The burden of pressure injuries is greater than you think

About 13% of overnight hospitalised patients in Australia will suffer a pressure injury¹ and, despite advancements in prevention and treatment, pressure injuries have serious clinical and economic consequences – not to mention a profound impact on patients.

 

The human cost of pressure injuries

For patients, the burden of pressure injuries extends well beyond physical discomfort. Sarah Sage, Clinical Nurse Consultant Wound Management at the Royal Melbourne Hospital, emphasises the devastating impact these wounds can have, particularly for patients nearing the end of life.

“They're not going to experience that pressure injury for a long time but the impact of that pressure injury in that moment is immense,” she says.

“You have a person who already has suffering or trauma, maybe cancer, and then they have this additional painful thing to deal with.”

At this stage, frequent repositioning - crucial for pressure injury management - can be painful and disruptive, requiring sedatives that may reduce patients’ ability to spend meaningful time with loved ones.

Pressure injuries also prolong a patient’s length of stay in hospital. A recent systematic review found that pressure injuries increased the length of stay by an average of 12.9 days².

Even for those who are discharged into the community, the aftermath of a pressure injury can be life-altering. A person may no longer be able to sit comfortably, enjoy social activities, or even watch television without discomfort, says Ms Sage.

Some wounds may take three to four months to heal, while others may remain open indefinitely if surgical intervention is not possible. In these cases, patients must live with the implications of a hard-to-heal (chronic) wound, including pain, infection risk and psychological distress.

Elizabeth Faust, a Wound, Ostomy and Continence Nurse Practitioner from Pennsylvania in the US, says: “Pressure injuries are painful and they take a lot of nursing time. They can challenge the nursing staff who have to treat and prevent the wounds – but it's ultimately that patient who really suffers.”

 

The cost to healthcare providers and facilities

Pressure injuries are not just a personal health crisis - they are also seen as a reflection of care quality.

Ms Faust says that, historically, the development of pressure injuries in hospitals has been perceived as an indicator of poor nursing care – a perception that still lingers despite the growing understanding of the many contributing factors. This reputation can negatively impact a facility’s credibility and reputation, further intensifying the pressure on care teams.

From a resource perspective, hospitals spend significant time and money on pressure injury prevention and treatment. These injuries need wound dressings for prophylaxis and treatment, medical devices such as heel boots, specialist consultations and extended nursing care.

Ms Sage highlights that time spent managing pressure injuries can reduce nurses’ attention to other vital aspects of patient care, such as emotional support, fall prevention, or pain management.

There’s also a substantial emotional toll on healthcare staff. When a patient develops a pressure injury, the team may face internal reviews or investigations, leading to guilt and stress.

As Ms Sage put it, “Discharging someone home with a hospital-acquired pressure injury or to another service is incredibly difficult.”

 

The financial burden

All these factors affect the bottom line. A 12-month Australian cost-of-illness study published in 2022 found that the total cost of pressure injuries in our public hospitals was $9.11 billion, based on a prevalence of 12.9%¹. This was largely due to excess length of stay in hospital and the costs of treatment – and $5.5 billion was due to hospital-acquired pressure injuries¹. It also found that Stage 2 pressure injuries accounted for most treatment costs, length of stay costs and loss of healthy years lost¹.

The authors concluded: “Reducing preventable pressure injuries and stopping the progression of Stage 1 pressure injuries will likely result in an immense cost-saving for Australia¹.”

 

What can healthcare professionals do to relieve the burden of pressure injuries?

Ms Faust says: “Health economics show that if we can prevent pressure injuries, we will save so much more money than if we are treating them because even when a patient develops a pressure injury, you don't stop the prevention strategies. So the additional costs of the dressings and the nursing time are all factors in the burden of that pressure injury.”

The good news is that healthcare professionals can – and do – gain endorsement and support from hospital executives or policymakers for pressure injury prevention strategies, although it can be challenging.

Michelle Barakat-Johnson, Professor of Wound Care and Skin Integrity at the University of Sydney and Sydney Local Health District, stresses the importance of approaching hospital executives and policymakers with clear, evidence-backed proposals.

Whether it’s introducing a new mattress system or updating protocols, successful advocacy begins with data, she says.

"Hospital executives and policymakers are driven by outcomes, numbers, and patient safety," she says.

"When I present an initiative, I make sure I can answer three key questions: What’s the evidence? What’s the cost, both financially and to the patient? And how will this impact clinicians - will it make their work easier?"

 

What works?

Professor Barakat-Johnson’s own research in one health district has shown that a comprehensive, evidence-based, intervention program reduced the burden and costs of pressure injuries. 

The program, known as the Hospital-Acquired Pressure Injury (HAPI) project, included changes such as replacing plastic sheets and underpads with correctly fitting incontinence pads, standardisation of incontinence products, applying prophylactic dressings (Mepilex® Border dressings from Mölnlycke®) to reduce shear and friction in high-risk patients, purchase of therapeutic beds and high-back chairs, an education campaign and district-wide collaboration³.

Results published in 2018 showed that the program led to a reduction in the incidence of hospital-acquired pressure injuries of 51.4% and a prevalence reduction of 71.6%, as well as a cost reduction of 23.1%, which added up to a reduction of A$837,387³.

Data five years down the track show that the incidence of hospital-acquired pressure injuries has decreased by 32.6 % since 2018/19 and Stage III and IV hospital-acquired complications dropped by 27.3%⁴.

The authors concluded: “This achievement highlights the benefits of utilising an implementation science approach to implementing a multi-faceted intervention in a complex healthcare setting…”

References:

1. Nghiem S, Campbell J, Walker RM, Byrnes J, Chaboyer W. Pressure injuries in Australian public hospitals: A cost of illness study. Int J Nurs Stud 2022;130:104191. doi: 10.1016/j.ijnurstu.2022.104191. 

2. Hasan B, Bechenati D, Bethel HM, Cho S, Rajjoub NS, Murad ST, Allababidi AK, Rajjo TI, Yousufuddin M. A systematic review of length of stay linked to hospital-acquired falls, pressure ulcers, central line-associated bloodstream infections, and surgical site infections. Mayo Clin Proc Innov Qual Outcomes 2025;9(3):100607.

3. Barakat-Johnson M, Lai M, Wand T, White K, De Abreu Lourenco R. Costs and consequences of an intervention-based program to reduce hospital-acquired pressure injuries in one health district in Australia. Aust Health Rev 2019;43(5):516-525. doi: 10.1071/AH18131.

4. Barakat-Johnson M, Lai M, Graham J, Hallahan A, Coyer F. The “HAPI” project five years on: incidence and prevalence of hospital-acquired pressure injuries in one local health district in Australia. J Tissue Viability 2025;34(1):100846. doi: 10.1016/j.jtv.2024.12.010.