Two healthcare worker are hurriedly transferring a patient on a stretcher in a  well-lit hospital hallway during the day, illustrating urgency and teamwork in medical care.

Caregiver & Patient Guide

Preventing Pressure Sores

Essential information for caregivers and patients on how to prevent pressure ulcers (bedsores) through proper positioning, skin care, and early detection.

Regular Repositioning
Daily Inspection
Prevention First

What Are Pressure Sores?

Pressure sores (also called pressure ulcers, bedsores, or pressure injuries) are areas of damaged skin and tissue caused by prolonged pressure that cuts off blood flow. Without adequate blood flow, skin and underlying tissue begin to die, creating wounds that can range from mild to life-threatening.

The Critical Truth

Pressure sores can develop in as little as 2-3 hours of immobility. Once formed, they can take months to heal and may require surgery. However, most pressure sores are completely preventable with proper care.

2.5 Million

People develop pressure sores annually in the U.S.

95%

Of pressure sores are preventable

Common Locations for Pressure Sores

Lying in Bed:

  • • Back of head
  • • Shoulder blades
  • • Tailbone/sacrum (most common)
  • • Hips and sides
  • • Heels and ankles
  • • Spine
  • • Back of knees

Sitting in Wheelchair:

  • • Buttocks and tailbone
  • • Spine
  • • Backs of arms and legs
  • • Back of thighs
  • • Shoulder blades

Who Is at Risk?

Understanding risk factors helps you take preventive action. Multiple risk factors increase danger significantly.

Limited Mobility

Bedridden, wheelchair-bound, unable to change position independently, sedated, or paralyzed patients are at highest risk.

Age

Older adults have thinner, more fragile skin, reduced circulation, and slower healing. Risk increases significantly after age 70.

Poor Nutrition

Malnutrition, low protein intake, dehydration, and being underweight weaken skin integrity and impair healing.

Moisture Issues

Incontinence (bowel or bladder), excessive sweating, or wound drainage softens skin and makes it vulnerable to breakdown.

Reduced Sensation

Nerve damage from diabetes, spinal cord injury, or sedation means patients can't feel discomfort that prompts repositioning.

Poor Circulation

Diabetes, peripheral artery disease, heart disease, or smoking reduce blood flow, making tissue more susceptible to pressure damage.

Mental Status

Dementia, confusion, sedation, or unconsciousness prevents self-repositioning and communication of discomfort.

Body Weight

Both very thin (bony prominences create pressure points) and obese (more pressure, harder to reposition) patients are at higher risk.

Certain Medications

Steroids thin the skin and impair healing. Sedatives reduce movement. Pain medications may mask discomfort signals.

High-Risk Alert

If your loved one has 3 or more of these risk factors, pressure sore prevention should be a top priority. Extra vigilance and aggressive preventive measures are essential.

Repositioning: The #1 Prevention Strategy

The 2-Hour Rule

Reposition bedbound patients AT LEAST every 2 hours, 24 hours a day. High-risk patients may need repositioning every 1-2 hours or even more frequently. This is NON-NEGOTIABLE for prevention.

For wheelchair users, encourage repositioning or weight shifts every 15-30 minutes. Use pressure-relief techniques like leaning forward, lifting off the seat, or shifting weight side to side.

Proper Repositioning Techniques

1

On Back (Supine) Position

  • Head elevated 30 degrees or less (higher angles increase pressure on tailbone)
  • Place pillow under calves to elevate heels OFF the bed surface
  • Use pillow or foam wedge under knees for comfort (not too bent)
  • Keep head and neck aligned—avoid turning head to one side for long periods
2

On Side (Lateral) Position

  • Turn to 30-degree angle, NOT flat on side (reduces hip pressure)
  • Place pillow along back for support
  • Put pillow between knees and ankles to prevent bone-on-bone contact
  • Support top arm with pillow to prevent rolling forward
  • Alternate between right and left sides
3

Semi-Sitting (Fowler's) Position

  • For eating or respiratory issues—limit time in this position
  • Keep angle between 30-45 degrees when possible
  • Use pillows to prevent sliding down (increases shearing force)
  • Ensure heels are elevated off bed surface

