Pressure injuries in the sacral region are a pervasive and preventable challenge in U.S. hospitals, representing the single largest contributor to avoidable complications and posing an urgent call to action in patient care. Despite efforts to prevent them, hospital-acquired sacral pressure injuries continue to result in morbidity, mortality, and associated increased healthcare costs.
Aside from the high cost of treatment, sacral pressure injuries (SPIs) significantly impact a patient’s quality of life. The development of sacral pressure injuries can interfere with the patient’s functional recovery, increase the risk of pain and infection, and contribute to extended hospital stays and negative patient experiences.
Sacral pressure injury prevention efforts also affect healthcare workers, particularly when boosting and repositioning patients. The cumulative weight a healthcare worker may have to lift within an 8-hour shift is equivalent to 1.8 tons. Consequently, transferring, lifting, boosting, and repositioning patients is the leading cause of work-related musculoskeletal disorders in healthcare.
What Causes a Sacral Pressure Injury?
A sacral pressure injury, also known as a sacral pressure ulcer or bedsore, is damage to the skin and/or underlying tissue over the sacrum—the triangular-shaped bone at the base of the spine that connects the pelvis to the lower body—as a result of prolonged pressure.
Patients are at higher risk for developing a sacral pressure injury when they are unable to easily change position while in bed or if their Braden Score is 18 or less (the Braden Scale is a risk assessment tool that identifies patients at high risk for developing pressure injuries).
The primary contributing factors for these types of injuries are:
- Pressure: Continuous pressure on the sacrum due to not regularly changing position while sitting or lying down.
- Friction: Skin rubbing against bedding or clothing creates irritation and potential breakdown. This can make fragile skin in the sacral region more vulnerable to injury.
- Shear: This occurs when two surfaces move in opposite directions. For example, a person can slide down when a bed is raised. In sacral pressure injuries, as the tailbone moves down, the skin over it might stay in place, pulling in the opposite direction.
Why The Current Standard of Care is Failing Patients and Healthcare Workers
Most sacral pressure injuries are preventable through interventions by healthcare workers, caregivers, and patients. Frequent turning and repositioning is a common strategy to reduce sacral pressure injuries (and other pressure-related injuries) among hospitalized patients.
This helps to redistribute and relieve pressure from at-risk areas and enhance blood flow in the affected region. Most clinical guidelines recommend a substantial change in the patient’s position every 2 hours, often referred to as the Q2 Turning Protocol.
The National Pressure Injury Advisory Panel (NPIAP) also created guidelines, including a Standardized Pressure Injury Prevention Protocol (S-PIPP) checklist for daily assessment, including the following methods to redistribute pressure:
- Use high-specification reactive foam for immobile persons
- Use positioning aids that minimize friction/shear (pillows, wedges)
- Provide a 30-degree turn off of the sacrum, confirm that the sacrum is offloaded with the hand
- Implement an early mobilization program
While these guidelines provide an effective strategy to prevent sacral pressure injuries, success is compromised by the limitations of current Q2 methods for turning and positioning. For example, the standard practice in many facilities involves manually repositioning patients using pillows propped behind them to provide support during turns and maintaining alignment afterward. The primary issue is that a pillow does not typically maintain its shape and will flatten over time. As a result, the patient is not supported in a proper position to relieve pressure. Furthermore, findings suggest that standard pillow turns are not maintained over time, resulting in patients lying on their backs rather than in a position that offloads pressure.
There are also commercially available assistive devices to aid with turning and repositioning, including patient positioning aids such as foam wedges. Unfortunately, current patient positioners fall short by:
- Failing to maintain the recommended 30° tilt position because the patient sinks in (reducing the degree of tilt position) or the positioner slides out of the recommended area
- Offering insufficient support, leading to patient discomfort and noncompliance
- Containing hard, unforgiving materials that can exacerbate pressure injuries
Furthermore, traditional foam wedges also typically require additional aids, such as a glide/repositioning sheet, to help move the patient back into place.
Performance of Support Surfaces: Immersion and Envelopment
Extensive literature supports the significance of load distribution on pressure injury risk. According to the NPIAP, immersion and envelopment are both needed for effective pressure redistribution. Immersion refers to the ability of a surface to distribute body weight by allowing a user to sink into the mattress. Envelopment is the ability of the support surface to conform to the shape of the body as it sinks in. Higher envelopment is characterized by lower, more uniform weight distribution with a high contact area. Unfortunately, commonly used support surfaces are not designed to manage pressure injury risk through immersion and envelopment.
New Advancements in Sacral Pressure Injury Prevention
A new patient positioner technology is designed to effectively offload the sacrum and seamlessly contour the body to reduce boosting while enhancing patient comfort and compliance. Offering an extra 10° of comfort, the patient starts at 40° and holds at 30°, ensuring effective sacral offloading.
These patient positioners, RF Health’s ELEVATE™, address the shortcomings of the current standard of care foam wedges. ELEVATE is the only Q2 positioner currently available that immerses and envelopes a patient to increase pressure redistribution over the largest area possible. ELEVATE’s Envelopment Technology™ allows the positioner to contour to the patient’s body for optimal bodyweight pressure distribution, so the patient stays in place at the NPIAP recommended 30º. This collectively increases the total surface area over which the body weight is distributed, reducing contact pressures.
The benefits of this technology include:
- Improved sacral offloading, reducing pressure injury risk
- Reduced risk of work-related injuries for healthcare workers
- Reduced boosting and repositioning needs
- Enhanced patient comfort and compliance
A Note About Mobility: A Critical Factor in Sacral Pressure Injury Prevention
Hospital-acquired immobility, a condition resulting from a lack of mobility and physical function due to prolonged bed rest during a hospital stay, is another significant contributor to sacral pressure injury development. Early mobilization programs and Q2 turning protocols are crucial to prevent the onset of hospital-acquired immobility and related complications.
In early mobilization programs, patients benefit from periodic changes in position, such as turning or sitting up in bed. Modern patient positioners such as ELEVATE help support critical early mobilization efforts by encouraging patient mobility and movement -providing stable, comfortable support for patients.
Conclusion
Sacral pressure injuries are a persistent yet preventable healthcare challenge. As the healthcare community continues to grapple with the complexities of sacral pressure injury prevention, it’s clear that a new approach is needed. By addressing the limitations of the current standard of care— pillows or foam wedges—and prioritizing comfort, mobility, and proper sacral offloading, innovations such as ELEVATE can help significantly reduce the risk of sacral pressure injuries, improve patient outcomes, and alleviate the strain on healthcare workers.