Victorian Government website (Victoria - the Place to Be)

Pressure sores

Pressure sores are areas of damage to the skin caused by constant pressure or friction. Other names for this type of damage include bed sores, pressure ulcers and decubitus (lying down) ulcers. Estimates vary, but it's believed that around four to eight per cent of hospitalised Australians have a pressure sore on any given day. The skin over bony areas, such as the tailbone (coccyx), is particularly at risk. Pressure sores are easy to prevent, but difficult to treat.

Degrees of severity
If a person is bedridden for long enough, the areas of skin in constant contact with the mattress will start to discolour. This is called reactive hyperaemia and shows that the skin is in danger of ulcerating. Pressures sores are graded to four levels, including:

  • Grade 1 - persistent skin discolouration: usually red, blue, purple or black.
  • Grade 2 - some skin loss or damage involving the topmost skin layers.
  • Grade 3 - necrosis (death) of the skin patch, limited to the skin layers.
  • Grade 4 - necrosis (death) of the skin patch and underlying structures, such as tendon, joint or bone.
Added complications
Untreated pressure sores can lead to a wide variety of secondary conditions, including:
  • Maggot infestation
  • Septicaemia (blood poisoning)
  • Cellulitis (inflammation of body tissue causing swelling and redness)
  • Osteomyelitis (inflammation of the bone).
Risk factors
To cause a pressure sore, constant pressure needs to be applied to the skin over a period of time. The skin of older people tends to be thinner and more delicate, which means an older person has an increased risk of developing a pressure sore during a prolonged stay in bed. Other risk factors for a pressure sore include:
  • Poor physical condition
  • Poor mental condition
  • Immobility
  • Being restricted to either sitting or lying down
  • Incontinence.
Prevention techniques
Anyone caring for someone confined to a bed or chair for any period of time needs to be mindful of pressure sores. To prevent skin damage, you need to relieve the pressure, reduce the time that pressure is applied, and improve skin quality. To prevent pressure sores, it will help to:
  • Check the skin at least daily for redness or signs of discolouration.
  • Turn the person regularly.
  • Use pillows as soft buffers between the skin and the bed.
  • Be aware of using good hygiene practices.
  • Keep the skin at the right moisture level, since damage is more likely to occur if skin is either too dry or too moist.
  • Use moisturising creams for dry skin.
  • Ensure the person eats a healthy diet.
Special care for the tailbone
The tailbone (coccyx) should never be massaged because the skin is too delicate. Foam ring pillows should also be avoided.

If a pressure sore develops
Depending on the severity of the pressure sore, there are a variety of treatments, including:
  • Turning programs.
  • Special mattresses and beds that reduce pressure.
  • Proper dressings to keep the sore moist and the surrounding skin dry.
  • Lightly packing any empty skin spaces with dressing to help prevent infection.
  • Regular cleansing with appropriate solutions.
  • Antibiotic creams applied to the area if the infection persists.
  • Surgery to remove the dead tissue.
  • Operations to close the wound, using skin grafts if necessary.
Where to get help
  • Your doctor
  • Hospital staff
  • Domiciliary care staff.
Things to remember
  • Anyone confined to a bed or chair for a long time is at risk of developing a pressure sore
  • Pressure sores are easy to prevent but difficult to treat
  • Prevention includes regular turning, good hygiene and a healthy diet.

    Related articles:


Leg ulcers.
Osteomyelitis.


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Article publication date: 15/03/2000
Last reviewed: 31/03/2004

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