close -up of clinician applying sacral silicone foam bandage to patient

Pressure Injuries Prevention Programs

Prevention starts with understanding where, how and why pressure injuries occur.


Data shows: pressure injuries as a growing healthcare concern¹

  • In fact, a 2019 report revealed pressure injury is the only hospital-acquired condition that increased in incidence rates (+6%) from 2014-2017, while other hospital-acquired conditions saw a decrease.² Pressure injury prevention strategies have been shown to shorten patients’ hospital stays and reduce their readmission rates¹. It’s our goal to pursue patient-centered science that can support your commitment to proactive care and potentially improve lives.

    When prevention isn’t possible: Explore pressure injury management options

Every pressure injury prevented is money saved

Annually, more than 2.5 million people in the U.S. alone develop pressure injuries.³ Taking extra care to prevent pressure injuries shouldn’t overburden staff or inflate care costs. In fact, putting the right plan in place should ultimately help reduce costs for your facility. Discover more economic impacts of prevention (PDF, 2.6 MB)

  • icon of a speed indicator
    Pressure injuries can develop in as little as 6 hours⁴

    When skin is exposed to friction and gravity, pressure injuries can develop in as little as six hours.

  • warning icon
    Pressure-injury-related complications result in 60K deaths annually⁵

    It’s estimated that 60,000 patients die each year as a direct result of pressure injury-related complications.

  • icon of an patient at an ICU
    Up to 41% of ICU patients may develop a pressure injury⁶

    From 2013-2019 Hospital Acquired Pressure Injuries (HAPIs) have shown an upward trend, 2.5% to 3.2% in all inpatient care units and an upward trend of 5.6% to 6.4% in critical care units.⁷,

Understanding what causes pressure injuries

Pressure injuries develop through mechanical forces – pressure, friction, and shear. These, along with moisture, set the stage for pressure injury development.

  • icon of an arrow from the top and from the bottom pointing towards each other

    A pressure injury may affect only the epidermis, or there may be an injury to the underlying tissue (like dermis, adipose, or muscle). ​Pressure injuries typically develop over boney prominences or may be related to medical devices such as tubes and braces. Tissue damage occurs due to intense or prolonged exposure, or a combination of these two, to sustained tissue deformation and pressure.

  • icon of an arrow from left to right and an arrow above that from right to left
    Friction and shear⁹

    Pressure alone can cause pressure injuries but they are more likely in combination with shear or friction. Shear is when two unaligned forces move one part of the body in one direction and the other in opposition at the interface of the skin and the bony surface prominence, causing damage to tissue deep within the skin. Friction occurs when two surfaces rub against one another, affecting the skin's surface.

  • icon of a water drop

    Skin microclimate -the temperature, humidity, and airflow next to the skin's surface- and moisture play an important role in skin health and integrity. Therefore, an excess of moisture which may include sweat, urine, feces, or excessive exudate, makes the stratum corium more suspectable to damage. And when combined with the friction from linen and bed sheets, this potential damage is exacerbated.

Watch this series of five-minute education videos to learn more.

  • overview of different extrinsic and intrinsic risks for pressure injuries
    Chapter 1: Definition

    Part 1 of the 5 part video series on pressure injury focuses on defining pressure injuries and outlining their risks and impact.

