This document provides an overview of pressure injuries and other wounds. It summarizes the changes made in 2015 by NPUAP to the pressure injury staging system, replacing Roman numerals with Arabic numerals and changing the term "pressure ulcer" to "pressure injury". Stage 1 is now defined as intact skin with non-blanchable erythema. Stage 2 involves partial skin loss exposing dermis. Stage 3 shows full skin loss exposing subcutaneous fat. Stage 4 penetrates deeper to expose fascia, muscle or bone. An unstageable injury has obscured tissue loss. Deep tissue injuries present as discolored intact skin. Medical device and mucosal membrane injuries are also described. Non-pressure issues like venous, arterial and
3. NPUAP Formed Task Force January
2015
damaged soft tissue now labeled as
“pressure injury” replacing “pressure ulcer.”
because the term “injury” was more inclusive of
all 6 stages.
Change from Roman to Arabic numerals
Example: Stage ii is now Stage 2
Medical Device Related Pressure Injury
Mucosal Membrane Pressure Injury
What’s New?
4. localized damage to the
skin and underlying soft
tissue usually over a bony
prominence or related to a
medical or other device.
Can present as intact skin
or an open ulcer and may
be painful.
What is a Pressure Injury ?
5. a result of intense and/or prolonged pressure or
pressure in combination with shear.
What is a Pressure Injury ?
9. Stage 1 Definition :tage 1 Definition : OldOld vs.vs. NewNew
Old Stage I Pressure Ulcer :
Non-blanchable erythema
Intact skin with non-blanchable
redness of a localized area usually
over a bony prominence.
Darkly pigmented skin may not
have visible blanching; its color may
differ from the surrounding area.
The area may be painful, firm, soft,
warmer or cooler as compared to
adjacent tissue.
Stage 1 may be difficult to detect in
individuals with dark skin tones
New Stage 1 Pressure Injury:
Non-blanchable erythema of intact
skin
Intact skin with a localized area of
non-blanchable erythema, which
may appear differently in darkly
pigmented skin.
Presence of blanchable erythema
or changes in sensation,
temperature, or firmness may
precede visual changes.
Color changes do not include
purple or maroon
discoloration; these may indicate
deep tissue pressure injury.
10. Updated Stage 1 Definition :tage 1 Definition :
Intact skin with a localized area of non-
blanchable erythema, which may appear
differently in darkly pigmented skin.
Presence of blanchable erythema or changes
in sensation, temperature, or firmness may
precede visual changes.
Color changes do not include purple or maroon
discoloration; these may indicate deep tissue
pressure injury.
11.
12. Stage 1 pressure areas can
develop in as short as 30
minutes
Boggy
He
Cocc
yx
13.
14. Stage 2 Definition :Stage 2 Definition : OldOld vs.vs. NewNew
Old Stage II Pressure Ulcer
•Partial thickness loss of dermis
presenting as a shallow open ulcer
with a red pink wound bed, without
slough.
May also present as an intact or
open/ruptured serum-filled or sero-
sanguineous filled blister.
Presents as a shiny or dry shallow
ulcer without slough or bruising*.
This category should not be used to
describe skin tears, tape burns,
incontinence associated dermatitis,
maceration or excoriation.
*Bruising indicates deep tissue
injury
Stage 2 Pressure Injury:
Partial-thickness loss of skin with
exposed dermis. The wound bed is
viable, pink or red, moist, and may
also present as an intact or ruptured
serum-filled blister.
Adipose (fat) is not visible and
deeper tissues are not visible.
Granulation tissue, slough and
eschar are not present. These
injuries commonly result from
adverse microclimate and shear in
the skin over the pelvis and shear in
the heel.
This stage should not be used to
describe moisture associated skin
damage (MASD) or traumatic
wounds(skin tears, burns, abrasions).
15. Updated Stage 2 Definition :Updated Stage 2 Definition :
Stage 2 Pressure Injury:
Partial-thickness loss of skin with exposed dermis.
The wound bed is viable, pink or red, moist, and may
also present as an intact or ruptured serum-filled
blister.
Adipose (fat) is not visible and deeper tissues are not
visible. Granulation tissue, slough and eschar are not
present. These injuries commonly result from adverse
microclimate and shear in the skin over the pelvis and
shear in the heel.
This stage should not be used to describe moisture
associated skin damage (MASD) or traumatic
wounds(skin tears, burns, abrasions).