DO:

  • • Use draw sheets or slide sheets to reposition (reduces friction)
  • • Lift, don't drag the patient
  • • Keep skin clean and dry before repositioning
  • • Use multiple people for heavy patients
  • • Document position changes and times

DON'T:

  • • Drag or pull patient across sheets (causes shearing)
  • • Leave patient on bedpan for extended periods
  • • Position directly on reddened areas
  • • Use donut-shaped cushions (cut off circulation)
  • • Skip repositioning because patient "looks comfortable"

Additional Prevention Strategies

Daily Skin Inspection & Care

Inspect Daily:

  • Check all pressure points every day
  • Look for redness that doesn't fade with pressure
  • Feel for warm or cool spots
  • Use a mirror to check hard-to-see areas

Keep Skin Healthy:

  • Keep skin clean and dry
  • Moisturize dry skin (not over pressure points)
  • Pat dry gently—don't rub
  • Manage incontinence promptly

Pressure-Relieving Support Surfaces

Specialized mattresses and cushions redistribute pressure and reduce risk:

For Beds:

  • • Foam overlays (4+ inches thick)
  • • Air mattresses (alternating pressure)
  • • Low-air-loss mattresses
  • • Gel or water mattresses

For Wheelchairs:

  • • Foam cushions (high-density)
  • • Gel cushions
  • • Air-filled cushions
  • • Custom-molded cushions

Note: Even with special surfaces, regular repositioning is still required!

Optimize Nutrition & Hydration

Good nutrition strengthens skin and supports healing:

  • Protein: Essential for skin integrity (75-100g/day)
  • Vitamin C: Supports collagen formation
  • Zinc: Wound healing and immunity
  • Hydration: 8-10 glasses water daily
Read our Nutrition Guide

Encourage Movement & Activity

Even small amounts of movement help:

  • Get patient out of bed when possible (with medical approval)
  • Encourage active range of motion exercises
  • Assist with passive exercises if patient can't move independently
  • Promote circulation with gentle leg exercises

Early Warning Signs: The Stages of Pressure Sores

Catching pressure sores in Stage 1 can prevent serious complications. Check skin daily and act immediately if you see warning signs.

1

Stage 1: Non-Blanch able Redness

What it looks like: Red or discolored area that doesn't turn white when you press on it. Skin is intact (not broken). May feel warm, firm, soft, or painful compared to surrounding skin.

ACTION: Immediately relieve ALL pressure from this area. Do not position on this spot. If caught here, it may heal in days.

2

Stage 2: Partial-Thickness Skin Loss

What it looks like: Open shallow wound, blister (intact or ruptured), or abrasion. Pink/red wound bed, no yellow tissue. Looks like a scrape or blister.

ACTION: Call healthcare provider immediately. Needs professional wound care. Keep area clean and protected.

3

Stage 3: Full-Thickness Skin Loss

What it looks like: Deep crater-like wound. Fat visible, but not muscle/bone. May have yellow dead tissue (slough). Edges may be undermined or tunneled.

ACTION: URGENT medical care needed. This is a serious wound requiring specialized treatment.

4

Stage 4: Full-Thickness Tissue Loss

What it looks like: Extremely deep wound exposing muscle, tendon, or bone. May have black dead tissue (eschar). Often has undermining and tunneling. Life-threatening infection risk.

ACTION: EMERGENCY medical attention. May require surgery. Poses serious health risks including sepsis and death.

See ANY Warning Signs? Call Immediately

Even Stage 1 pressure sores need immediate intervention. Don't wait—call your healthcare provider or wound care specialist right away.

Call 877-545-1300 Now

Daily Prevention Checklist

Every 2 Hours:

Daily Tasks:

We're Here to Help Prevent Pressure Sores

Our wound care specialists can assess risk, provide education, and help you implement effective prevention strategies at home.

Mobile Service

We come to you

Expert Assessment

Risk evaluation & education

Prevention Plans

Customized for your situation