A physiotherapist assisting an elderly patient to prevent her from having hospital-acquired pressure injuries

What Are Hospital-Acquired Pressure Injuries?

Finding out that you or a loved one has developed hospital-acquired pressure injuries during a hospital stay can add extra stress to an already taxing ordeal. But what are hospital-acquired pressure injuries exactly, and what can you do about them?

When researching pressure injuries, you may feel overwhelmed by the amount of medical information. 

And trust us, you're not alone. 

While there's a ton of information out there on the internet, it's not always the easiest to understand. That's why we're creating this blog post - to break down what hospital-acquired pressure injuries are, why they happen, how they progress, and what you can do to treat them. 

Whether you are trying to learn the best ways to prevent pressure injuries, or are researching for someone you love who has already been diagnosed - read on to learn the best way to handle this stressful medical condition. 

What are hospital-acquired pressure injuries?

If you’ve heard of the term “bed sores,” or even the term “pressure ulcers,” then you are already familiar with what hospital-acquired pressure injuries are. 

First, let’s talk about the elephant in the room – the term “hospital-acquired.”  You would be correct in assuming that it means an individual ends up with a bodily injury or physical condition that they did not have at the start of their hospital stay. 

In the case of hospital-acquired pressure injuries, they are bed sores that have been acquired during a hospital stay.

Of course, we all assume that when one is cared for at a hospital facility, they should not end up with additional conditions during their care. However, the reality is that many patients do end up with hospital-acquired complications. 

In fact, each year, more than 2.5 million patients in U.S acute care facilities suffer from hospital-acquired pressure ulcers - and 60,000 of them die from their complications. 

This is why healthcare facilities have strict procedures and care plans to try to prevent and combat the occurrence of bed sores. 

Unfortunately, pressure injuries are not cheap to treat, costing an average of $10,708 per patient. This adds up to a total cost of $26.8 billion in spending annually in the United States alone.

Are you or a loved one on bed rest, in a wheelchair, or spending extended time in the hospital? If so, then it is crucial to know what causes hospital-acquired pressure ulcers. It is also important to be able to recognize the various stages so you can catch them early on.

If found early, there's a good chance these sores will heal quickly and with little discomfort. However, without treatment, they can get much, much worse. 

What causes hospital-acquired pressure injuries?

Hospital-acquired pressure injuries typically occur when prolonged pressure is exerted on a patient’s body while in the hospital. This can happen due to improper patient positioning during a procedure, or pressure from medical equipment such as beds or ventilators.

Hospital-acquired pressure injuries can also form when a person is lying in one position for too long. They usually occur on bony areas such as the heels, elbows, and tailbone where there is less tissue and fat to cushion against the pressure of gravity weighing the body down in bed. 

Pressure injuries can be caused by any prolonged force being applied to the skin. In the case of hospital-acquired pressure injuries, these forces can include:

  • Friction: When skin rubs against clothing or bedding, it can cause friction. This can make fragile skin more susceptible to injury, especially if the skin is moist. Sweat, urine, or fecal matter on the skin can increase the risk of developing a pressure injury.
  • Shear stress: This happens when you're in a bed that is on an incline. As your body is pulled down by gravity, your body can slowly slide down, and as the skin can stick to sheets, it causes internal structures to be damaged.
  • Pressure: Whether it’s gravity, a lumpy bed, or a piece of medical machinery, any prolonged pressure to one area of the body can cut off blood flow and cause tissues to break down. 

Now you have some idea of what hospital-acquired bed sores are, and what causes them, but it’s also important to understand how they progress. 

The four stages of pressure injuries

While pressure injuries can vary from person to person, here are the four general stages they all go through. 

Stage 1 pressure injury: sores are not open wounds

At stage 1, a hospital-acquired pressure injury is the least severe. Only the top layer of skin is affected, and you might experience burning, itching, or pain. 

A pressure ulcer might start as a small spot and develop into a large one. You might notice a firmer or softer, warmer or cooler spot on the skin that causes some pain and discomfort. 

A stage 1 pressure injury can also have a red area, which is harder to see on darker skin tones. If you press the red area and it doesn't lighten, it is a sign that less blood is getting to the area and a pressure ulcer is forming. 

The most important thing you can do when first spotting hospital-acquired pressure ulcers is relieve the pressure. Ensuring that your skin is constantly getting fresh air gives your body space to heal and can prevent the ulcer from becoming an open wound.

A stage 1 pressure ulcer typically improves within 2-3 days with proper treatment.

Stage 2 pressure injury: partial-thickness skin loss

A hospital-acquired pressure injury reaches stage 2 when it starts to go below the surface of the 

skin. This can manifest as broken skin, an open wound, or a blister filled with pus.

The area around a stage 2 pressure injury will be swollen, warm, and/or red. The wound may ooze clear fluid or pus and can be very painful.

It's essential to cleanse the wound with either water or a salt-water mixture, and then lightly dry it. Note that this process may be painful, so consult with your doctor ahead of time.

