Prevention

The best approach to managing pressure injuries is to prevent them from occurring. Trans et al. (2016), completed a literature review with the purpose of summarizing the innovations and technologies used for pressure injury prevention. In reviewing 353 articles, the authors confirmed that the most common sites for development of pressure injuries are the sacrum, heels and buttocks, but more typically the ischial tuberosities in sitting. They also confirmed that prevention needs to start with risk identification followed by a multidisciplinary approach for support surface assessment and provision, nutritional assessment, and establishment of a repositioning routine delivered through an education-based prevention program tailored to personal needs. As noted in the Incidence and Prevalence section (1.2), a primary cause of pressure injuries is externally applied pressure over bony prominences for a period of time. There are various factors that influence how the body tissue tolerates and responds to this externally applied pressure. These factors have been classified as intrinsic, such as metabolism, age, tissue tolerance, and as extrinsic such as the surfaces a person sits upon. Given the significant differences in the strategies/approaches to the prevention of intrinsic and extrinsic factors, the data presented in this section has been organized into Prevention through Intrinsic Factors including use of electrical stimulation for prevention and fat grafting for prevention and, Prevention Affecting Extrinsic Factors including considerations for affecting extrinsic factors, education and prevention programs, and equipment/products for prevention. A discussion on Pressure Mapping and Wheelchair Cushions appears in the Wheeled Mobility and Seating Equipment evidence module.