21. Stage 3 Definition :Stage 3 Definition : OldOld vs.vs. NewNew
Old Stage III Pressure Ulcer
Full thickness tissue loss.
Subcutaneous fat may be visible
but bone, tendon or muscle are not
exposed. Slough may be present but
does not obscure the depth of
tissue loss. May include
undermining and tunneling. The
depth of a Stage III pressure ulcer
varies by anatomical location. The
bridge of the nose, ear, occiput and
malleolus do not have (adipose)
subcutaneous tissue and Stage III
ulcers can be shallow. In contrast,
areas of significant adiposity can
develop extremely deep Stage III
pressure ulcers. Bone/tendon is not
visible or directly palpable.
Stage 3 Pressure Injury:
Full-thickness loss of skin, in which
adipose(fat) is visible in the ulcer and
granulation tissue and epibole(rolled
wound edges) are often present.
Slough and/or eschar may be visible.
The depth of tissue damage varies
by anatomical location; areas of
significant adiposity can develop
deep wounds. Undermining and
tunneling may occur. Fascia, muscle,
tendon, ligament, cartilage and/or
bone are not exposed. If slough or
eschar obscures the extent of tissue
loss this is an Unstageable pressure
Injury.
22. Updated Stage 3 Definition :Updated Stage 3 Definition :
Stage 3 Pressure Injury:
Full-thickness loss of skin, in which adipose(fat) is
visible in the ulcer and granulation tissue and
epibole(rolled wound edges) are often present. Slough
and/or eschar may be visible. The depth of tissue
damage varies by anatomical location; areas of
significant adiposity can develop deep wounds.
Undermining and tunneling may occur. Fascia,
muscle, tendon, ligament, cartilage and/or bone are
not exposed. If slough or eschar obscures the extent
of tissue loss this is an Unstageable pressure Injury.
26. Stage 4 Definition :Stage 4 Definition : OldOld vs.vs. NewNew
Old Stage Iv Pressure Ulcer
Full thickness tissue loss with
exposed bone, tendon or muscle.
Slough or eschar maybe present.
Often includes undermining and
tunneling. The depth of a Stage IV
pressure ulcer varies by anatomical
location. The bridge of the nose,
ear, occiput and malleolus do not
have (adipose) subcutaneous tissue
and these ulcers can be shallow.
Stage IV ulcers can extend into
muscle and/or supporting structures
(e.g., fascia, tendon or joint
capsule) making osteomyelitis or
osteitis likely to occur. Exposed
bone/muscle is visible or directly
palpable.
Stage 4 Pressure Injury:
Full-thickness skin and tissue loss
with exposed or directly palpable
fascia, muscle, tendon, ligament,
cartilage or bone in the ulcer. Slough
and/or eschar may be visible.
Epibole(rolled edges),undermining
and/or tunneling often occur. Depth
varies by anatomical location. If
slough or eschar obscures the extent
of tissue loss this is an
Unstageable Pressure Injury.
27. Updated Stage 4 DefinitionUpdated Stage 4 Definition
Stage 4 Pressure Injury:
Full-thickness skin and tissue loss with exposed or
directly palpable fascia, muscle, tendon, ligament,
cartilage or bone in the ulcer. Slough and/or eschar
may be visible. Epibole (rolled edges),undermining
and/or tunneling often occur. Depth varies by
anatomical location. If slough or eschar obscures the
extent of tissue loss this is an Unstageable Pressure
Injury.
32. If you can seeIf you can see
or feelor feel anyany
cartilagecartilage in thein the
wound,wound,
it isit is a Stage 4a Stage 4
pressure injury.pressure injury.
33.
34. Unstageable Definition :Unstageable Definition : OldOld vs.vs. NewNew
Old Unstageable Pressure
Ulcer: •Full thickness tissue loss in
which actual depth of the ulcer is
completely obscured by slough
(yellow, tan, gray, green or brown)
and/or eschar(tan, brown or black)
in the wound bed. Until enough
slough and/or eschar are removed
to expose the base of the wound,
the true depth cannot be
determined; but it will be either a
Stage III or IV. Stable (dry,
adherent, intact without erythema or
fluctuance) eschar on the heels
serves as “the body’s natural
(biological) cover” and should not
be removed.
