In Australia and New Zealand pressure injuries are quite common with 12.9% of patients in acute-care hospitals having them. They are a significant concern in healthcare settings for elderly, immobile and patients who have undergone surgery, that these injuries may occur. The great thing is, 95% of pressure injuries are preventable even in home care settings. Through a mixture of proactive measures like repeatedly repositioning, good skin care, nutrition and hydration, and using specialised mattresses and pillows that support the body, pressure tears can be reduced or prevented altogether.
What Is a Pressure Injury?
Pressure injuries, also known as pressure sores or bed sores, is damage to the skin and underlying tissue caused by prolonged pressure or friction. They most commonly occur in bony areas of the body like heels, elbows, tailbone, shoulders and the back of the head. Pressure injuries often aren’t visible as they occur in bony areas of the body like the spine, heels and hips.
There are 4 main stages to pressure injuries: Stage 1 non-blanchable redness of intact skin, Stage 2 partial-thickness skin loss, Stage 3 full-thickness skin loss to subcutaneous tissue and Stage 4 full-thickness tissue loss with damage to muscle, bone or other support structures.
Stage 1 (Non-Blanchable Redness)
At this stage, skin may be warm or cool to the touch with a red, blue or purplish area that doesn’t turn white when pressure is applied.
Stage 2 (Partial-Thickness Skin Loss)
At this stage the wound is red and moist and can either be intact or appear as a ruptured serum-filled blister.
Stage 3 (Full-Thickness Skin Loss to Subcutaneous Tissue)
If your care recipient has a stage 3 pressure injury the wound will look like a deep crater. Subcutaneous (deepest layer of the skin) tissue may be visible.
Stage 4 (Full-Thickness Tissue Loss with Damage to Muscle, Bone or Other Support Structures)
This is the worst stage of pressure injuries with exposed muscle or bone present. If your care recipient progresses to this stage surgery is often required.
As a carer, you need to recognise the warning signs and understand how you can prevent these injuries reducing the risk of infection and ensuring your care recipient is comfortable and healthy. These skin issues can
Who Is Most at Risk?
Those most at risk of developing pressure injuries are older adults, those with limited mobility, people who may be underweight or overweight and those with incontinence.
Older adults are susceptible to developing pressure injuries as their skin is generally thinner and more fragile. This coupled with limited mobility and an increased likelihood of incontinence, makes this group of people the most likely to present these injuries.
If your care recipient has limited mobility they may be at risk of developing pressure injuries. People unable to move or reposition themselves frequently due to injury, illness or surgery are at high risk.
Poor nutrition can also be a factor that increases the likelihood of developing pressure injuries as someone who is malnourished will likely have thinner skin and someone overweight can place added pressure on capillaries.
Moisture from urinary or bowel incontinence can harm the skin, increasing its vulnerability to injury. As a carer, it’s important to ensure the skin barrier of your client is cleansed, moisturised and protected with the appropriate products. Abena’s skincare products contain pH neutral skin barriers that cleanse, moisturise and protect affected skin.
Use this risk-factor checklist to assess your care recipient:
1. Mobility and Activity
☐ Limited ability to move or reposition independently
☐ Bed- or chair-bound most of the day
☐ Weakness, paralysis or stiffness limiting movement
2. Skin and Sensory Changes
☐ Reduced sensation (e.g., can’t feel pain or pressure)
☐ Redness, swelling, or existing pressure marks
☐ Skin that is thin, dry or fragile
3. Moisture Exposure
☐ Incontinence (urine or bowel)
☐ Excessive sweating
☐ Wound drainage or other sources of moisture
4. Nutrition and Hydration
☐ Poor appetite or unintentional weight loss
☐ Dehydration (dry mouth, dark urine)
☐ Low protein or nutrient intake
5. Circulation and Health Conditions
☐ Diabetes, vascular disease, or poor circulation
☐ Low blood pressure or anaemia
☐ Swelling (oedema) in legs or feet
6. Age and General Health
☐ Older age (thin, less elastic skin)
☐ Acute illness, infection or fever
☐ Taking medications affecting skin or healing (e.g., steroids)
Assessing Risk: Braden Scale & Daily Skin Checks
Carers can use a mini Braden Scale and conduct daily skin checks by carefully inspecting the skin for any changes in color, texture, or moisture, while also assessing the person’s mobility, nutrition and potential friction areas. During daily checks, pay close attention to bony prominences and skin folds, use adequate lighting, and look for signs such as dryness, redness (testing if it blanches), swelling, or skin breakdown. The full Braden Scale assessment involves scoring six key areas — Sensory Perception, Moisture, Activity, Mobility, Nutrition, and Friction & Shear — to determine the individual’s overall risk level for developing pressure injuries.
