Each year, over 4,000 Australians experience hospital-acquired pressure injuries. These types of injury take a long time to heal, and can have serious consequences for patients’ health. Because of their nature, pressure injuries can also inhibit rehabilitation, mobility and long-term quality of life.

Preventing pressure injuries is a primary challenge for healthcare facilities. Despite advances in pressure injury prevention equipment and training, sometimes these injuries still occur in approximately 9.7% of every 10,000 patients. When pressure ulcers occur, it’s important for healthcare staff to properly classify and treat the injury.

How are pressure injuries staged?

Our skin consists of three layers of tissue - the epidermis (outer layer), the dermis (connective tissue) and the hypodermis (deeper subcutaneous tissue).

Pressure ulcers are staged depending on their depth and severity. They can range from a patch of red skin to a deep injury involving muscle and bone.

Grade I

This first stage is the mildest, and occurs in the epidermis. Skin with a Grade 1 pressure ulcer will look red, blue or purple. It may feel warm and sore to the touch. In this stage, there are no visible breaks in the skin.

Recovery time: This type of injury can heal in 3-4 days if caught and treated early.

Grade II

The second stage is characterised by a broken sore that’s created a shallow, open wound in the top two layers of skin (the epidermis and dermis). There may also be clear to yellowish fluid leaking from the wound, or a blister that has either already broken or is about to.

More pain accompanies this type of skin ulcer. The surrounding skin might also look swollen, sore and red. If this is the case, it’s a sign there’s already some degree of tissue damage or death.

Recovery time: Approximately 1 month if treated effectively.

Grade III

Pressure injuries that have progressed to Grade III have broken through the top two layers of skin, and into the hypodermis underneath. A Grade III skin ulcer might look like a crater, with reddened, hot and sore tissue surrounding the edges.

Also, as the sore has progressed to the subcutaneous fatty layer underneath the skin, the body is more susceptible to infection of the skin and underlying tissue.

Signs of infection such as liquid or pus draining from the crater, and / or a foul smell should be vigilantly monitored and treated.

Recovery time: With proper treatment, these sores may heal in 1 to 4 months.

Grade IV

This is the most serious stage of skin ulcers. Grade IV sores extend below the subcutaneous fat under the skin, and into your deeper tissues including muscles, tendons and ligaments. In extreme cases, these types of ulcer can extend all the way down to the bone.

Not surprisingly, Grade IV ulcers are extremely painful. They also expose the patient to a high risk of infection.

Extensive destruction of the skin is visible, including necrosis (decay) or damage to the sore area itself as well as surrounding tissue. Significant drainage and pus, as well as a foul odour may also be present.

The tissue may turn purple or even black, and there may be hardened dead wound tissue (eschar) present within the sore.

Recovery time: Two to six months with vigilant monitoring from a dedicated wound care team.

In some severe cases, two kinds of pressure sores may occur that don’t fit into one of the four stages. These are:

• Unstageable - If the ulcer is covered with eschar, the base of the ulcer may not be visible enough to properly stage the injury.
• Deep tissue injury - These injuries may look like a Grade I or II injury, however underneath the surface there may be significant damage to the deeper tissue.