Unstageable Full-Thickness
Pressure Injury:
Full-thickness skin and tissue loss in
which the extent of tissue damage
within the ulcer cannot be confirmed
because it is obscured by slough or
eschar. If slough or eschar is s
removed, a Stage 3 or Stage 4
pressure injury will be revealed.
Stable eschar( i.e. dry, adherent,
intact without erythema or fluctuance)
on an ischemic limb or the
heel(s)should not be softened or
removed.
35. Updated Unstageable Definition :Updated Unstageable Definition :
Unstageable Full-Thickness Pressure Injury:
Full-thickness skin and tissue loss in which the
extent of tissue damage within the ulcer cannot be
confirmed because it is obscured by slough or
eschar.
If slough or eschar is s removed, a Stage 3 or Stage
4 pressure injury will be revealed. Stable eschar( i.e.
dry, adherent, intact without erythema or fluctuance)
on an ischemic limb or the heel(s)should not be
softened or removed.
38. Deep Tissue Injury Definition :Deep Tissue Injury Definition :OldOld vs.vs. NewNew
Old DTI Ulcer: Purple or maroon
localized area of discolored intact
skin or blood-filled blister due to
damage of underlying soft tissue
from pressure and/or shear.
The area may be preceded by
tissue that is painful, firm, mushy,
boggy, warmer or cooler as
compared to adjacent tissue.
Evolution may include a thin blister
over a dark wound bed. The wound
may further evolve and become
covered by thin eschar. Evolution
may be rapid exposing additional
layers of tissue even with
optimal treatment
New Deep Tissue Pressure
Injury:
Intact or non-intact skin with localized
area of persistent non-blanchable
deep red, maroon, purple
discoloration or epidermal separation
revealing a dark wound bed or blood
filled blister. Pain and temperature
change
often precede skin color changes.
Discoloration may appear differently
in darkly pigmented skin. This injury
results from intense and/or prolonged
pressure and shear forces at the
bone-muscle interface. The wound
may evolve rapidly to reveal the
actual extent of tissue injury, or may
resolve without tissue loss.
41. Medical Device Related Definition:Medical Device Related Definition:OldOld vs.vs. NewNew
Old medical Devise
related pressure Ulcer:
Medical device
related pressure ulcers are
pressure ulcers that result
from the use of devices
designed and applied for
diagnostic or therapeutic
purposes. The resultant
pressure ulcer generally
closely conforms to the
pattern or shape of the
device.
New medical device related
pressure injury:
This describes an etiology.
Medical device related
pressure injuries result from
the use of devices designed
and applied for diagnostic or
therapeutic purposes. The
resultant pressure injury
generally conforms to the
pattern or shape of the device.
The injury should be staged
using the staging system.
42.
43. Mucosal Pressure Definition:Mucosal Pressure Definition:OldOld vs.vs. NewNew
Old Mucosal pressure
Ulcer:
Mucosal Pressure Ulcers are
pressure ulcers found on
mucous membranes with a
history of a medical device in
use at the location of the
ulcer.
New Mucousal Membrane
pressure injury:
Mucosal membrane pressure
injury is found on mucous
membranes with a history of a
medical device in use at the
location of the injury. Due to
the anatomy of the tissue these
injuries cannot be staged
47. New skin that is light
pink and shiny
In Stage 2 pressure ulcers,
epithelial tissue is seen in
the center and edges of the
ulcer.
In full thickness Stage 3 and
4 pressure ulcers, epithelial
tissue advances from the
edges of the wound.
Tissue Type:Tissue Type: EpithelialEpithelial
49. Non-viable yellow, tan, gray,
green or brown tissue;
usually moist, can be soft, stringy
and mucinous in texture.
Slough may be adherent to the
base of the wound or present in
clumps throughout the wound bed.
If slough is present in a pressure
injury-it is at a stage 3 or higher
Tissue Type:Tissue Type: SloughSlough
50.
51. Dead or devitalized tissue
that is hard or soft in
texture
usually black, brown, or tan in
color, and may appear scab
like.
usually firmly adherent to the
base of the wound and often
the sides/ edges of the wound.
Presence of eschar is a stage 4
or higher
Tissue Type-Tissue Type-EscharEschar
54. Due to venous insufficiency
Medial Aspect of the leg
Beefy Red
Jagged
Painless
may start with some kind of
minor trauma
Does not typically occur over
a bony prominence
VenousVenous Ulcer CharacteristicsUlcer Characteristics
56. Ischemia is the etiology but
pressure or trauma may be a
factor
frequently seen on the dorsum
(top) of the foot
Small, punctuated ulcers that are
usually well circumscribed
painful
Delayed capillary refill/pulse
Hairless extremities
skin is shiny, thin, dry, cold
ArterialArterial Ulcer CharacteristicsUlcer Characteristics
57. Usually occur on the bottom of the
foot.
