At a Glance: A hospital-acquired pressure injury is a pressure ulcer that develops during a hospital stay. These injuries form when sustained pressure cuts off blood flow to the skin and the soft tissue beneath it, most often over a bony prominence. Patients with limited mobility and poor nutritional status or who are staying in the intensive care unit are at higher risk. Prevention depends on regular repositioning, skin assessment, and the right support surfaces, and the same measures protect a patient after discharge.
A pressure injury, also called a pressure ulcer or bedsore, is localized damage to the skin and underlying soft tissue caused by sustained pressure. They often develop over a bony prominence such as the tailbone, hips, or heels. When that damage develops during a hospital stay rather than before it, it is called a hospital-acquired pressure injury. This distinction matters because these injuries are considered largely preventable, and tracking them is one way hospitals measure the quality of their care.
For caregivers supporting a family member with a disability or a mobility-limiting medical condition, understanding how these injuries happen is useful well beyond the hospital. The same pressure that causes a hospital-acquired pressure injury continues to threaten the skin once the patient is discharged, and the prevention methods used during short-term hospital stays are the same ones that protect a patient during recovery.
What Is a Hospital-Acquired Pressure Injury?
A hospital-acquired pressure injury (HAPI) is any pressure injury that was not present when a patient was admitted and that developed during their stay. A pressure injury is a localized damage to the skin and soft tissue, usually over a bony prominence, resulting from intense or prolonged pressure or pressure combined with shear.
These injuries are common and costly. More than 2.5 million patients in the United States develop pressure injuries each year, and complications from them contribute to tens of thousands of deaths. Research has also linked a hospital-acquired pressure injury to a longer hospital stay and a higher mortality rate. Because a hospital-acquired pressure injury is treated as a preventable hospital-acquired condition, it often appears as a secondary diagnosis in a patient’s record and factors into hospital quality reporting. For that reason, hospital-acquired pressure ulcers are tracked closely as a patient safety measure, and reducing them is a common focus of quality improvement work.
Pressure injuries are described in stages based on how deep the damage goes:
- Stage 1: Intact skin with an area of redness that does not turn white when pressed.
- Stage 2: Partial-thickness skin loss, appearing as a shallow open wound or blister.
- Stage 3: Full-thickness skin loss that may expose fat.
- Stage 4: Full-thickness loss extending to muscle, tendon, or bone.
How Pressure Injuries Develop
A pressure injury forms when pressure on the skin exceeds the pressure inside the small blood vessels, cutting off blood flow. Without oxygen and nutrients, the tissue begins to break down. The process can start within hours, and the earliest damage sometimes begins in the deeper tissue before it is visible on the skin surface.
Several forces work together to cause the damage:
- Pressure: Sustained weight on one area, especially over a bony prominence, restricts blood flow.
- Shear: When the skin stays in place while the tissue beneath slides, blood vessels stretch and tear.
- Moisture: Damp skin from sweat or incontinence weakens and breaks down more easily.
Because the body concentrates weight over bony areas, the most common sites for a hospital-acquired pressure injury are the sacrum (especially the tailbone), the heels, the hips, and the shoulder blades. Medical device-related injuries are also common, forming where tubing, masks, or braces press against the skin.
Who Is Most at Risk of Pressure Injuries?
A hospital-acquired pressure injury can affect any patient, but some face a much higher risk. There’s a consistent set of risk factors, and recognizing them is the first step in protecting patient outcomes.
Patients With Limited Mobility
The single greatest risk factor is limited mobility. A patient who cannot reposition themselves stays in contact with the same surface for long periods, and pressure builds with no relief. This includes patients recovering from surgery, those with neurological conditions, and anyone on extended bed rest.
Patients in Intensive Care
Patients in the intensive care unit face increased risk because they are often sedated, immobile, and connected to medical devices. Studies of ICU settings have reported pressure injury prevalence around 16%, well above the rate in general hospital wards.
Patients With Poor Nutrition or Circulation
Nutritional status plays a direct role in skin health. A patient who is undernourished has less protective tissue and heals more slowly. Poor circulation, common in patients with diabetes, further reduces the skin’s ability to withstand pressure. Advanced age, incontinence, and reduced sensation add to the risk.
How Hospitals Prevent Pressure Injuries
Pressure injury prevention is built on a set of practices that hospitals apply to at-risk patients. These same interventions carry over directly to home care.
- Risk Assessment: Medical professionals use validated tools such as the Braden Scale to score each patient’s risk at admission and throughout their stay. This helps guide the level of prevention needed.
- Repositioning: Turning and repositioning at-risk patients on a schedule, often every two hours, relieves pressure and changes contact points.
- Skin Assessment: Regular skin checks catch early redness or changes before they become open wounds.
- Support Surfaces: Pressure-redistributing mattresses and cushions spread body weight to protect high-risk areas.
- Nutrition: Supporting good nutritional status gives the skin what it needs to stay healthy and heal.
These measures reflect current clinical practice for pressure ulcer prevention, and staff education paired with consistent prevention interventions is what makes them work as part of everyday patient care. When hospitals apply them reliably, the rate of hospital-acquired pressure injuries drops, which is why this rate is used among nursing quality indicators across health care facilities.
Continuing Pressure Wound Prevention at Home
A patient who was at risk in the hospital is often still at risk at home, especially if they have limited mobility or are recovering from a wound. For caregivers, continuing the same routine is what protects the skin.
That routine includes repositioning on a schedule, checking the skin daily for early signs of damage, managing moisture, supporting good nutrition, and using a support surface built to redistribute pressure. A standard home mattress does not provide the pressure relief an at-risk patient needs, which is where a therapeutic support surface makes a difference.
Ethos Therapy Solutions offers air fluidized therapy beds, mattress overlays and replacements, and more solutions that redistribute pressure and protect skin at risk of breakdown. Matching the surface to the patient’s risk is part of a complete approach to wound management. To find the right surface for a patient’s needs, contact the Ethos team or explore the full range of options.