Pressure ulcers most commonly develop in individuals who are not moving about, such as those who are on chronic bedrest or consistently use a wheelchair.

[1] In addition to turning and re-positioning the person in the bed or wheelchair, eating a balanced diet with adequate protein[2] and keeping the skin free from exposure to urine and stool is important.

[7] Padula and colleagues have witnessed a +29% uptick in pressure injury rates in recent years associated with the rollout of penalizing Medicare policies.

Some complications include autonomic dysreflexia, bladder distension, bone infection, pyarthrosis, sepsis, amyloidosis, anemia, urethral fistula, gangrene and very rarely malignant transformation (Marjolin's ulcer – secondary carcinomas in chronic wounds).

Sores may recur if those with pressure ulcers do not follow recommended treatment or may instead develop seromas, hematomas, infections, or wound dehiscence.

[10][11] Other factors are age of 70 years and older, current smoking history, dry skin, low body mass index, urinary and fecal incontinence, physical restraints, malignancy, vasopressin prescription, and history of prior pressure injury development.

Within 2 hours, this shortage of blood supply, called ischemia, may lead to tissue damage and cell death.

This is the deep tissue injury form of pressure ulcers and begins as purple intact skin.

Signs of pressure ulcer infection include slow or delayed healing and pale granulation tissue.

Signs and symptoms of systemic infection include fever, pain, redness, swelling, warmth of the area, and purulent discharge.

Hydrogen peroxide (a near-universal toxin) is not recommended for this task as it increases inflammation and impedes healing.

Systemic antibiotics are not recommended in treating local infection in a pressure ulcer, as it can lead to bacterial resistance.

[21] Briefly, they are as follows:[22][23] The term medical device related pressure ulcer refers to a cause rather than a classification.

[37] Suggested approaches include modifications to bedding and mattresses, different support systems for taking pressure off of affected areas, airing of surfaces of the body, skin care, nutrition, and organizational modifications (for example, changing the care routines in hospitals or homes where people require extended bedrest).

[37][39][40][41][42] Numerous evidence-based and expert consensus-based clinical guidelines have been to developed to help guide medical professionals internationally[21] and in specific countries including the UK.

[46] In 2022, United States Congress passed legislation updating the Military Construction and Veterans Affairs and Related Agencies Appropriations Act, 2015 (H.R.

4355) to establish the SPIPP Checklist as law that United States Department of Veterans Affairs (VA) facilities should adhere to in order to keep patients safe from harm.

After the risk assessment tool is used, a plan will be developed for the patient individually to prevent Hospital- Acquired Pressure Injuries.

[47] Efforts in the United States and South Korea have sought to automate risk assessment and classification by training machine learning models on electronic health records.

[51] In the 1940s Ludwig Guttmann introduced a program of turning paraplegics every two hours thus allowing bedsores to heal.

[citation needed] Various interventions have been developed to redistribute pressure including the use of different bed mattresses, support surfaces, and the use of static chairs.

The evidence supporting these interventions and whether they prevent new ulcers, increase the comfort level, or have other positive or more negative adverse effects is weak.

Some support surfaces, including antidecubitus mattresses and cushions, contain multiple air chambers that are alternately pumped.

[citation needed] Recommendations to treat pressure ulcers include the use of bed rest, pressure redistributing support surfaces, nutritional support, repositioning, wound care (e.g. debridement, wound dressings) and biophysical agents (e.g. electrical stimulation).

Necrotic tissue is an ideal area for bacterial growth, which has the ability to greatly compromise wound healing.

Some guidelines for dressing are:[83] Other treatments include anabolic steroids,[84] medical grade honey,[85] negative pressure wound therapy,[86] phototherapy,[87] pressure relieving devices,[88] reconstructive surgery,[89] support surfaces,[90] ultrasound[91] and topical phenytoin.

[94] When selecting treatments, consideration should be given to patients' quality of life as well as the interventions' ease of use, reliability, and cost.

There are differences across countries, but using this methodology, pressure ulcer prevalence in Europe was consistently high, from 8.3% (Italy) to 22.9% (Sweden).

[99] Some research shows differences in pressure-ulcer detection among white and black residents in nursing homes.