May have discoloration in feet:
black, blue, or red
They precede over 80% of leg
amputations in the US
Diabetic Foot UlcersDiabetic Foot Ulcers
60. usually starts on the sacrum
May start as a Stage 2 and
rapidly become a Stage 3
or 4
may be shaped like a pear,
butterfly or horseshoe with
irregular borders
colors of red, yellow, black
or purple.
The life expectancy of the
sudden onset presentation
can be within 8-24 hours.
KennedyKennedy Ulcers-CharacteristicsUlcers-Characteristics
70. Contributing Factors::Contributing Factors::
Skin CareSkin Care
Manage moistureManage moisture
keep skin clean/ drykeep skin clean/ dry
pH balanced cleanserpH balanced cleanser
manage incontinencemanage incontinence
protect from urine/stool/perspirationprotect from urine/stool/perspiration
Minimize friction and shearMinimize friction and shear
Lift sheet/devicesLift sheet/devices
LIFT –do not drag/pull up in bedLIFT –do not drag/pull up in bed
71. Contributing Factors:Contributing Factors: PositioningPositioning
Frequent TurningFrequent Turning
avoid positioning on area of erythemaavoid positioning on area of erythema
Use foam wedges for 30 degree lateralUse foam wedges for 30 degree lateral
positioningpositioning
Maintain sheets without creasesMaintain sheets without creases
Avoid multiple layers of incontinence paddingAvoid multiple layers of incontinence padding
Protect/offload heelsProtect/offload heels
Pressure Reducing Support Surface for bedPressure Reducing Support Surface for bed
or chairor chair
72. Preventing Heel UlcersPreventing Heel Ulcers
National Pressure Ulcer Advisory Panel (NPUAP) directive:
“Ensure that the heels are free of the surface of the bed.
Heel-protection devices should elevate the heel completely (offload them)
in such a way as to distribute the weight of the leg along the calf."
“Total heel offloading is the only effective method for heel ulcer
prevention."
“Heel ulcers are the most common facility-acquired pressure ulcer in long-
term acute care facilities and second most common pressure ulcer overall."
73. Patients at low risk for heel pressure
ulcers/skin breakdown (These devices do
NOT provide pressure relief!)
74. Patients at moderate to highPatients at moderate to high
risk for heel pressurerisk for heel pressure
79. TreatmentTreatment
1. Optimize the host response by:
evaluating nutritional status/deficits;
stabilizing glycemic control
improving arterial blood flow
reducing immunosuppressant therapy if
possible.
2. Prevent contamination of the pressure ulcer.
3. Reduce bacterial load and biofilm
4. Use non-toxic topical antiseptics for a limited
time period
80. WarningsWarningsHydrogen peroxide is highly toxic to tissues even at low
concentrations14, 15 and should not be used as a preferred topical
antiseptic. Its use should be totally avoided in cavity wounds due to
the risk of surgical emphysema and gas embolus.
Iodine products should be avoided in patients with impaired renal
failure, history of thyroid disorders or known iodine sensitivity.
Sodium hypochlorite (Dakin’s solution) is cytotoxic at all
concentrations and should be used with caution, at concentrations no
greater than 0.025%, for short periods only when no other appropriate
option is available.
There is a risk of acidosis when acetic acid is used for extended
periods over large wound surface areas.
81. TreatmentTreatment 5. Consider the use of
medical-grade honey in
heavily contaminated or
infected pressure ulcers until
definitive debridement is
accomplished.
•Caution: Before applying a honey
dressing, ensure the individual is
not allergic to honey. Individuals
who have bee or bee stings allergies
are usually able to use properly
irradiated honey products.
82. TreatmentTreatment 6. Limit the use of topical
antibiotics on infected
pressure ulcers, except in
special situations where the
benefit to the patient
outweighs the risk of
antibiotic side effects and
resistance.
•In general, topical
antibiotics are not
recommended for treating
pressure ulcers.
83. TreatmentTreatment
7. Use systemic antibiotics for
individuals with clinical evidence of
systemic infection, such as positive
blood cultures, cellulitis, fasciitis,
osteomyelitis, systemic
inflammatory response syndrome
(SIRS), or sepsis.
