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Evidence to Improve Care

Pressure Injuries

Care for Patients in All Settings

Click below to see a list of brief quality statements and scroll down for more information.​​


Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence. ​

See below for the quality statements and click for more detail.​


Quality Statement 1: Risk and Skin Assessment
People with at least one risk factor for developing a pressure injury undergo a comprehensive risk assessment, including a skin assessment, to determine their level of risk. Those at risk are reassessed on an ongoing basis.


Quality Statement 2: Patient Education and Self-Management
People who have developed or are at risk of developing a pressure injury and their families and caregivers are offered education about pressure injuries, including an overview of the condition; the importance of mobilization and repositioning for pressure redistribution; and who to contact in the event of a concerning change.


Quality Statement 3: Comprehensive Assessment
People with a pressure injury undergo a comprehensive assessment, including an evaluation of risk factors that affect healing to determine the healing potential of the wound.


Quality Statement 4: Individualized Care Plan
People who have developed or are at risk of developing a pressure injury have a mutually agreed-upon individualized care plan that identifies patient-centred concerns and is reviewed and updated regularly.


Quality Statement 5: Support Surfaces
People who have developed or are at risk of developing a pressure injury are provided with appropriate support surfaces based on their assessment.


Quality Statement 6: Repositioning
People who have developed or are at risk of developing a pressure injury receive interventions that enable repositioning at regular intervals, encouraging people to reposition themselves if they are mobile or helping them to do so if they cannot reposition themselves.


Quality Statement 7: Wound Debridement
People with a pressure injury have their wound debrided if it is determined as necessary in their assessment, and if it is not contraindicated. Debridement is carried out by a trained health care professional using an appropriate method.


Quality Statement 8: Local Infection Management
People with a pressure injury and a local infection receive appropriate treatment, including antimicrobial and non-antimicrobial interventions.


Quality Statement 9: Deep/Surrounding Tissue Infection or Systemic Infection Management
People with a pressure injury and suspected deep/surrounding tissue infection or systemic infection receive urgent assessment (within 24 hours of initiation of care) and systemic antimicrobial treatment.


Quality Statement 10: Wound Moisture Management
People with a pressure injury receive wound care that maintains the appropriate moisture balance or moisture reduction in the wound bed.


Quality Statement 11: Surgical Consultation
People who are adherent to treatment and have a stage 3 or 4 healable pressure injury that is not responding to optimal care are referred for a surgical consultation to determine their eligibility for surgical intervention.


Quality Statement 12: Health Care Provider Training and Education
People who have developed or are at risk of developing a pressure injury receive care from health care providers with training and education on the assessment and treatment of pressure injuries.


Quality Statement 13: Transitions in Care
People with a pressure injury who transition between care settings have a team or provider who is accountable for coordination and communication to ensure the effective transfer of information related to their care.

9

Deep/Surrounding Tissue Infection or Systemic Infection Management

People with a pressure injury and suspected deep/surrounding tissue infection or systemic infection receive urgent assessment (within 24 hours of initiation of care) and systemic antimicrobial treatment.


All pressure injuries contain bacteria, but not all are infected or require infection treatment. Overuse and inappropriate use of antibiotics may contribute to the development of antibiotic-resistant bacteria. Topical antibiotics should not be used in the treatment of pressure injuries, because their use may be associated with antibiotic resistance and sensitivities. Deep/surrounding or systemic infection may be suspected when three or more of the following signs and symptoms are present: increased size; elevated temperature in the peri-wound; ability to probe to bone or the presence of exposed bone; new areas of tissue breakdown; presence of red tissue and swelling or edema; increased exudate; and foul odour. Pain is also a sign of deep infection.

For Patients

If you have a suspected deep/surrounding tissue or systemic infection, you should have an urgent assessment within 24 hours and treatment with antibiotics.


For Clinicians

Carry out an assessment within 24 hours and provide systemic antimicrobial treatment for people with a pressure injury and suspected deep/surrounding tissue infection or systemic infection.


For Health Services

Ensure that systems, processes, and resources are in place to support clinicians in treating people with a pressure injury and suspected deep/surrounding tissue infection or systemic infection.

Process Indicators

Percentage of people with a pressure injury and a suspected deep/surrounding tissue infection who receive an assessment within 24 hours of initiation of care

  • Denominator: number of people with a pressure injury and a suspected deep/surrounding tissue infection

  • Numerator: number of people in the denominator who receive an assessment within 24 hours of initiation of care

  • Data source: local data collection


Percentage of people with a pressure injury and a suspected systemic infection who receive an assessment within 24 hours of initiation of care

  • Denominator: number of people with a pressure injury and a suspected systemic infection

  • Numerator: number of people in the denominator who receive an assessment within 24 hours of initiation of care

  • Data source: local data collection


Percentage of people with a pressure injury and a confirmed deep/surrounding tissue infection who receive systemic antimicrobial treatment

  • Denominator: number of people with a pressure injury and a confirmed deep/surrounding tissue infection

  • Numerator: number of people in the denominator who receive systemic antimicrobial treatment

  • Data source: local data collection


Percentage of people with a pressure injury and a confirmed systemic infection who receive systemic antimicrobial treatment

  • Denominator: number of people with a pressure injury and a confirmed systemic infection

  • Numerator: number of people in the denominator who receive systemic antimicrobial treatment

  • Data source: local data collection

Deep/surrounding tissue infection

This is characterized as a deeper wound, such as an abscess, osteomyelitis, septic arthritis, or fasciitis.


Systemic infection

This is characterized as a local infection with signs of systemic inflammatory response syndrome.

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