Despite being largely preventable, hospital-acquired pressure injuries (HAPIs) remain one of the most common and costly hospital-acquired conditions in the United States. More than 2.5 million people are affected annually, with approximately 1 in 10 hospitalized patients developing a pressure injury during their stay.
The financial burden is also staggering: the U.S. healthcare system spends an estimated $12 billion annually managing hospital-acquired pressure injuries, with chronic cases driving that figure to over $22 billion. On an individual level, treatment costs can range from $20,900 to $151,700 per injury. Furthermore, pressure injuries are associated with a 57% longer length of stay and a 22% higher rate of 30-day readmissions.
The Impact on Patients and Healthcare Teams
The most common sites to develop pressure injuries are the sacrum and heels. Both types of HAPIs lead to increased patient suffering, a higher risk of infection, longer recovery times, increased mortality rates, and decreased quality of life.
And the consequences of hospital-acquired pressure injuries extend beyond the bedside. HAPIs are also associated with financial penalties, reputational risk, and greater resource utilization for healthcare providers, as well as added burden on clinical staff.
The Critical Role and Challenge for Nurses
Hospital-acquired pressure injuries demand more time, attention, and care coordination. Nurses are at the front line of pressure injury prevention; they are responsible for identifying at-risk patients and initiating early interventions. Their role is critical to improving outcomes and reducing the incidence of HAPIs.
However, the added workload associated with HAPIs is significant. In a 500-bed hospital, more than 150 nursing hours per day may be dedicated to managing and preventing pressure injuries. Furthermore, transferring, lifting, boosting, and repositioning patients is the leading cause of work-related musculoskeletal disorders in healthcare. The cumulative weight a nurse may have to lift during an 8-hour shift is equal to 1.8 tons (or 9 tons per week)!
Healthcare organizations must rethink how pressure injury prevention is integrated into care workflows in ways that improve patient outcomes, operational efficiency, and work-life quality.
Regulatory Pressure Is Rising
The Centers for Medicare & Medicaid Services (CMS) has long recognized the occurrence of hospital-acquired pressure injuries as a growing concern and an indicator of the quality of care delivered in healthcare settings. Hospitals are currently required to report Stage 3 and 4 pressure injuries for quality reporting and reimbursement purposes. However, change is on the horizon.
CMS recently introduced a new electronic Clinical Quality Measure (eCQM), called “Hospital Harm – Pressure Injury“, for the 2025 Inpatient Quality Reporting (IQR) program. This measure will expand reporting requirements to include new Stage 2 pressure. While reporting is voluntary in 2025, it will become mandatory in 2028 and is expected to influence reimbursement rates.
This regulatory change signals a broader shift toward increased accountability, transparency, earlier detection, and stronger incentives for prevention. Hospitals that delay adapting to these new expectations risk financial penalties and lower performance scores in the future.
Effective Prevention and Management Strategies
The cost of preventing hospital-acquired pressure injury is significantly lower than the cost of treatment.
Proactive strategies for HAPI prevention support operational efficiency, enhance patient experiences and outcomes, and help healthcare systems reduce avoidable costs.
Patients are at higher risk of developing a pressure injury:
- Have limited mobility
- Have a medical condition that prevents them from changing positions or moving
- A Braden Score of 18 or less
However, most pressure injuries are preventable through interventions by healthcare workers, caregivers, and patients. The National Pressure Injury Advisory Panel (NPIAP) outlines several key strategies for prevention, such as the methods detailed below.
Core Prevention Practices
- Repositioning every two hours remains the cornerstone of pressure relief, especially for at-risk patients.
- Use a 30-degree turn off of the sacrum and protect vulnerable areas such as bony prominences
- Utilize offloading tools such as specialized support surfaces to redistribute pressure
- Use heel suspension devices that elevate (float) and offload the heel completely
Tools and Support Devices
- Follow the NPIAP Standardized Pressure Injury Prevention Protocol (S-PIPP) checklist for daily assessment and care planning.
- Use positioning aids that reduce friction and shear, both of which contribute to tissue breakdown.
- For immobile patients, use high-specification reactive foam surfaces to improve pressure redistribution.
Mobility and Engagement
- When possible, implement early mobilization programs to encourage movement and reduce immobility-related pressure.
- Engage patients and caregivers in education around repositioning, skin care, and the importance of frequent movement.
By aligning care practices with these proven strategies, healthcare organizations can make significant progress in reducing pressure injury rates.
The Importance of Immersion and Envelopment in Hospital-Acquired Pressure Injury Prevention
When selecting support surfaces for pressure injury prevention, clinicians should prioritize options that provide both immersion and envelopment, two critical characteristics for optimal pressure redistribution. Extensive clinical literature, including guidance from the National Pressure Injury Advisory Panel (NPIAP), reinforces the significance of load distribution with immersion and envelopment in reducing the risk of pressure injuries.
Immersion refers to the ability of a surface to distribute body weight by allowing a user to “sink in.” 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. Together, these properties maximize contact area and reduce peak pressures on vulnerable areas such as the sacrum and heels.
However, many commonly used hospital support surfaces do not provide effective immersion and envelopment, limiting their effectiveness in high-risk patients. Investing in advanced surfaces designed to optimize both factors can play a crucial role in a comprehensive pressure injury prevention strategy.
Innovations in Pressure Injury Prevention
At RF Health, we’re committed to overcoming these challenges by offering patient-centered solutions that support healthcare teams and improve outcomes using voice of the customer (VOC) based feedback from clinicians in the field. Our Pressure Injury Prevention (PIP) portfolio directly targets the two most common and costly HAPIs: sacral and heel pressure injuries.
Our pressure injury prevention solutions ELEVATE™ and HeelP.O.D.™ feature immersion and envelopment technologies so the devices effectively contour to the body shape and remain securely in place.
HeelPOD uniquely offloads or “floats” the foot, ensuring full heel access and visualization. The device supports wound care efforts by allowing continuous use during wound debridement, dressing changes, skin assessments, and range of motion therapy. It streamlines application and removal, saving valuable time in patient care while enhancing patient comfort and compliance.
ELEVATE Patient Positioners effectively offload the sacrum and seamlessly contour to the body for optimal bodyweight pressure redistribution – overall enhancing patient comfort and compliance. The weight-activated grip keeps the patient in place with a proprietary material that grips to the mattress; the patient starts at 40 ° and holds at 30°, as recommended by the NPIAP guidelines.
These innovative pressure injury prevention solutions are designed to prevent patients from getting a HAPI and ease the burden on clinical teams.
When pressure injuries are prevented:
- Hospitals avoid CMS penalties and litigation risk
- Length of stay is reduced
- Costs of care decrease
- Patient outcomes improve
Learn more about hospital-acquired pressure injury prevention in our latest infographic.