The Braden Scale evaluates six key areas related to pressure injury risk. While a full assessment is usually completed by a nurse, carers can be trained to assist by gathering relevant information for each category:
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Sensory Perception: How well the person can feel and respond to pain or discomfort.
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Moisture: How frequently the skin is exposed to moisture (such as from incontinence or sweating).
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Activity: How much physical movement or walking the person is able to do.
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Mobility: How easily the person can change or control their body position.
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Nutrition: The person’s typical intake of food and fluids.
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Friction and Shear: The amount of rubbing or sliding the skin experiences during movement or repositioning.
For full accurate testing a caregiver should use the full Braden Scale tool. It’s important to document your findings whenever you perform a skin check and gather that information and report it to healthcare professionals.
The Five Core Prevention Strategies
1. Regular Repositioning & Micro‑Shifts
Ensure your care recipient is moving frequently and changing positions at least every 2 hours. For those who are unable to move without help, create a schedule for repositioning that can be followed to relieve pressure on bony areas. Make sure you are using proper techniques to reposition your care recipient. This includes optimal offloading of pressure points, such as using pillows to act as a soft buffer when moving your client.
2. Support Surfaces
These are specialist equipment that are made to relieve pressure like mattresses, overlays, cushions, distributing weight evenly. For bony areas like the heels of your care recipient, use cushions to keep them from pressing against the bed. As a caregiver, evaluating these support surfaces regularly to decide if they are working correctly and are suitable for your client’s needs.
3. Skin Care & Moisture Management
Caring for the skin is vital in ensuring it stays healthy. Having healthy skin that is clean, moisturised and without friction reduces the risk of pressure tears. If your care recipient is incontinent, make sure their skin is dry and clean by gently cleansing with mild soap and warm water or moist skin cleansing wipes that are gentle on the skin.
Abena’s Moist Skin Cleanse Wipes are perfect for personal care as they are gentle on the skin and don’t require a water wash.
Moisturising is also an important factor in reducing the risk of pressure injuries. Make sure your care recipients skin isn’t excessively dry by using moisturisers that strengthen and protect the skin barrier. Abena’s Skincare Lotion is specifically formulated for normal to dry skin and delivers 14% plant lipids plus vitamins A, E & F to help heal and protect the skin.
To avoid friction, make sure you are using products that don’t need to be rubbed in, particularly for those bony areas. Abena’s 10% Zinc Oxide Spray protects and regenerates the skin without having to rub in the skin. Not only is this product soothing with ingredients like Calendula and Chamomile, it promotes natural skin restoration.
4. Nutrition & Hydration for Skin Health
Staying hydrated and eating a balanced diet is another way to reduce the risk of pressure injuries. Being a healthy weight (not under or over weight) reduces pressure on those bony parts of the body and helps maintain healthy skin. If your care recipient is in need of nutritional supplements to maintain hydration and nutrition consult a GP or medical practitioner.
5. Education, Documentation & Early Escalation
Empowering everyone involved in care — from nurses and personal carers to family members — is central to preventing pressure injuries. Education ensures that all caregivers understand how to identify early warning signs, reposition effectively, and use protective products correctly. Documentation provides an accurate record of skin assessments, product use, and any changes, helping teams spot patterns and respond promptly. Most importantly, early escalation—reporting concerns to a nurse or GP as soon as redness, warmth, or skin breakdown appears—can stop minor issues from becoming complex wounds. A culture of awareness, communication, and timely action turns prevention from a task into a shared responsibility.
