Seek medical help urgently today if there is:

• Fever, confusion, increasing weakness, or severe pain
• Pus, foul smell, spreading redness/warmth, or black tissue
• A deep crater, exposed fat/muscle/bone, or a wound over the sacrum/heel that is worsening
• Diabetes, poor circulation, paralysis, or a person who is unable to reposition themselves

Home and caregiver care

1. Remove pressure immediately

• Reposition in bed at least every 2 hours, adjusted for comfort, skin condition, and the care plan.
• If sitting, shift weight at least every 15 minutes if able. Assisted repositioning is generally needed at least hourly.
• Keep heels fully off the mattress using pillows placed under the calves, not directly under the heels.
• Use a pressure-redistributing foam mattress or cushion. Avoid donut-shaped rings because they can concentrate pressure.
• Use draw sheets or lifting aids to move the person. Do not drag them across sheets, because friction and shear worsen injury.

2. Check the skin daily

• A red or dark area that does not fade after pressure is relieved can be an early pressure injury.
• Do not massage red or bruised skin.

3. Clean and protect the wound

• Wash hands before and after care.
• Gently rinse an open sore with clean water or sterile saline. Pat surrounding skin dry.
• Cover with the dressing recommended by a clinician. Foam dressings are commonly used for shallow, draining wounds, but dressing choice depends on depth, drainage, dead tissue, and infection.
• Do not routinely use hydrogen peroxide, alcohol, iodine, or harsh antiseptics in an open wound unless a clinician directs it. They can damage healing tissue.
• Do not try to cut away black, yellow, or dead tissue at home.

4. Keep skin dry from urine or stool, but not dried out

• Change wet pads, diapers, sheets, or clothing promptly.
• Clean gently after each episode of incontinence and use a moisture-barrier cream on intact surrounding skin.
• Manage sweating and wound drainage. Moisture increases the risk of skin breakdown.

5. Support healing with food and fluids

• Ensure adequate calories, protein, and fluids, unless fluid intake is restricted for heart or kidney disease.
• Include protein-rich foods such as eggs, dairy, pulses/beans, fish, chicken, tofu, or meat.
• Ask a doctor or dietitian to assess unexplained weight loss, poor appetite, anemia, or dehydration. Poor nutrition and moist skin are recognized risk factors for pressure injuries. Swanson's Family Medicine Review - A Problem-Oriented Approach notes immobility, pressure, moisture, and impaired nutrition among major contributors.

6. Control pain and treat the cause

What a clinician may need to do

• Stage and measure the wound, photograph it for tracking, and create a dressing plan
• Remove dead tissue professionally if appropriate
• Assess infection. Antibiotics are usually for spreading skin infection, sepsis, or bone infection, not simply because a chronic wound is present
• Arrange special mattress/cushion, wound nurse care, nutrition support, and possibly surgery for severe wounds