84. Selecting Wound DressingsSelecting Wound Dressings
Select a wound dressing based on the:
1. ability to keep the wound bed moist
2. need to address bacterial bio burden
3. nature and volume of wound exudate
4. condition of the tissue in the ulcer bed
5. condition of periulcer skin
6. ulcer size, depth and location
7. presence of tunneling and/or undermining
8. goals of the individual with the ulcer
87. Deep Tissue InjuryDeep Tissue Injury
Intact or non-intact skin with localized area of
persistent non-blanchable deep red, maroon,
purple discoloration or epidermal separation
revealing a dark wound bed or blood filled blister.
88.
89. Stage 2 Pressure Injury
Partial-thickness loss of skin with exposed
dermis. The wound bed is viable, pink or red,
moist, and may also present as an intact or
ruptured serum-filled blister.
Adipose (fat) is not visible
and deeper tissues
are not visible.
Granulation tissue,
slough and eschar
are not present.
90.
91. Unstageble Full Thickness PressureUnstageble Full Thickness Pressure
InjuryInjury
Full-thickness skin and tissue loss in which the
extent of tissue damage within the ulcer cannot
be confirmed because it is obscured by slough
or eschar. If slough or
eschar is removed, a
Stage 3 or Stage 4
pressure injury
will be revealed.
92.
93. Stage 3 Pressure InjuryStage 3 Pressure Injury
Full-thickness loss of skin, in which adipose(fat)
is visible in the ulcer and granulation tissue and
epibole (rolled wound edges) are often present.
Slough and/or eschar may be visible.
94.
95. Deep Tissue Pressure InjuryDeep Tissue Pressure Injury
Intact or non-intact skin with localized area of
persistent non-blanchable deep red, maroon,
purple discoloration or epidermal separation
revealing a dark wound bed or blood filled
blister.
96.
97. Stage 4 Pressure InjuryStage 4 Pressure Injury
Full-thickness skin and tissue loss with exposed
or directly palpable fascia, muscle, tendon,
ligament, cartilage or bone in the ulcer. Slough
and/or eschar may be visible..
98.
99. Stage 1 Pressure InjuryStage 1 Pressure Injury
Non-blanchable erythema of intact skin
Intact skin with a localized area of non-
blanchable erythema, which may appear
differently in darkly pigmented skin.
101. ResourcesResources
National Pressure Ulcer Advisory Panel
www.nupap.org
•2014 Prevention and Treatment of Pressure Ulcers:
Clinical Practice Guideline (Quick Reference Guide
available as FREE download)
Association for the Advancement of Wound
Care
•http://aawconline.org/
•http://bradenscale.com/
Wound, Ostomy, Continence Nurses
Societywww.wocn.org
Editor's Notes
The National Pressure Ulcer Advisory Panel redefined the definition of a pressure injuries during the NPUAP 2016 Staging Consensus Conference that was held April 8-9, 2016 in Rosemont (Chicago), IL.
The updated staging definitions were presented at a meeting of over 400 professionals. Using a consensus format, Dr. Mikel Gray from the University of Virginia adeptly guided the Staging Task Force and meeting participants to consensus on the updated definitions through an interactive discussion and voting process. During the meeting, the participants also validated the new terminology using photographs.
The updated staging system includes the following definitions:
NPUAP Formed Task Force January 2015
damaged soft tissue now labeled as “pressure injury” replacing “pressure ulcer.”
The term “injury” was more inclusive of all 6 stages, as
Stage 1 is present as intact skin, as is Deep Tissue Pressure Injury, which has always used "injury" in the nomenclature
Medical Device Related Pressure Injury:
•This describes an etiology. Medical device related pressure injuries result from the use of devices designed and applied for diagnostic or therapeutic purposes. The resultant pressure injury generally conforms to the pattern or shape of the device. The injury should be staged using the staging system.
Mucosal Membrane Pressure Injury:
•Mucosal membrane pressure injury is found on mucous membranes with a history of a medical device in use at the location of the injury. Due to the anatomy of the tissue these injuries cannot be staged.
The National Pressure Ulcer Advisory Panel redefined the definition of a pressure injuries during the NPUAP 2016 Staging Consensus Conference that was held April 8-9, 2016 in Rosemont (Chicago), IL.
