 3:55 min

  • Stage 1 to 4 of pressure injuries

    Chapter 3: Staging

    In part 3 of the 5 part video series on pressure ulcer/injury, this video focuses on defining the stages of pressure ulcers/injuries.

    Video 5:32 min

  •  locations where pressure injuries can occur

    Chapter 4: Assessment

    In part 4 of the 5 part video series on pressure ulcer/injury, this video focuses on how to assess pressure ulcers/injuries.

    Video 3:39 min

  • places for pressure injuries and IAD

    Chapter 5: Incontinences Associated Dermatitis vs Pressure Ulcer/Injury

    In part 5 of the 5 part video series on pressure ulcer/injury, this video focuses on the correlation between incontinence associated dermatitis (IAD) and pressure ulcers/injuries.

    Video 5:10 min

Sites most susceptible to pressure ulcers/injuries

  • Stage 1 pressure injury of buttocks - provided by NPUAP

    Sacrococcygeal area

    Most Hospital Acquired pressure ulcers/injuries occur on the sacrum followed closely by the buttocks. Immobility is the greatest risk factor for development of pressure ulcers/injuries.10

    Moisture associated skin damage may compromise the epidermis barrier function and predispose tissue to pressure ulcer/injury.9

  • pressure injury of heel - provided by NPUAP


    Immobility, as with sacral pressure ulcers/injuries, makes the heel an area to watch closely. Consider repositioning the patient and using prophylactic dressings that can reduce pressure, friction and shear.

  • National Pressure Ulcer Advisory

    Presence of a medical device

    Medical device related pressure ulcer/injury (MDRPI) is caused by a device used for diagnostic or therapeutic purposes. Examples include respiratory devices such as tracheostomy faceplates, tubes and securement devices, endotracheal tubes; orthopedic devices such as cervical collars; urinary or faecal collection devices or compression stockings among other things.
    MDRPIs may be defined as those found on mucous membranes (the moist lining of the body cavities such as the tongue, oral mucosa, nasal passage) or non-mucosal. Ulcers/injuries can also be caused by other objects found in a patients room, such as remotes, cell phones, and chargers.11

Pressure ulcer/injury prevention guidelines

Pressure ulcer/injury development is a complex, dynamic process. Pressure ulcers/injuries aren't caused by just one factor, but multiple factors happening over a short or long period of time depending on the patient. The following are key elements of pressure ulcer/injury prevention based on recommendations from the European Pressure Ulcer Advisory Panel (EPUAP) /National Pressure Injury Advisory Panel (NPIAP).

  • icon of a check list

    Implement the use of a structured risk assessment tool.

  •  icon of a patient laying in bed on the side

    Conduct a head-to-toe skin and tissue assessment to identify early signs of damage.

  • icon of a dressing

    Implement preventative skin care strategies.

  •  icon of a plate with a checkmark

    Assess and optimise nutritional status.

  • icon of a person with walker

    Frequent repositioning and early mobilisation.

  • icon of a foot on a pillow

    Evaluate the need for a pressure reduction support surface.

  • icon of a nose with a connected medical device

    Implement strategies to prevent MDRPIs.

  • icon of a medical professional providing education

    Educate staff, patients and family members.

  • woman with 3 grapefruits
    How to Stage a Pressure Ulcer/Injury Using a Grapefruit

    In this four-minute video, Heather Hettrick, PT, PhD, CWS, CLT, CLWT, uses a grapefruit to outline the various stages of a pressure ulcer/injury, including differentiating erythema.

    Watch pressure ulcer/injury video (4:04 min)

  • Knowing how to properly assess and stage a pressure ulcer/injury, as outlined by the EPUAP, is an important component in reducing patient risk.

    Download a free copy of a pocket-sized staging card and a wound measuring guide to help aid in your assessment of suspected PI.

Protection for high-risk locations like the sacrum and heels

To protect against friction and shear, the European Pressure Ulcer Advisory Panel (EPUAP) recommends using a polyurethane foam dressing to protect bony prominences like the sacrum and heels.9

  • To align with these standards, Tegaderm Silicone Foam Dressing, through its breathability, management of moisture, minimisation of local shear force, minimal disruption to skin upon removal, and cushioning, may help prevent skin damage.

    Explore Tegaderm Silicone Foam Dressings

    Get hands-on experience with Tegaderm Silicone Foam Dressings and discover how they can help to enhance your comprehensive pressure ulcer/injury prevention program.

  • Kerrapro Pressure Reducing Pads effectively redistribute pressure, dissipating it over the pad to protect the skin from pressure ulcers/injuries.11 Silicone is very hardwearing, allowing Kerrapro pad to reduce pressure effectively while being reused throughout treatment.

