Introduction

A pressure injury or ulcer is a localised injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.1 This is a critical issue not only for patients, increasing morbidity and mortality, but also for healthcare workers, contributing to burnout from continuous turning of patients, which greatly increase healthcare costs. Pressure ulcers are a source of multiple complications, and are associated with poorer function, reduced mobility and diminished ability to perform self-care.2 The estimated prevalence of pressure injuries is 18.1% among patients in a tertiary hospital in Singapore in 2019, while the incidence was 3.4 per 1000 admissions.3 In the USA, cost estimates for a single case of a pressure ulcer range from US$500 to US$150 000, with a total cost amounting to US$11 billion annually.4 In addition, the death toll secondary to complications from pressure injuries account for approximately 60 000 deaths per year in the USA alone.5

Pressure injuries most commonly occur over the bony prominences of the sacral and hip regions, with the lower extremities affected in less than 25% of cases.6 The differing …