Preventing and Treating Pressure Ulcers: A Clinically Grounded Guide for Caregivers

CarePatrol of Baltimore | Protecting Seniors Through Better Care

By Paula Sotir

Pressure ulcers—also known as pressure injuries or bedsores—affect more than 2.5 million Americans each year (Agency for Healthcare Research and Quality [AHRQ], n.d.). These wounds can develop quickly, especially in older adults with limited mobility, and may lead to serious complications such as infection, hospitalization, and decreased quality of life (National Institutes of Health [NIH], n.d.).

Pressure injuries can develop quickly and are largely preventable. Early action protects residents and maintains COMAR compliance.

The good news: Most pressure ulcers are preventable with consistent, evidence‑based care.

 Why Pressure Ulcers Matter

Pressure ulcers occur when prolonged pressure reduces blood flow to the skin and underlying tissue. The National Pressure Injury Advisory Panel (NPIAP) notes that injuries can develop in as little as two hours when pressure is not relieved (NPIAP, n.d.). Pressure ulcers are a source of pain and potential infection. Prevention and management are important for healthy outcomes.

Understanding early detection and prevention methods are essential for caregivers.

SECTION 1: Evidence‑Based Pressure Ulcer Prevention

1. Repositioning: The Most Important Strategy

Turn every 2 hours (bed). Reposition every 1 hour (chair). Float heels at ALL times.

This aligns with national clinical guidance:

• Repositioning every 2 hours reduces pressure injury incidence in bed‑bound patients (NIH, n.d.).
• Wheelchair users should shift weight every 15–30 minutes (NPIAP, n.d.).

Caregiver actions:

• Use pillows or wedges to offload bony areas.
• Keep heels elevated (“floating”).
• Avoid positioning directly on reddened skin.

2. Daily Skin Checks

Johns Hopkins Medicine recommends daily skin inspection for at‑risk individuals (Johns Hopkins Medicine, n.d.). New redness or wound… worsening condition… signs of infection should be reported.

Look for:

• Non‑blanchable redness
• Warm, cool, firm, or boggy areas
• Blisters or skin breakdown
• Purple or dark areas (especially in darker skin tones)

3. Moisture & Incontinence Management

Moisture weakens skin and increases friction. Moisture‑associated skin damage significantly increases pressure injury risk (Lachenbruch et al., 2016).

Best practices:

• Cleanse gently with pH‑balanced cleansers.
• Pat dry—never rub.
• Apply moisture‑barrier creams.
• Use breathable incontinence products.

4. Nutrition & Hydration

Adequate nutrition is essential for skin integrity and wound healing. The Mayo Clinic and Cleveland Clinic emphasize protein, hydration, and micronutrients (Mayo Clinic, n.d.; Cleveland Clinic, n.d.).

Evidence shows:

• Protein intake of 1.25–1.5 g/kg/day supports wound healing (Cereda et al., 2015).
• Vitamins A, C, E, and zinc aid tissue repair.

Encourage:

• Lean proteins
• Hydration
• Fruits and vegetables rich in antioxidants

5. Support Surfaces

AHRQ recommends pressure‑redistributing surfaces for high‑risk individuals (AHRQ, n.d.).

Examples:

• Alternating‑pressure mattresses
• Medical‑grade foam overlays
• Gel or foam wheelchair cushions

These reduce pressure but do not replace repositioning.

6. Avoid Friction & Shear

Shear occurs when deeper tissues slide while the skin stays in place. NIH guidance recommends keeping the head of the bed at ≤30 degrees unless medically necessary (NIH, n.d.).

Prevent shear by:

• Using draw sheets
• Avoiding dragging during transfers
• Maintaining proper bed positioning

SECTION 2: Treating Pressure Ulcers When They Form

Documentation must reflect changes in condition, interventions implemented, and the resident’s response to treatment.

1. Stage the Wound Correctly

NPIAP’s staging system is the national standard (NPIAP, n.d.):

• Stage 1: Non‑blanchable redness
• Stage 2: Partial‑thickness skin loss
• Stage 3: Full‑thickness skin loss
• Stage 4: Exposed bone, muscle, or tendon

Accurate staging guides treatment and regulatory compliance.

