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Clinical evidence

The evidence for pressure injury care

Pressure injury care is guided by a single, internationally recognized clinical practice guideline. Here is what it recommends, and how our bedside care follows it.

The clinical challenge

A pressure injury, also called a pressure ulcer or bedsore, is localized damage to skin and underlying tissue, usually over a bony area, caused by sustained pressure or pressure combined with shear. They are common in people with limited mobility, and once they develop they can be slow to heal and prone to infection. Getting the fundamentals right, early and consistently, is what changes the trajectory.

What the guideline says

The most authoritative source is the Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline, developed jointly by the European Pressure Ulcer Advisory Panel, the National Pressure Injury Advisory Panel, and the Pan Pacific Pressure Injury Alliance and last updated in 2019.1 It is built on a formal, GRADE-style review of the evidence and is used worldwide. Its core recommendations include:

  • Accurate staging and assessment. Classify the injury and reassess it regularly, because the stage drives the plan.1
  • Pressure redistribution. Reposition the patient and use an appropriate support surface to take pressure off the wound and at-risk areas.1
  • Wound bed management. Debride non-viable tissue when appropriate, manage moisture and bacterial burden, and match the dressing to the wound.1
  • Nutrition. Screen for and address undernutrition, which impairs healing.1

Separately, one of the largest wound datasets ever analyzed, a retrospective cohort of more than 312,000 wounds published in JAMA Dermatology, found that more frequent debridement was associated with faster healing across wound types.2 Because it was retrospective, it shows an association rather than proof of cause, but it is consistent with the guideline's emphasis on keeping the wound bed clean.

Strength of evidence: strong (guideline) The international guideline is rigorously developed. Individual recommendations within it range from strong to conditional depending on the underlying studies, and it represents the accepted standard of care for pressure injuries.

How our care follows the evidence

Our pressure injury service is built around these same fundamentals, delivered at the bedside:

  • We stage and measure the wound and track it visit over visit, so the plan reflects where the wound actually is.
  • We debride non-viable tissue when clinically appropriate, and select dressings matched to drainage, depth, and infection risk.
  • We coach caregivers and staff on pressure redistribution and repositioning, and we watch for early signs of infection.
  • We coordinate nutrition support with the patient's primary care provider, and send notes and progress photos back to the care team.

Care is provided by our Advanced Practice Providers, nurse practitioners and physician assistants, with physician oversight. Medicare Part B may cover medically necessary pressure injury care when eligibility criteria are met.

Our pressure injury service Evidence: debridement All evidence

References

  1. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. 2019. internationalguideline.com/2019
  2. Wilcox JR, Carter MJ, Covington S. Frequency of Debridements and Time to Heal: A Retrospective Cohort Study of 312,744 Wounds. JAMA Dermatology. 2013;149(9):1050-1058. pubmed.ncbi.nlm.nih.gov/23884238

This page summarizes published clinical evidence for educational purposes. It is not medical advice or a guarantee of any outcome, and individual results vary. Coverage under Medicare depends on medical necessity and documentation.