**3. Etiology**

Pressure ulcers, the term that will be used throughout this chapter, occur across all health care settings with the most common setting for the occurrence of pressure ulcers being acute care hospitals followed by long‐term care facilities then equally in occurrence in an individual's home and nursing facilities [5]. Pressure ulcers usually occur on the lower half of the body with two‐thirds occurring in the pelvic region such as the sacrum, coccyx or hip areas and one‐ third occurring on the lower extremities. The occurrence of pressure ulcers on the heels is increasing. **Table 1** indicates bony prominences of the body, the location where pressure ulcers occur most often [6].

Approximately 10% of pressure ulcers are device related [7]. Multiple medical devices or pieces of medical equipment can lead to pressure ulcer development. Items such as endotracheal tubes, feeding tubes, cervical collars, tracheostomy tubes and positive pressure airway masks all have the potential for creating pressure ulcers due to pressure points created by the device. Transfer boards or slide boards place an individual at risk for shear injuries due to sliding over the firm surface.

The most common age group for the incidence of pressure ulcers is the elderly, especially those 70 and older. The occurrence of a pressure ulcer in an elderly individual increases their mortality rate fivefold. In hospital, when a patient has developed a pressure ulcer, mortality increases by 25% in the over 70 age group [5].

**Table 1.** Pressure ulcer pressure points.

quality care to those who have been entrusted to their care [3]. It is important to identify individuals who are at risk for pressure ulcer development or those who have developed a pressure ulcer, in order to implement preventative or treatment measures; these individuals

The National Pressure Ulcer Advisory Panel (NPUAP), an organization comprised of leading experts in health care dedicated to the prevention and management of pressure ulcers, during a consensus conference held in the spring of 2016 replaced the term pressure ulcer with pressure injury to more accurately reflect injuries related to pressure in both intact and ulcerated skin [1]. The NPUAP also revised their definition of a pressure injury as *localized damaged to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, comorbidities and condition of the soft tissue* [1]. The European Pressure Ulcer Advisory Panel (EPUAP), also a leading organization of wound care experts, continues to use the term pressure ulcer as well as the definition originally developed in conjunction with the NPUAP, which states a pressure ulcer is a *localized injury to the skin and/or underlying tissue usually over a bony*

Pressure ulcers, the term that will be used throughout this chapter, occur across all health care settings with the most common setting for the occurrence of pressure ulcers being acute care hospitals followed by long‐term care facilities then equally in occurrence in an individual's home and nursing facilities [5]. Pressure ulcers usually occur on the lower half of the body with two‐thirds occurring in the pelvic region such as the sacrum, coccyx or hip areas and one‐ third occurring on the lower extremities. The occurrence of pressure ulcers on the heels is increasing. **Table 1** indicates bony prominences of the body, the location where pressure ulcers

Approximately 10% of pressure ulcers are device related [7]. Multiple medical devices or pieces of medical equipment can lead to pressure ulcer development. Items such as endotracheal tubes, feeding tubes, cervical collars, tracheostomy tubes and positive pressure airway masks all have the potential for creating pressure ulcers due to pressure points created by the device. Transfer boards or slide boards place an individual at risk for shear injuries due to sliding over

The most common age group for the incidence of pressure ulcers is the elderly, especially those 70 and older. The occurrence of a pressure ulcer in an elderly individual increases their

*prominence, as a result of pressure, or pressure in combination with shear* [4].

also require close monitoring.

324 Wound Healing - New insights into Ancient Challenges

**2. Definition**

**3. Etiology**

occur most often [6].

the firm surface.
