Pressure Injury 101: Stage 3 Pressure Ulcers

Here are the signs of stage three ulcer development.


In the healthcare industry, conversations surrounding risk management and patient care will inevitably lead to the topic of pressure injuries. And rightly so, as they are concerning to health care practitioners right across the globe. In the United States alone, 2.5 million people develop pressure injuries (also known as pressure sores or bedsores) each year. Of that number, a startling 60,000 patients die as a result of pressure injuries. Those bedsores, also known as hospital acquired pressure ulcers (HAPUs), develop in operating rooms and hospital beds. In fact, up to 45% of HAPUs originate in the operating room—reminding us that pressure injury management must remain a top priority when designing patient care plans. If left untreated, pressure sores and pressure ulcers can cause severe tissue damage and even death; proper treatment (and better yet—complete prevention) is key.

In the past year, we’ve seen continual reminders that the prevention of pressure sores must go beyond simple management efforts, instead reaching to more intelligent prevention tactics. The COVID-19 pandemic continues raging worldwide, putting significant strain on hospitals. To alleviate pressure on healthcare workers, we have an opportunity to work smarter in the prevention and mitigation of pressure injuries by integrating technology that helps staff optimize labor-intensive and time consuming pressure sore prevention methods.

At XSENSOR, we produce high-tech equipment that enables health care professionals to prevent the development of bed sores efficiently. With equipment crafted specifically to assess risk, redistribute pressure and help with diagnosis and treatment, we're working toward a future where pressure injury monitoring puts less strain on health practitioners, so they can dedicate life-saving attention where it’s most needed.


What are the stages of a pressure sore?

Pressure sores, also known commonly as pressure ulcers, bedsores or decubitus ulcers, are injuries to the body caused by sustained pressure. Pressure sore severity can be categorized according to four main phases—from a stage one ulcer where the skin is just beginning to show damage, to a stage four ulcer with open wounds, sores and signs of infection. Whatever the stage, all should be taken seriously and treated with urgency. Here are the four stages of a pressure sore.

Stage 1 Pressure Sores and Ulcers: Early on in pressure ulcer development, the skin is developing injury. While no open sores or broken skin are present yet, skin may appear redder, warmer or firmer than usual. Known as a non-blanchable erythema of intact skin, the color change may indicate the beginnings of a serious injury to the deep tissue. 

Stage 2 Pressure Sores and Ulcers: This is where the true sore, or ulcer, develops as a break in the skin and an open sore. It is often very painful, and can create serious damage within the skin. Known as partial-thickness skin loss with exposed dermis, these bed wounds can quickly become something worse and may even present as a blood-filled blister.

Stage 3 Pressure Sores and Ulcers: In stage three, the pressure ulcer has developed into the soft tissue underneath the skin. Known as full-thickness skin loss, this stage may show a deep wound, especially in an area with more adipose tissue. 

Stage 4 Pressure Sores and Ulcers: By the final and most serious stage of a pressure sore, the skin may have receded into the muscle and bone, causing lasting damage to the skin and underlying areas. Known as full-thickness skin and tissue loss, this stage can involve visible or palpable fascia, tendon, muscle and bone, muscle tendon and even dead tissue.


How to identify a stage three pressure ulcer

Stage 3 Pressure Injury Lightly Pigmented Skin

When identifying a stage three ulcer, you’ll see a stark difference compared to stage one and two. During stage one, tissue injury is just beginning, but is not yet markedly visible. In stage two pressure injury development, the skin will open, forming a visible ulcer. Health care professionals and patients may see a small abrasion, a blood-filled blister or a dip in the skin. Tissue damage may become apparent, causing serious issues if not dealt with quickly. 

 However, stage three pressure ulcers are worse, extending down into the tissue—particularly where more adipose tissue is present—and often showing exposed fat. Stage three pressure ulcers may not even cause incredible pain. As can happen with deep tissue damage, they may progress quickly because they do not signal pain for the patient.

Stage 3 Pressure Injury Darkly Pigmented Skin Here are some signs to keep in mind when monitoring for a stage three pressure ulcer:

  • The skin has developed a crater, and might even include visible adipose tissue.
  • The sore has a foul odor.
  • The sore is oozing clear liquid, pus or blood.
  • The sore may be covered by slough, but not in a way that destroys tissue visibility.


How to treat a stage three pressure ulcer

Wound care strategies must be implemented quickly with stage three pressure ulcers, especially if any signs of infection are already present. The goal will be preventing the ulcer from progressing to stage four.

Step one of treating a stage three pressure ulcer should, ideally, have taken place at the beginning of the hospital stay itself, using risk assessment technology. By integrating this technology at the outset, health care professionals are able to proactively mitigate development.

Next, health care staff should implement turning and pressure-relieving strategies to significantly reduce or keep pressure off of the wound, while keeping their mind on the bigger picture: when treating one pressure sore, they can’t give a new one opportunity to develop.

Every hospital or health care institution has wound care strategies included in their protocols, which should be implemented immediately. Irrigating and properly dressing the wound is essential, as are antibiotics if needed.

technology to prevent pressure injuries


Equipment to prevent stage three pressure ulcers

Pressure injuries and ulcers present significant challenges in hospital settings. When not identified and treated promptly, they cause unnecessary suffering (and are sometimes life-threatening) for patients. And because the efforts to prevent and mitigate them can be labour-intensive, pressure injury care may cause inefficiencies in health care settings, diverting valuable staff attention from more urgent situations.

By implementing technology that helps prevent ulcer development in the first place, your hospital can make great strides in improving patient care and boosting the efficiency of your staff. XSENSOR offers continuous pressure monitoring technology, giving medical professionals correct, up-to-date data to aid in the mitigation and complete prevention of pressure injuries.

XSENSOR’s ForeSite technology is designed to prevent pressure sores from forming or progressing, by working with three main culprits: surgical tables, hospital beds and wheelchairs.

  • For hospital beds: Our unique ForeSite Intelligent Surface system has more than 1500 sensor cells on the surface of the mattress or overlay to measure patient body surface pressures, displaying data in real time for continuous monitoring. The system includes AI powered body position tracking and a turn clock to track repositioning that informs better patient care.
  • For surgical tables: Our ForeSite OR system carries the same technology through to the operating room, which is excellent for safe positioning and managing risk in longer surgeries.
  • For wheelchairs: Our ForeSite SS system utilizes high accuracy sensing to design safe seating for those in wheelchairs.

At XSENSOR, we’re working toward the same goal that you are: high quality patient care and positive experiences across the board. Our intelligent, dynamic sensing technology gives you the tools to do that work with excellence. Contact us today, and we’ll elevate your standard of care together.

Ultimate Guide To Preventing Pressure Injuries in the Hospital


Berlowitz D, Lukas CV, Parker V, et al. (2014). Preventing pressure ulcers in hospitals: a toolkit for improving quality of care. Agency for Healthcare Research and Quality.

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