What pressure ulcer prevention and skin integrity mean

Pressure ulcers, sometimes called pressure sores or bed sores, are injuries to the skin and underlying tissue linked to prolonged pressure. Skin integrity means keeping the skin intact, healthy and protected. In care homes, prevention is part of everyday personal care, mobility support and comfort, not a task that starts only after skin has already broken down.

NICE says risk rises when people have factors such as reduced mobility, inability to reposition, previous or current pressure damage, malnutrition or significant cognitive impairment. In practice, frontline carers help prevent harm because they see how the resident actually spends the day and night, whether the current plan is being followed, and whether something has changed since yesterday.

What affects skin integrity in daily care

• Pressure: too much time in one position can damage skin over bony areas.
• Friction and shear: dragging, sliding and poor positioning can damage skin even before a wound is visible.
• Moisture: sweat, urine, faeces or wound fluid can make fragile skin easier to break down.
• Poor intake: low food or fluid intake can make healing and skin resilience worse.
• Equipment and routine: cushions, mattresses, chair time and turning plans only help if they are correct, available and used properly.

For carers, the role is usually to notice, support, record and report. In some homes trained nurses or senior staff complete formal risk and skin assessments, but all carers should still recognise warning signs, follow the current prevention plan and say when the plan no longer fits what they are seeing.

Pressure ulcer prevention works best when staff treat skin care, mobility, continence, nutrition, hydration and equipment as one connected picture.