    Video 4:49 min

  • [MUSIC PLAYING] In module 2, we will review how pressure injuries develop. The rationale on pressure injury development has evolved. While ischemia, or inadequate blood supply, plays a role, we now know the primary driver for pressure injury is soft tissue deformation. Direct damage from sustained deformation can result in cell damage in a matter of minutes. How do pressure injuries develop? They're caused by a combination of mechanical forces, pressure, friction, and shear. Let's explore this in more detail, starting with pressure. As mentioned earlier, when soft tissues are subjected to prolonged pressure over a bony prominence and another surface like a bed or medical device, that's pressure. Friction occurs when two surfaces rub against one another. Have you ever experienced rug burn from sliding across carpet? That's friction. Shear happens when unaligned forces push part of the body in one direction and another part of the body in the opposite direction. Imagine going down a playground slide on a hot summer day and your skin sticks to the slide halfway down, stopping your motion. Your skeleton is still being propelled downward, but your skin stays in the same spot. That's shear. Now think about a patient sliding down in a hospital bed. There's friction from their skin rubbing repeatedly against their clothing and/or bed sheets. And there's shear at the interface between their skin and a bony prominence as they slide down. While friction affects the surface of the skin, shear affects the tissues deep within the skin, leading to tissue breakdown that can ultimately lead to a pressure injury. Moisture, which may include sweat, urine, feces, or excessive wound exudate, is another component of pressure injury risk. When the skin is wet, the stratum corneum, or outermost layer of the skin, becomes weaker and more susceptible to damage. Moisture can also exacerbate the damage done by friction, as it creates more drag between patient skin and the fabric of their gown and bedsheets. Microclimate is the word that may be unfamiliar to you, but it is important. Microclimate refers to the temperature, humidity, and airflow next to the surface of the skin. With an increase in temperature and humidity, the skin becomes weaker and there is an increased risk of friction at the surface of the skin. So imagine a patient sitting on a plastic incontinence pad, the warmth and moisture trapped between the surfaces of the skin and the pad. Any friction in this area will increase the patient's risk for pressure injury. So where should you look for pressure injuries? As mentioned, pressure injuries can occur on nearly any location on the body. But there are some areas that are more vulnerable than others. For patients in the supine position, at-risk areas include heels, sacral, coccygeal area, elbows, shoulders, and head. For patients in the ICU spending extended time in the prone position, attention should be focused on feet, knees, groin, hip bones, elbows, chin, nose, and forehead. Thank you for watching module 2 where we discussed how pressure injuries develop. We hope you will join us for the next module.

    highlight of locations where shear and friction can cause pressure injuries
    Chapter 2: Cause

    Part 2 of the 5 part video series on pressure injury focuses on how pressure injuries develop.

    Video 3:55 min

  • Stage 1 to 4 of pressure injuries
    Chapter 3: Staging

    Part 3 of the 5 part video series on pressure injury focuses on defining the stages of pressure injuries.

    Video 5:32 min

  • different locations where pressure injuries can occur
    Chapter 4: Assessment

    Part 4 of the 5 part video series on pressure injury focuses on how to assess pressure injuries.

    Video 3:39 min

  • potential places for pressure injuries and IAD
    Chapter 5: Incontinence Associated Dermatitis vs. Pressure Injury

    Part 5 of the 5 part video series on pressure injury focuses on the correlation between incontinence associated dermatitis (IAD) and pressure injuries.

    Video 5:10 min

Sites most susceptible to pressure injuries

  • Stage 1 pressure injury of buttocks - provided by NPUAP
    Sacrococcygeal area

    Most Hospital Acquired Pressure Injuries occur on the sacrum followed closely by the buttocks. Immobility is the greatest risk factor for development of pressure injuries.¹⁰

    Moisture associated skin damage may compromise the epidermis barrier function and predispose tissue to pressure injury.⁹

  • Stage 3 pressure injury of heel - provided by NPUAP

    Immobility, as with sacral pressure injuries, makes the heel an area to watch closely. Consider repositioning the patient and using prophylactic dressings that can reduce pressure, friction, and shear.

  • Close-up of a patient's face with a medical device-related pressure injury. Photo courtesy of National Pressure Ulcer Advisory Panel 2015
    Presence of a medical device

    Medical device related pressure injury (MDRPI) is caused by a device used for diagnostic or therapeutic purposes. Examples include respiratory devices such as tracheostomy faceplates, tubes and securement devices, endotracheal tubes; orthopedic devices such as cervical collars; urinary or fecal collection devices or compression stockings among other things. MDRPIs may be defined as those found on mucous membranes (the moist lining of the body cavities such as the tongue, oral mucosa, nasal passage) or non-mucosal locations. Injuries can also be caused by other objects found in a patients room, such as remotes, cell phones, and chargers.¹¹

