Pressure Injury Prevention and Treatment: Updated 2024 Guidelines
Pressure injuries, formerly called bedsores or decubitus ulcers, affect millions and can develop in as little as 2 hours. Modern care emphasizes prevention and uses staged treatment approaches based on tissue damage depth.
2024 Staging Classification
- Stage 1: Non-blanchable redness, intact skin
- Stage 2: Partial thickness, blistering or shallow crater
- Stage 3: Full thickness, subcutaneous fat visible
- Stage 4: Muscle, bone, or tendon exposed
- Unstageable: Base obscured by slough or eschar
- Deep Tissue Injury: Purple/maroon area, intact or blood-filled blister
High-Risk Areas
- Sacrum and coccyx (tailbone area)
- Heels and ankles
- Hips and greater trochanters
- Shoulder blades
- Back of head (occipital)
- Elbows
Prevention Strategies (Best Practice 2024)
- Repositioning: Every 2 hours, 30-degree side-lying
- Support Surfaces: Pressure-redistributing mattresses
- Skin Care: Moisture management, barrier creams
- Nutrition: Protein 1.25-1.5g/kg body weight
- Mobility: Progressive mobilization programs
- Risk Assessment: Braden Scale scoring daily
Stage-Specific Treatment Approaches
- Stage 1: Offloading, barrier films, foam dressings
- Stage 2: Hydrocolloid or foam, maintain moisture
- Stage 3: Debridement, alginate or hydrofiber fillers
- Stage 4: Surgical consultation, NPWT, flap coverage
- Unstageable: Debride to determine depth, then stage-appropriate care
Advanced Pressure Injury Therapies
- Electrical stimulation for Stage 3-4 wounds
- Ultrasound therapy for chronic injuries
- Negative pressure wound therapy
- Platelet-rich plasma injections
- Collagen-based dressings
- Biological skin substitutes
Nutrition Protocol for Healing
- Calories: 30-35 kcal/kg/day
- Protein: 1.25-1.5 g/kg/day minimum
- Vitamin C: 500mg twice daily
- Zinc: 40mg daily if deficient
- Arginine supplementation for Stage 3-4
- Hydration: 30ml/kg/day minimum
Documentation Requirements
- Weekly measurements and photos
- Undermining and tunneling assessment
- Periwound skin condition
- Signs of infection
- Pain levels
Expert Tip:
- Use a mirror to check heels and sacrum daily if bedridden—catching redness early (Stage 1) can prevent progression with simple position changes.
Next Step
Implement a turning schedule immediately and request pressure-mapping assessment for appropriate support surface selection.
