Understanding Bed Sores: Causes, Stages & Prevention

Pressure injuries (bed sores) are localized damage to skin/underlying tissue over bony prominences from sustained pressure, shear, or friction.

NPUAP/EPUAP Staging

• Stage 1: Non-blanchable erythema of intact skin.
• Stage 2: Partial-thickness skin loss (epidermis/dermis); shallow open ulcer or intact/ruptured blister.
• Stage 3: Full-thickness skin loss; adipose visible; no muscle/bone exposure.
• Stage 4: Full-thickness skin/tissue loss; muscle, bone, tendon exposed.
• Unstageable: Obscured by slough/eschar.
• Deep Tissue Pressure Injury: Persistent non-blanchable deep red/maroon/purple discoloration — intact or blood-filled blister.

Risk Factors

Immobility, moisture (incontinence), malnutrition, impaired perfusion, neuropathy, age, comorbidities.

Prevention (Standard of Care)

• Repositioning q2h (bed), q1h (chair); 30° lateral tilt.
• Pressure-redistributing surfaces (foam, air, gel).
• Skin care: Clean, dry, moisturize; barrier creams for incontinence.
• Nutrition: Protein 1.25–1.5 g/kg, calories, vitamins C/Zinc.
• Daily skin inspection.

Key Takeaway

Pressure injuries are preventable with systematic risk assessment, repositioning, support surfaces, skin care, and nutrition. Staging guides treatment urgency.