  • (SPEECH) [MUSIC PLAYING] (DESCRIPTION) Text, 3M, Science, Applied to Life. Where Practice Meets Perspective, Understanding Skin and Wound Care with Dr. Heather Hettrick. How a grapefruit can help you stage a pressure ulcer/injury. Dr. Hettrick stands at a table with three grapefruits in front of her. (SPEECH) When learning to stage pressure injuries or pressure ulcers, it's very important to be able to discern the level of tissue destruction that's involved. So what I like to use to give a visual representation are grapefruits. So (DESCRIPTION) Text, Stage 1, Intact skin with non-blanchable erythema or dyschromia. She picks up an unpeeled grapefruit. (SPEECH) if we start with a stage 1 pressure injury, we know that the skin is still intact, but it will present with an erythema or a redness that is non-blanchable, meaning if I press on this, you will not see the blood evacuate that area and then reperfuse, meaning it will turn white and then reperfuse, spread again. (DESCRIPTION) She presses her index finger into the grapefruit. (SPEECH) The trick with this, however, is in patients with non-Caucasian skin, what we need to look for is subtle changes in their natural skin tone. We will see what's called a dyschromia or a darkening of their skin tone. So don't be fooled looking for erythema in darker-complected patients. But again a stage 1 is intact skin with non-blanchable erythema or a dyschromia. (DESCRIPTION) She turns the grapefruit to show a patch of the peel that has been abraded. Text, Stage 2: A partial-thickness injury with visibility to the papillary layer of the dermis. (SPEECH) Stage 2 now is actually disrupted the skin barrier function. You can see, as represented here, that the tissue, which is supposed to be represented of the epidermis, has now been removed. We've used a zester. But basically, what you can see is what would be the papillary layer of the dermis. So this is still considered a partial thickness injury because it is partially invaded the skin. But it's only removed or invaded the epidermis and that first layer of the dermis, the papillary layer. (DESCRIPTION) She places the grapefruit back on the table and picks up the middle grapefruit and shows a large patch of the skin has been peeled away exposing the white pith underneath. Text, Stage 3: Destruction of the papillary and reticular layers but not the subcutaneous tissue. (SPEECH) When we go on to a stage 3 and even a stage 4 or deep tissue injury, we are now talking about full thickness pressure injuries, again, because of the levels of tissue involved. So in a stage 3, you can quickly see the difference from how the stage 2 presented. Here, we have full involvement of the epidermis. But now, we have invaded both the papillary and the reticular layer of the dermis into, but not through, the subcutaneous tissue layer, as represented here by this fibrous tissue of the grapefruit. So again, this is a full thickness injury because it is fully invaded the epidermis and the dermis, but it has not gone into deeper tissue structures. (DESCRIPTION) She turns the grapefruit to show a patch of the skin peeled away to expose the flesh of the grapefruit. Text, Stage 4: Deep, full-thickness tissue loss with exposed bone, tendon or muscle. (SPEECH) When we invade deeper tissue structures, such as this representation, this is very similar to how a stage 4 pressure injury will present. And what you can see again is you have epidermal involvement, also the papillary and the reticular layer of the dermis. We have gone through and extended past the subcutaneous tissue. And now, we are in deep tissue structures. This could be muscle, bone, tendon, ligament, even metal if patients have had surgery. So this is a very deep injury. This is something that needs to be readily addressed. And we need to protect these tissues to keep them viable. The other aspect that we must consider with pressure injuries is the elusive deep tissue injury. (DESCRIPTION) She picks up the third grapefruit with intact skin but with a small reddened patch. Text, Deep Tissue Injury: Intact, but bruised or discolored skin with potential for rapid deterioration. (SPEECH) And again, what you will see when these first evolve is intact skin, but it will present with a purple or a dark purple-red discoloration of that tissue. But even though it won't blanch, which you will note, which is different, is the tissue consistency. So (DESCRIPTION) She presses the discolored patch of the grapefruit with her fingertip all over. (SPEECH) it's very important not just to rely on your visual assessment skills in looking at pressure injuries but to palpate those tissues, too. Because with deep tissue injury, you will often feel extensive tissue consistency changes. It could be cooler, warmer. It could be boggy. It could be hard. It's not going to feel like normal tissue. And with pressure injury, the pathophysiology, we have to remember happens down at the bony tissue interface when perfusion is not allowed to deliver oxygen and nutrients to those structures. Muscle, tendon, bone, all of those things die relatively quickly. They necrose. So these are actually myocutaneous infarctions. And the reason being that the skin tends to be the last thing that tends to become involved. The skin has the highest resistance to hypoxia. So it's very important to be able to recognize the level of tissue involvement, so you can adequately stage pressure injuries. [MUSIC PLAYING] (DESCRIPTION) Text, Learn more at 3-M dot com/pressureinjury. 3M, Science, Applied to Life. 3M is a trademark of 3M. Copyright 2017, all rights reserved.

