Pressure injuries (bedsores): prevention and care
A pressure injury is damage to the skin or the tissue beneath it caused by sustained pressure or friction, usually over a bony area. Many can be prevented, and early action makes a real difference to healing and to avoiding complications.
This information is general education and does not replace an individual medical assessment. Do not change your treatment or dressings without speaking to your care team.
What is a pressure injury?
A pressure injury develops when part of the body stays under pressure for too long, reducing blood flow to the skin and deeper tissue until it is damaged. Sliding down the bed and friction make the damage worse.
They are also called bedsores or pressure ulcers. Clinicians now use the term “pressure injury” because damage can start before an open wound appears.
The most common sites are:
- The lower back and sacrum
- The heels
- The hips
- The back of the head, shoulders and elbows
- Skin under medical devices such as oxygen tubing, splints and catheters
Who is most at risk?
- People who are bed-bound or use a wheelchair for long periods.
- Older adults, especially with limited mobility or fragile skin.
- People with reduced sensation, for example after a stroke or spinal cord injury.
- People with urinary or faecal incontinence, because moisture weakens the skin.
- Poor nutrition, low fluid intake or significant weight loss.
- Patients in intensive care and anyone with a medical device pressing on the skin.
- Anyone who has had a pressure injury before.
Pressure injury stages at a glance
Pressure injuries are classified by the depth of visible damage. The stage helps the care team choose the right care. It does not mean an injury “heals backwards” through the stages.
| Stage | What you see |
|---|---|
| Stage 1 | Redness on intact skin that does not fade when pressed with a finger. It can be harder to see on darker skin. |
| Stage 2 | Shallow loss of skin: a pink, shallow wound or an intact or open blister. |
| Stage 3 | Full-thickness skin loss with fat visible, but no bone or tendon. |
| Stage 4 | Full-thickness skin and tissue loss with muscle, tendon or bone visible. |
| Unstageable | The wound bed is covered by yellow slough or black eschar, hiding its depth. |
| Deep tissue injury | Persistent dark red, purple or maroon discolouration, or a blood blister, signalling damage under the skin. |
A deep tissue injury can turn into a deep wound quickly even with good care. Don’t try to remove black eschar yourself, especially on the heel.
How to check the skin every day
- Check pressure areas at least once a day.
- If you see redness, press it gently with a finger and lift. If it doesn’t go paler and then return, it may be the start of a pressure injury.
- On darker skin, redness can be hard to see. Look for differences in warmth, texture or colour compared with nearby skin.
- Check the skin under and around medical devices.
- If you notice a change: take pressure off the area, don’t massage it, and tell the care team.
How are pressure injuries prevented?
Prevention is far easier than treatment. It follows a plan set by the care team for the individual patient, and usually includes:
- Regular repositioning on a schedule suited to the patient, avoiding lying on any reddened area.
- A pressure-redistributing surface, such as a suitable mattress or seat cushion, as recommended by the care team.
- Floating the heels by placing a pillow under the calves so the heels do not touch the bed.
- Skin care: keeping skin clean and dry, using a gentle cleanser and barrier products when there is incontinence.
- No rubbing or massaging reddened skin over bony areas.
- Lifting, not dragging, when moving someone in bed, using a sheet or a second helper.
- Enough nutrition and fluids, with a doctor or dietitian review if weight is falling.
- Checking the skin every day, including under medical devices.
Caring for an existing pressure injury
- A full assessment: staging, measuring and regular documentation.
- Taking pressure completely off the affected area wherever possible.
- Cleaning the wound and choosing a dressing that suits the tissue type and the amount of exudate.
- Removing dead tissue when needed, done only by a trained professional.
- Monitoring for infection and assessing pain and nutrition.
- Involving the physician or surgeon for deep (Stage 3 and 4) or unstageable injuries.
Negative pressure wound therapy may be used for some deep pressure injuries, if the treating team decides it is appropriate.
When does a pressure injury need urgent review?
Contact the treating doctor the same day, or go to the emergency department, if you notice:
- The wound getting bigger quickly, or black tissue appearing.
- A bad smell, pus, or a clear increase in fluid from the wound.
- Redness, warmth or swelling spreading around the wound.
- Fever, chills, confusion or a general decline in the person’s condition.
- Bone or tendon visible in the wound.
Educational videos
Watch the educational videosShort wound-care explainers on InstagramA multidisciplinary team
A complex wound is never treated by one specialty alone. Care is coordinated with a multidisciplinary team according to each case, because healing depends on treating the cause: circulation, infection, pressure, nutrition and the need for surgery.
- Orthopaedic surgery
- Vascular surgery
- General surgery
- Plastic and reconstructive surgery
- Podiatry
- Infectious diseases
- Clinical nutrition
- Other healthcare professionals as each case requires
Get in touch
For patients and families: discuss any change to your care plan with your treating doctor or care team.
For enquiries, training and collaboration with healthcare teams and facilities across Jordan.
Related pages
References
- EPUAP, NPIAP, PPPIA. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. 4th edition, 2026.
- Edsberg LE, Black JM, Goldberg M, et al. Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System. Journal of Wound, Ostomy and Continence Nursing. 2016;43(6):585–597.
- International Wound Infection Institute (IWII). Wound Infection in Clinical Practice: Principles of Best Practice. International Consensus Update 2022. Wounds International.
- Atkin L, Bućko Z, Conde Montero E, et al. Implementing TIMERS: the race against hard-to-heal wounds. Journal of Wound Care. 2019;28(Sup3a):S1–S50.
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