dermatologic disorders
Pressure Injuries
Introduction
Pressure injuries are areas of necrosis and often ulceration (also called pressure ulcers) where soft tissues are compressed between bony prominences and external hard surfaces. They are caused by unrelieved mechanical pressure in combination with friction, shearing forces, and moisture. Risk factors include age > 65, impaired circulation and tissue perfusion, immobilization, undernutrition, decreased sensation, and incontinence. Severity ranges from nonblanchable skin erythema to full-thickness skin loss with extensive soft-tissue necrosis. Diagnosis is clinical. Treatment includes pressure reduction, avoidance of friction and shearing forces, and diligent wound care. Advanced treatments, including negative-pressure wound therapy, cellular and tissue-based products, and surgical intervention, are sometimes needed. Prognosis is excellent for early-stage injuries; neglected and late-stage injuries pose risk of serious infection and are difficult to heal. Between 1993 and 2006, the number of hospitalized patients with pressure ulcers increased by > 75%, a rate over 5 times the increase of hospital admissions overall, and older adults in particular were affected. The rate increased most in patients who developed pressure ulcers during hospitalization. Pressure injuries affect up to 3 million adults in the United States annually, with a prevalence among hospitalized patients of 5% to 15%, with the percentage considerably higher in some long-term care environments and intensive care units ( Reference ). "Pressure injury" is terminology recommended by the National Pressure Injury Advisory Panel (NPIAP) instead of "pressure ulcer" to describe these chronic wounds because lesser degrees of skin damage due to pressure may not be associated with skin ulceration. 