Choosing Pressure‑Relieving Products
Preventing pressure injuries starts with using the right protective supports. The best choice depends on the person’s mobility, skin condition, and level of risk. Common options include:
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Silicone Foam Dressings – Conform gently to the skin, reduce shear and friction, and cushion vulnerable areas such as heels and sacrum. Many are breathable and can be worn for several days.
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Off-Loading Pads – Designed to redistribute pressure away from bony prominences. Ideal for people who spend long periods in one position or use mobility aids.
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Airflow Cushions – Use air cells or channels to promote ventilation and even pressure distribution when sitting. They help keep skin cool and dry, lowering the risk of breakdown.
When to Call a Nurse or GP
Recognising early warning signs and knowing when to seek help is vital for preventing minor skin damage from progressing into a serious pressure injury. Even with the best prevention strategies, skin can sometimes break down — and timely assessment makes all the difference.
You should contact a nurse or general practitioner (GP) if you notice any of the following:
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Non-blanching redness — If an area of redness does not fade to white when gently pressed and remains discoloured after 30 minutes of pressure relief, this may be the first sign of a developing pressure injury (Stage 1).
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Changes in skin temperature or texture — Skin that feels unusually warm, firm, or boggy (soft and spongy) may indicate underlying tissue damage.
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Suspected infection — Look for swelling, increasing pain, pus or drainage, a foul odour, or spreading redness around the wound. Fever or confusion can also be signs of systemic infection, particularly in older adults.
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Blisters or open wounds — These represent Stage 2 pressure injuries or higher, where the skin is already broken. Professional assessment and a tailored dressing or off-loading plan are needed immediately.
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Persistent deterioration — If an existing sore does not improve within a few days of regular care and repositioning, or if the area expands or deepens, professional review is essential.
A nurse or GP can evaluate the injury, recommend suitable dressings, advise on pressure-relieving supports, and refer to a wound care specialist if necessary. Early intervention often prevents further tissue loss and promotes faster healing.
Before You Call
When reaching out to a nurse or GP, having a few key details ready can help them assess the situation more effectively. Note when the redness or wound was first noticed, any changes in colour, size, or drainage, and what pressure-relieving measures or dressings have been used so far. If possible, take clear photos of the area in good lighting — this can help clinicians track changes over time. Also mention any pain, fever, or reduced mobility, as these can signal infection or worsening tissue damage. The more information you can share, the quicker the healthcare professional can recommend the right treatment plan.
Final Thoughts
Proactive skin care is the most effective defence against pressure injuries. Check the skin daily, keep it clean and moisturised, and reposition regularly to relieve pressure. Combine these practices with the right support products and prompt medical advice for the best outcomes in comfort, dignity, and healing.
Explore AMHC’s support products here…
Sources
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Australian Commission on Safety and Quality in Health Care. (2020). Preventing Pressure Injuries and Wound Management – Fact Sheet. Retrieved from https://www.safetyandquality.gov.au
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Haesler, E., & Carville, K. (2020). Pressure injuries in Australian health care: incidence, prevalence and prevention. Australian Nursing and Midwifery Journal, via ScienceDirect. Retrieved from https://www.sciencedirect.com)
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Victorian Department of Health. (n.d.). Pressure injuries and skin tears – Older people in hospital. Retrieved from https://www.health.vic.gov.au
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Victorian Department of Health. (n.d.). Identifying and preventing skin tears – Older people in hospital. Retrieved from https://www.health.vic.gov.au
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Cobalt Health. (2023). Pressure Injury Prevention Strategies: Importance and Best Practices. Retrieved from https://cobalthealth.com.au
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Queensland Health. (n.d.). Pressure Injury Prevention. Retrieved from https://www.qld.gov.au
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Clinical Excellence Commission (NSW Health). (2023). Pressure Injury Prevention Strategies: Information for Clinicians. Retrieved from https://www.cec.health.nsw.gov.au