Keep the area covered with a clear dressing or moist gauze. Be on the lookout for signs of infection such as a fever, pus, or redness.  

With proper care, a stage 2 pressure sore should improve within three days to 3 weeks.

Stage 3 pressure injury: full-thickness skin loss

A stage 3 pressure injury is when the wound starts to extend deeper, penetrating through the second layer of skin into the fat tissue. If the tissue surrounding the sore is black, it is a sign that the tissue has died.

The healing process for a stage 3 pressure wound differs from that of a stage 2 pressure injury because it will take longer to heal. In most cases, the wound will not close and will remain open without proper care. 

Stage 3 pressure injuries may need to be debrided, cleaned, and sutured in order to heal. It may also be necessary to drain the wound. This is done by surgically opening the wound and inserting a small tube into it to drain the fluid.

Stage 3 hospital-acquired pressure injuries will take at least one month to heal but could take up to 4 months, especially if there is an underlying condition like slowed diabetes wound healing

Stage 4 pressure injury: full loss of skin and tissue 

By stage 4, a pressure injury has penetrated the entire skin and tissue and reached the bone. 

At this stage, pressure injuries are severe and very difficult to heal. If left for an extended period, they can lead to permanent nerve damage and even require amputation. 

Stage 4 pressure ulcers are very deep and extensive. The skin around the sore is black and appears infected with symptoms like redness around the edges, pus, foul odor, and/or drainage. You might even see tendons, muscles, or bones under the skin.

If you have a stage 4 pressure sore, you must see a doctor immediately as these wounds need immediate attention and might require surgery. 

If a hospital-acquired pressure injury has reached this stage under the watch of medical professionals, it’s important to advocate for yourself or your loved one and ask for better care. 

Once hospital-acquired pressure ulcers have reached this stage, pressure ulcer treatment can last anywhere from 3 months to many years to heal.

But how DO these injuries heal? Let’s discuss how pressure injuries are treated, and what can be done to prevent them in the first place. 

How are hospital-acquired pressure injuries treated?

Hospital-acquired pressure injuries can vary significantly in how they are treated depending on their location, severity, and the specific needs of the patient. 

The first step for treating any pressure injury is keeping the area clean. This is typically done with a saline solution. Once the area is clean, it is crucial to keep it clean and moist by covering it with an appropriate bandage. 

In general, wounds heal faster when covered. The type of bandage your doctor uses, however, will depend on the specific wound

Other than keeping the area clean, the best way to help hospital-acquired pressure ulcers heal is to change positions regularly. You can also use special mattresses and dressings to help reduce pressure and promote healing. 

In more severe cases, surgery may be needed – raising the cost of hospital-acquired pressure ulcers.

Knowing that the cost to treat pressure injuries can reach as much as $70,000, many health insurance companies like Medicare and Medicaid won’t cover them. This is one reason why learning how to prevent bed sores should be a priority for any patient admitted to a hospital.

How to prevent pressure injuries

As is the case for most ills, prevention is the best policy. So what do you need to do to prevent hospital-acquired bed sores from happening in the first place?

Doctors and nurses play an essential role in helping you prevent a pressure ulcer from happening. 

A nurse’s role in pressure ulcer prevention includes repositioning mobility-challenged patients at regular intervals to reduce mechanical load, adhering to individualized bathing schedules, and identifying skin breakdown early on.

As a patient, there are a few things you can also do to prevent pressure ulcers:

  • Keep your skin clean and dry to prevent irritants or excessive moisture from increasing frictional forces, leading to skin breakdown.

  • If you’re wondering how nutrition affects pressure ulcers, eating a healthy diet can help keep your skin tissue healthy.

  • Move around often to avoid putting too much pressure on one area for too long (or make sure a nurse or loved one is moving you if you are unable to move yourself).

  • Take measures to control any medical conditions that may contribute to developing pressure ulcers, such as diabetes or poor circulation.

  • Take a daily collagen supplement to help boost your body’s wound healing potential and prevent tissue breakdown. 

The best collagen products for hospital-acquired pressure injuries

With proper care and supplements, hospital-acquired pressure injuries can be treated, preventing them from reaching the later stages. Medical-grade collagen supplements, like the ones from ProT Gold, are trusted by thousands of medical facilities across the nation for use in medical nutrition. 

Enlisting the support of high-quality collagen protein daily may make all the difference when treating a hospital-acquired pressure injury. 

Medical-grade collagen supplements can not only help to prevent pressure injuries by improving the health of your skin, they can also speed wound healing if you have a current pressure injury. 

Hospital-acquired pressure injuries are dangerous complications, but they can be prevented with a little care and planning. If you notice any of the signs or symptoms of pressure injuries listed above, you should seek medical help immediately.

As long as you’re aware of the risks, and are arming yourself with proper nutrition and collagen, you have a good chance of preventing or overcoming pressure ulcers.