The updated staging definitions were presented at a meeting of over 400 professionals. Using a consensus format, Dr. Mikel Gray from the University of Virginia adeptly guided the Staging Task Force and meeting participants to consensus on the updated definitions through an interactive discussion and voting process. During the meeting, the participants also validated the new terminology using photographs.
The updated staging system includes the following definitions:
Pressure Injury:A pressure injury is localized damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful.
The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, co-morbidities and condition of the soft tissue.
Considered pre injury
Here we go..
Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone in the ulcer.
If necrotic tissue, subcutaneous tissue, granulation tissue, fascia, muscle or other underlying structures are visible, this indicates a full thickness pressure injury (Unstageable, Stage 3 or Stage 4). Do not use DTPI to describe vascular, traumatic, neuropathic, or dermatologic conditions.
On tongue from ng tube
Inflammation- (2-3 days)
consists of a vascular and cellular response
Proliferation –( 2-3 weeks)
Begins at the time of injury
Rebuilding & revascularization begins
Maturation /remodeling Stage- (2-3 yrs)
Depositing of scar tissue
The body attempts to contract/close the wound
http://www.shieldhealthcare.com/community/wp-content/uploads/2015/07/Stages-of-Healing_image.jpg
Pink and shiny in dark skin as well
The wound may start with some kind of minor trauma, such as hitting the leg on a wheelchair.
The wound does not typically occur over a bony prominence, and pressure forces play virtually no role in the development of the ulcer
Ischemia is the major etiology of these ulcers, but pressure may be a factor
The wound may also start with some kind of minor trauma, such as hitting the leg on a wheelchair
Doppler, waveform, Ankle Brachial Indices (ABI) and Transcutaneous Oxygen Pressure measurements (TCPO2) to aid in your diagnosis. Duplex scanning and arteriograms may also be performed if indicated.
Diabetes can damage the nerves of the legs and feet so that they may not feel a blister or sore when it begins to appear. If undetected, the sore may become larger and infected
Diabetic foot ulcers are sores that occur on the feet of people with Type 1 or Type 2 Diabetes
Up to 25% of people with diabetes develop foot problems.
Diabetic foot ulcers usually occur on the bottom of the foot.
They precede over 80% of leg amputations in the US.
May have discoloration in feet: black, blue, or red
It usually starts out as a blister or a Stage II and can rapidly progresses to a Stage III or a Stage IV.
In the beginning it can look much like an abrasion as if someone took the patient and drug his or her bottom along a black top driveway.
It can become deeper and starts to turn colors.
The colors can start out as a red/purple area then turn to yellow and then black.
The life expectancy of the sudden onset presentation can be within 8-24 hours.
The two statements you hear most are:
1. “Oh, my gosh, that was not there the other day.”2. “I worked Friday, it was not there then, I was off the weekend and when I came back on Monday there it was.
Urine
Stool - especially liquid stool
Perspiration
Primarily consisting of water, perspiration also contains urea, glucose, sodium, and chloride.
Chronic perspiration most often results in MASD when in a skin fold, where evaporation is minimized.
Effluent from an ostomy
Wound Exudate
Consider applying a polyurethane foam dressing to bony prominences (e.g., heels, sacrum) for the prevention of pressure ulcers in anatomical areas frequently subjected to friction and shear.
Prophylactic dressings differ in their qualities; therefore it is important to select a dressing that is appropriate to the individual and the clinical use.
http://www.molnlycke.sg/PageFiles/69800/pressure-distribution.png
Microclimate Control
The use of specialized surfaces that come into contact with the skin may be able to alter the microclimate by changing the rate of evaporation of moisture and the rate at which heat dissipates from the skin.
http://www.arjohuntleigh.co.uk/PageFiles/1366/SKINIQ.jpg
Electrical Stimulation of the Muscles
•There is emerging evidence that electrical stimulation (ES) induces intermittent tetanic muscle contractions and reduces the risk of pressure ulcer development in at risk body parts
Many systemic factors contribute to the development of pressure ulcers. If these same factors can be improved, the individual’s intrinsic ability to fight infection can usually also be improved3. Reduce bacterial load and biofilm in the pressure ulcer as outlined in the Wound Care: Cleansing and Wound Care: Debridement sections
Consider the use of tissue appropriate strength, non-toxic topical antiseptics for a limited time period to control bacterial bio burden
Judicious use of systemic antibiotics remains an important consideration