• Limited mobility, wheelchair/bed-bound
• Diabetes, vascular disease, anemia, malnutrition
• Incontinence, moisture, or sweating
• Older age, thin skin, prior pressure injuries
• Sedating medicines; dementia or poor awareness of pain/position

Lying on the back

• Back of head, shoulder blades
• Elbows, spine, tailbone/sacrum
• Heels

Side-lying & sitting

• Hips/greater trochanters, knees/ankles (bony contact)
• Ischial tuberosities (“sitting bones”), sacrum/coccyx
• Heels and toes, especially with sheets pulling

Turn & offload

• Reposition at least every 2 hours in bed; every 15–30 minutes in chair (brief weight shifts)
• Heels off the bed—use pillows/heel protectors
• Use 30° side-lying (not directly on the hip)
• Keep head of bed as low as safely possible to reduce shear

Surfaces & cushions

• High-quality foam or alternating-pressure mattress when high risk or existing sores
• Wheelchair cushion (gel/air/contour) fitted by therapist
• Don’t sit on donut cushions—can worsen pressure

Skin routine

• Inspect skin daily (sacrum, heels, hips); check for non-blanching redness
• Cleanse gently; pat dry; apply barrier cream where moisture exposed
• Moisturize dry skin; avoid vigorous rubbing over bony areas

Movement & fit

• Adjust splints/oxygen tubing/catheters to avoid pressure points
• Keep sheets smooth; avoid wrinkles and “friction burn”
• Encourage small, frequent mobility as able; physical therapy referral

• Prompt cleanse after urine/stool; use pH-balanced cleansers
• Apply zinc oxide or dimethicone barrier creams each change
• Breathable briefs; avoid plastic underpads directly on skin
• Consider fecal/urine diversion devices (clinician-guided) for severe cases

• Target adequate calories and protein (protein most meals/snacks)
• Hydration plan; consider dietitian for tailored needs
• Vitamin C and zinc only if deficient or advised—avoid high doses without guidance

Dressings (match to wound)

• Foam for moderate drainage; cushioning
• Hydrocolloid for shallow, low-drainage wounds (not infected)
• Alginate for heavy drainage; needs cover dressing
• Hydrogel for dry wounds/eschar (when appropriate)
• Silver/iodine dressings short-term if high bioburden (clinician guided)

Debridement

• Autolytic (occlusive dressings), enzymatic ointments
• Conservative sharp and surgical debridement by trained clinicians
• Stable, dry heel eschar may be left intact unless infection—specialist decides

Advanced options

• Negative pressure wound therapy (vacuum-assisted) for select deep wounds
• Consult wound clinic for stalled wounds or complex cases

• Time oral pain medicine before dressing changes
• Moist dressings reduce pain vs. dry gauze
• Pressure relief cushions and gentle positioning supports

• Set a written turning schedule; use phone alarms
• Log wound size, drainage, odor, pain; bring to visits
• Use draw sheets/lift devices—avoid dragging the skin

How fast can a sore develop?

High-risk skin can break down within hours under constant pressure—especially heels and sacrum. That’s why scheduled turning matters.

Is redness always bad?

If a red area doesn’t blanch (stay white briefly when pressed) or feels warm/firm, it’s an early injury—offload right away.

Do I need a special mattress?

People at moderate to high risk or with existing sores often benefit from high-quality foam or alternating-pressure surfaces—get fitted advice.

Should I use antibiotic ointment?

Not routinely. Choose dressings matched to drainage; reserve antibiotics for clear infection under clinician guidance.