Understanding and Preventing Hospital-Acquired Pressure Injuries
What are Hospital-Acquired Pressure Injuries (HAPIs)?
Hospital Acquired Pressure Injuries (HAPIs), also known as bedsores, pressure ulcers, or decubitus ulcers, are localized injuries to the skin and underlying tissue caused by prolonged pressure, friction, shear, or moisture. Patients are at higher risk for developing a pressure injury if they have limited mobility or their Braden Score is 18 or less.
Sacral pressure injuries are the leading cause of hospital-acquired pressure injuries, with heel ulcers ranking as the second leading cause. HAPIs are painful, difficult to treat, and largely preventable. They are also considered an indicator of the quality of care provided in a healthcare setting.
Despite prevention guidelines, HAPIs remain a serious and costly issue. The Agency for Healthcare Research and Quality (AHRQ) estimates that more than 2.5 million patients in the U.S. develop pressure injuries each year, with over 60,000 deaths attributed to related complications. These injuries can increase the risk of pain and infection as well as the length of hospital stays and readmission, drive up costs, and decrease patient satisfaction and outcomes if not taken seriously.
$9.1-$11.6B
Annual national
pressure injury cost
$21 to $152K
Cost range for individual
patient care cost per HAPI
>17,000
Annual lawsuits related to HAPIs,
second to wrongful death
How Hospital-Acquired Pressure Injuries Impact Care and Outcomes
For healthcare providers, HAPIs are associated with financial penalties, reputational risk, greater resource utilization, and added burden on clinical staff. Preventing HAPIs is not only essential for improving patient experiences and outcomes but also for supporting operational efficiency and reducing avoidable costs.
The Centers for Medicare & Medicaid Services (CMS) has recognized this growing problem and introduced the “Hospital Harm – Pressure Injury” electronic Clinical Quality Measure (eCQM) measure for the 2025 Inpatient Quality Reporting program. This measure will require hospitals to report new Stage 2 pressure injuries starting in 2028, making it voluntary in 2025, directly impacting reimbursement rates.
Prevention is Possible
According to the National Pressure Injury Prevention Panel (NPIAP) key prevention strategies include:
- Routine skin inspections for early identification of pressure points and skin changes.
- Equipping care teams with the best practices and tools to recognize risk factors and act early.
- Turning and repositioning patients at risk, ideally every two hours. For the sacral area, provide a 30-degree turn off of the sacrum.
- Using positioning aids that minimize friction/shear
- Offloading and elevating the heels to reduce direct pressure on this high-risk area.
- Implementing an early mobilization programs.
While pressure injury prevention guidelines emphasize key elements such as repositioning and offloading, maintaining turning schedules and timely access to appropriate equipment are often where the challenges occur. Patient compliance is an important factor, as many find current pressure offloading devices uncomfortable; often leading to patient refusals. The right tools make the difference.
At RF Health, we believe in proactive, practical solutions that make prevention easier at every touchpoint of care. With products that address the leading causes of hospital-acquired pressure injuries, including ELEVATE and HeelP.O.D., we help healthcare teams protect skin integrity, reduce harm, and elevate the standard of care with minimal disruption to workflow.
When pressure injuries are prevented:
Patient outcomes improve
Length of stay is reduced
Costs of care decrease
Hospitals avoid CMS penalties and litigation risk
A Note on Immersion and Envelopment
Extensive literature supports the significance of load distribution on pressure injury risk. According to the National Pressure Injury Advisory Panel (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 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.
Unfortunately, commonly used support surfaces are not designed to manage pressure injury risk through immersion and envelopment. However, our ELEVATE and HeelP.O.D pressure injury prevention solutions feature proprietary immersion and envelopment technologies to enable the devices to more effectively contour to the body shape and remain securely in place, improving patient comfort and compliance.