    Explore Kerrapro Pressure Reducing Pads (PDF, 230 KB)

    Request a demo to experience how Kerrapro Pressure Reducing Pads can help to enhance your comprehensive pressure ulcer/injury prevention program.

Pressure ulcer/injury prevention starts with skin protection

Skin integrity and management of skin conditions is critical in the prevention of pressure ulcers/injuries. The European Pressure Ulcer Advisory Panel (EPUAP) recommends a preventative skin care protocol, which includes cleansing and protecting the skin with a barrier product, to aid in prevention of pressure ulcers/injuries.

NOTE: Specific indications, contraindications, warnings, precautions, and safety information exist for these products and therapies, some of which may be Rx only. Please consult a clinician and product Instruction for Use prior to application.

  • Gently wash and condition each part of the body and give protection where necessary with a low friction medical wipe. Contain 3% dimethicone providing an effective barrier from moisture and body fluids.

  • This unique non-stinging barrier film is ideal for routine skin protection from moisture and friction. Consider use of this breathable, fast-drying barrier on heels, elbows and tops of ears.

  • Unique 3M technology protects skin from faeces, urine and other bodily fluids, a leading factor in pressure ulcer/injury development. Cavilon Advanced Skin Protectant also can be used to protect intact skin in areas exposed to friction and shear from bedding, clothing, shoes or any other material..12,13

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Putting 3M solutions into action

Discover why Tegaderm Silicone Foam Dressings and Kerrapro Pressure Reducing Pads are an excellent choice for your wound management and pressure ulcer/injury prevention programs.

  • This guide includes visual references on how to properly prepare and place dressings as well as how to temporarily lift dressings for skin or wound assessments.

  • Learn how to select the right Kerrapro pressure reducing pad for optimal pressure redistribution on at risk areas.

    *In-vitro data; the clinical significance is unknown

Clinical resources to transform outcomes in pressure ulcers/injuries prevention ​

Explore articles that highlight the importance of skin, preventing complications, and improving patient care.

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  1. Health Research & Educational Trust (2016, January). Hospital Acquired Pressure Ulcers (HAPU) Change Package: 2016 Update. Chicago, IL: Health Research & Educational Trust. Accessed at
  2. Declines in Hospital-Acquired Conditions. Content last reviewed May 2019. Agency for Healthcare Research and Quality, Rockville, MD.
  3. AHRQ National Scorecard on Hospital-Acquired Conditions Updated Baseline Rates and Preliminary Results 2014–2017. Published January 2019. Accessed July 1, 2019.
  4. Gefen A. How much time does it take to get a pressure ulcer? Integrated evidence from human, animal, and in vitro studies. Ostomy Wound Manag 2008:54(10): 26-35.
  5. Gould, L. J., Bohn, G., Bryant, R., Paine, T., Couch, K., Cowan, L., ... & Simman, R. (2019). Pressure Ulcer Summit 2018: An Interdisciplinary Approach to Improve Our Understanding of the Risk of Pressure‐Induced Tissue Damage. Wound Repair and Regeneration, DOI: 10.1111/wrr.12730.
  6. Cox J, Roche S, Murphy V. Pressure Injury Risk Factors in Critical Care Patients: A Descriptive Analysis. Adv Skin Wound Care. 2018 Jul;31(7):328-334.
  7. VanGilder CA, Cox J, Edsberg LE, Koloms K. Pressure Injury Prevalence in Acute Care Hospitals With Unit-Specific Analysis: Results From the International Pressure Ulcer Prevalence (IPUP) Survey Database. J Wound Ostomy Continence Nurs. 2021 Nov-Dec 01;48(6):492-503.
  8. Wassel CL, Delhougne G, Gayle JA, Dreyfus J, Larson B. Risk of readmissions, mortality, and hospital-acquired conditions across hospital-acquired pressure injury (HAPI) stages in a US National Hospital Discharge database. Int Wound J. 2020 Dec;17(6):1924-1934.
  9. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. Emily Haesler (Ed.). EPUAP/NPIAP/PPPIAP: 2019.
  10. Edsberg LE, Cox J, Koloms K, VanGilder-Freese CA. Implementation of Pressure Injury Prevention Strategies in Acute Care: Results From the 2018-2019 International Pressure Injury Prevalence Survey. J Wound Ostomy Continence Nurs. 2022 May-Jun 01;49(3):211-219.
  11. KCI. CHCR026-Pressure testing of KerraPro using electronic pressure transference apparatus. May 2014
  12. Brennan, Mary R.; Milne, Catherine T.; Agrell-Kann, Marie; Ekholm, Bruce P. Clinical Evaluation of a Skin Protectant for the Management of Incontinence Associated Dermatitis: An Open-Label, Nonrandomized, Prospective Study. J of Wound, Ostomy & Continence Nursing. 2017. 44(2):172-180.
  13. 3M Data on File. EM-05-013924, EM-05-305812