    woman with 3 grapefruits pointing towards a hole in one of them
    How to Stage a Pressure Injury Using a Grapefruit

    In this four-minute video, Heather Hettrick, PT, PhD, CWS, CLT, CLWT, uses a grapefruit to outline the various stages of a pressure injury, including differentiating erythema.

    Watch pressure injury video (4:04 min)

  • Knowing how to properly assess and stage a pressure injury, as outlined by the NPIAP, is an important component in reducing patient risk.

    Download a free copy of a pocket-sized staging card and a wound measuring guide to help aid in your assessment of suspected pressure injury.

    Download pressure injury staging card

Protection for high-risk locations like the sacrum and heels

To protect against friction and shear, the NPIAP recommends using a polyurethane foam dressing to protect bony prominences like the sacrum and heels.⁹

  • Protect Bony Prominences

    To align with these standards, Tegaderm Silicone Foam Dressing, through its breathability, management of moisture, minimization of local shear force, minimal disruption to skin upon removal, and cushioning, may help prevent skin damage.

    Explore Tegaderm Silicone Foam Dressings

    Get hands-on experience with Tegaderm Silicone Foam Dressings and discover how they can help to enhance your comprehensive pressure injury prevention program.

Pressure injury prevention starts with skin protection

Skin integrity and management of skin conditions is critical in the prevention of pressure injuries. The NPIAP recommends a preventative skin care regimen, which includes cleansing and protecting the skin with a barrier product, to aid in prevention of pressure injuries.

NOTE: Specific indications, contraindications, warnings, precautions, and safety information exist for these products and therapies, some of which may be Rx only. Please consult a clinician and product Instruction for Use prior to application.

Putting 3M solutions into action

Discover why Tegaderm Silicone Foam Dressings are an appropriate choice for your wound management and pressure ulcer/injury prevention programs.

Clinical resources to transform outcomes in pressure injuries prevention

Explore articles that highlight the importance of skin, preventing complications, and improving patient care.

Training opportunities and educational resources

Deepen your clinical expertise with training opportunities and educational resources designed especially for you.
3M webinars and archived events keep you up to date with the latest product guidelines and scientifically supported standards of care.

  • Computer screen showing a webinar about pressure injury prevention
    Real Talk about Pressure Injuries: Why are we Still Struggling with Prevention?

    Although significant progress has been made in recent years to prevent pressure ulcer/injury (PU/I), it was still one of only two hospital-acquired conditions that increased according to a 2019 Agency for Healthcare Research and Quality (AHRQ) report. Join Jessica Pehrson, RN, MSN, CWS, as she outlines common areas where PU/I diagnosis, treatment, and prevention often come up short despite the latest global efforts to determine root causes and expand clinical recommendations for assessment and management.
    Note: The presenter is an employee of 3M.

    Viewing on desktop? Register/Login to view the course

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    Develop with 3M℠ Health Care Academy

    Increase your knowledge of the latest techniques and training with the wide range of courses available on 3M℠ Health Care Academy. Discover online learning that's right for you.

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images left to right show: a pressure injury on adult heel, transparent film dressing on an infant hand, a patient with venous leg ulcer, a patient with diabetic foot ulcer.