2. Cleanse the Wound Properly

NIH wound‑care guidelines recommend:

• Cleansing with normal saline
• Avoiding cytotoxic agents unless directed by a clinician (NIH, n.d.)

3. Use Appropriate Dressings

Modern dressings maintain moisture balance and protect the wound.

Evidence‑based options include:

• Hydrocolloid (minimal drainage)
• Foam (moderate drainage)
• Alginate or hydrofiber (heavy drainage)
• Antimicrobial dressings (infection risk)

4. Offload the Area Completely

Do NOT lay on red areas.

Healing cannot occur if pressure continues.

5. Monitor & Document Progress

A COMAR‑aligned process includes:

Measurements (L x W x D)… drainage… tissue type… periwound skin… pain… improving/stable/worsening.

Residents and facilities are protected when documentation is consistent. Progress notes should clearly indicate whether the wound is improving, declining, or stable. Clinicians should compare current findings to prior assessments.

Indicators of improvement include reduction in size, increased granulation tissue, decreased drainage, and intact surrounding skin.

Indicators of decline include increased size, necrotic tissue, worsening drainage, or signs of infection.

6. Know When to Refer

Refer early and often to prevent progression and maintain compliance.

Refer to wound‑care specialists if:

• The wound worsens
• Drainage increases
• Odor develops
• Signs of infection appear
• Healing stalls

Early referral improves outcomes (Thomas, 2006).

SECTION 3: Practical Tips for Caregivers

✔ Keep linens dry and wrinkle‑free ✔ Avoid tight clothing or thick seams ✔ Use a turning schedule ✔ Communicate changes immediately ✔ Document every wound assessment ✔ Engage in ongoing caregiver training.

SECTION 4: How CarePatrol of Baltimore Helps

CarePatrol of Baltimore helps families identify senior living communities that:

• Follow evidence‑based pressure‑injury prevention protocols
• Maintain strong COMAR‑aligned documentation
• Provide consistent repositioning and offloading
• Train staff to recognize early signs of skin breakdown
• Collaborate with specialized wound‑care providers

Our mission is to ensure your loved one receives safe, proactive care—because aging well means healing well.

Save our Caregiver Checklist: Preventing Wounds In Older Adults 

 Reference List

Government & National Agencies Agency for Healthcare Research and Quality. (n.d.). Preventing pressure ulcers in hospitals. https://www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/index.html (ahrq.gov in Bing)

Centers for Disease Control and Prevention. (n.d.). Skin care and pressure injury prevention. https://www.cdc.gov

National Institutes of Health. (n.d.). Pressure ulcers. https://medlineplus.gov/pressureulcers.html (medlineplus.gov in Bing)

National Pressure Injury Advisory Panel. (n.d.). Pressure injury staging. https://npiap.com/page/PressureInjuryStages (npiap.com in Bing)

Major Research Hospitals

Cleveland Clinic. (n.d.). Pressure ulcers. https://my.clevelandclinic.org/health/diseases/15106-pressure-ulcers (my.clevelandclinic.org in Bing)

Johns Hopkins Medicine. (n.d.). Pressure sores. https://www.hopkinsmedicine.org/health/conditions-and-diseases/pressure-sores (hopkinsmedicine.org in Bing)

Mayo Clinic. (n.d.). Bedsores (pressure ulcers). https://www.mayoclinic.org/diseases-conditions/bed-sores/symptoms-causes/syc-20355893 (mayoclinic.org in Bing)

Peer‑Reviewed Journals

Cereda, E., et al. (2015). Efficacy of nutritional interventions for pressure ulcer healing. Annals of Internal Medicine. https://pubmed.ncbi.nlm.nih.gov/25984843/ (pubmed.ncbi.nlm.nih.gov in Bing)

Lachenbruch, C., et al. (2016). Moisture and pressure ulcers: A systematic review. Journal of Wound, Ostomy & Continence Nursing. https://pubmed.ncbi.nlm.nih.gov/26808392/ (pubmed.ncbi.nlm.nih.gov in Bing)

Thomas, D. (2006). Prevention and treatment of pressure ulcers: What works? Journal of the American Medical Directors Association. https://pubmed.ncbi.nlm.nih.gov/16413476/ (pubmed.ncbi.nlm.nih.gov in Bing)