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What is Pressure Ulcer ?

Updated: Apr 13, 2021

Pressure ulcer (which commonly known as pressure sore or bed sore) are area of damage to the skin and underlying tissues due to prolonged pressure. Pressure ulcer (bed sore) can affect any parts of the body that put under pressure such as lying or sitting in the same position for too long. The reduction in blood supply to the skin and tissue result from the prolonged pressure and immobility will result in the sore and damage. Pressure ulcer (bed sore) commonly develop in the parts where skin is close to bone, such as hips, base of the spine, ankle, heels and elbows. They normally form gradually but may sometimes develop in a few hours.

In the latest NHMS 2019 report, it is estimated that around 1 in 50 of in Malaysia is receiving care at home in the last 12 months and 10.4% of them are receiving medical treatment such as tube-feeding, wound care, prevention of pressure ulcers (bed sore) and others.

Pressure Ulcer (Bed Sore) Risk factors:

1. Aging

2. Reduced mobility or immobility (example: due to Parkinson’s disease, stroke, pain and altered level of consciousness)

3. Friction and shear

4. Dehydration and malnutrition

5. Incontinence and excessive moisture

6. Reduced blood supply in the legs

7. Reduced skin sensation (such as neuropathy in diabetes)

8. Certain skin infections

Pressure ulcers (bed sore) are commonly happen in people who:

1. Are older

2. Unable to move or shift around easily due to medical conditions

3. Are in a nursing home or hospital

How to differentiate the stages of pressure ulcer (bed sore)?

The severity of the pressure ulcers (bed sore) can be described using the National Pressure Injury Advisory Panel (NPIAP) staging system. The severity of the pressure ulcers (bed sore) can range from discoloration of skin initially and further progress to full thickness skin loss and bone damage over time. Pressure ulcers (bed sore) can be divided into 4 stages1,7:

Stage 1: Early symptoms of pressure ulcer (bed sore) which includes discoloration of skin (red patches of the skin) and the discolored skin not turning white when pressed. Pain and itchiness may develop at the affected area with warm, hard or spongy sensation when touched.

Stage 2: An open wound or blisters formed when the pressure ulcers (bed sore) get worse. The wound appears to be pink, red, moist and may present as blisters.

Stage 3: An open wound which involves a deeper layer of skin where fat is visible. Slough may appear. Tunneling and undermining may occur. Muscle, ligament, tendon and/or bone are not exposed in this stage.

Stage 4: A very deep wound that reaches the muscle and bone. Slough, tunneling and undermining may occur.

Apart from that, there are other types of pressure ulcer (bed sore), which are:

Deep tissue pressure injury: Maroon or purple localized area of skin or blood-filled blisters due to soft tissue damage from pressure. The area mar be painful, warmer or cooler and firm.

Unstage: An open wound which involves a deeper layer of skin where fat is visible. Slough may appear. Tunneling and undermining may occur. Muscle, ligament, tendon and/or bone are not exposed in this a few tips that you can use to prevent pressure ulcer (bed sore)

Can pressure ulcers (bed sore) be prevented?

Yes. There are a few tips that you can use to prevent pressure ulcer (bed sore).


Repositioning is undertaken to reduce the duration and magnitude of pressure over vulnerable areas of the body and to contribute to the patient’s comfort, hygiene and dignity. Repositioned regularly by minimizing shear and friction forces on the skin can prevent pressure ulcer. 


Identifying at-risk patients and following best practices for pressure ulcer prevention, it may be possible to stop pressure ulcer (bed sore) before they develop and reduce their impact if they occur.


Once a pressure ulcer has developed, nutrition plays a vital role in the healing process. This is because the body needs protein, energy (calories), vitamins and minerals (such as vitamin C, iron and zinc), and plenty of fluids to support the wound healing process.


Increase comfort for an individual suffering from pressure sores (bed sore). Ripple mattress is one of the method which can help on prevent pressure ulcer. Ripple mattress provides high levels of support for the head and body to relieve any mounting stress on pressure points. Pressure relief mattresses differ from a regular mattress as they have carefully designed air pockets, specifically designed to place less pressure on the main pressure points in the body.

Frequent repositioning and choosing the correct pressure relieving ripple mattress are the most important steps to prevent pressure ulcers (bed sore). Proper skin care and maintain a balanced diet are just supportive interventions to prevent pressure ulcer (bed sore). Repositioning and turning your body every 2 hours (from back, to one side then to another side) is important in reducing pressure at an area for too long and to improve the circulation of blood to the area of pressure ulcer. Gentle turning and repositioning are crucial to reduce friction to the skin. Pressure-relieving support surfaces (especially powered active air surfaces) is effective in reducing the incidence of pressure ulcers (bed sore) as compared to a standard hospital mattress. Studies also showed that patient’s satisfaction was higher with the pressure-relieving mattress and the incidence of pressure ulcer (bed sore) is as low as around 7%.

Benefits of using pressure-relieving mattress (ripple mattress):

1. Reduced risk of developing pressure ulcer (bed sore)

2. Cost-effective

3. Reduced length of hospitalization

4. Reduced wound care nursing times

5. Reduced the need for long term wound care supplies

For more info about APEX ripple mattress

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