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View References

NOTE: Specific indications, warning, precautions and safety information exist for all 3M products and therapies. Prior to use of any medical device, it is important for
the provider to consult the treating physician and read and understand all Instructions for Use, including Safety Information, Application Instructions, and Therapy
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*Wound care product options are generated based on the application, preferences and wound characteristics selected. Other 3M products may also be suitable/available. It is
up to each clinician to assess whether any product will meet their wound care objectives. Any product identified through this guide is not intended to promote compatibility or
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3M does not make any claims that its products prevent, treat, or reduce the incidence of infection. For specific 3M products, please refer to the Instructions for Use.

Selection aid results to be used in conjunction with good clinical practice; utilize appropriate debridement and/or antibiotics where necessary. Untreated osteomyelitis
is contraindicated for use with 3M™ V.A.C.® Therapy. 3M™ Cavilon™ Advanced Skin Protectant is compatible with 3M acrylic negative pressure drapes.

1. Reproduced from WoundSource ( © 2021 HMP Global, Inc. Used with permission.
2. Reproduced from Scottsdale Wound Management Guide ( © 2021 HMP Global, Inc. Used with permission.

© 2023 3M. All rights reserved. 3M and the other marks shown are marks and/or registered marks. Unauthorized use prohibited.

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1. Health Research & Educational Trust (2016, January). Hospital Acquired Pressure Ulcers (HAPU) Change Package: 2016 Update. Chicago, IL: Health Research & Educational Trust. Accessed at

2. Declines in Hospital-Acquired Conditions. Content last reviewed May 2019. Agency for Healthcare Research and Quality, Rockville, MD.

3. AHRQ National Scorecard on Hospital-Acquired Conditions Updated Baseline Rates and Preliminary Results 2014–2017. Published January 2019. Accessed July 1, 2019.

4. Gefen A. How much time does it take to get a pressure ulcer? Integrated evidence from human, animal, and in vitro studies. Ostomy Wound Manag 2008:54(10): 26-35.

5. Gould, L. J., Bohn, G., Bryant, R., Paine, T., Couch, K., Cowan, L., ... & Simman, R. (2019). Pressure Ulcer Summit 2018: An Interdisciplinary Approach to Improve Our Understanding of the Risk of Pressure‐Induced Tissue Damage. Wound Repair and Regeneration, DOI: 10.1111/wrr.12730.

6. Cox J, Roche S, Murphy V. Pressure Injury Risk Factors in Critical Care Patients: A Descriptive Analysis. Adv Skin Wound Care. 2018 Jul;31(7):328-334.

7. VanGilder CA, Cox J, Edsberg LE, Koloms K. Pressure Injury Prevalence in Acute Care Hospitals With Unit-Specific Analysis: Results From the International Pressure Ulcer Prevalence (IPUP) Survey Database. J Wound Ostomy Continence Nurs. 2021 Nov-Dec 01;48(6):492-503.

8. Wassel CL, Delhougne G, Gayle JA, Dreyfus J, Larson B. Risk of readmissions, mortality, and hospital-acquired conditions across hospital-acquired pressure injury (HAPI) stages in a US National Hospital Discharge database. Int Wound J. 2020 Dec;17(6):1924-1934.

9. 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. Emily Haesler (Ed.). EPUAP/NPIAP/PPPIAP: 2019.

10. Edsberg LE, Cox J, Koloms K, VanGilder-Freese CA. Implementation of Pressure Injury Prevention Strategies in Acute Care: Results From the 2018-2019 International Pressure Injury Prevalence Survey. J Wound Ostomy Continence Nurs. 2022 May-Jun 01;49(3):211-219.

11. Gefen A, Alves P, Ciprandi G et al. Device related pressure ulcers: SECURE prevention. J Wound Care 2020; 29(Sup2a): S1–S52.

12. Brennan, Mary R.; Milne, Catherine T.; Agrell-Kann, Marie; Ekholm, Bruce P. Clinical Evaluation of a Skin Protectant for the Management of Incontinence Associated Dermatitis: An Open-Label, Nonrandomized, Prospective Study. J of Wound, Ostomy & Continence Nursing. 2017. 44(2):172-180.

13. 3M Data on File. EM-05-013924, EM-05-305812