Despite decades of clinical guidance and growing awareness that many pressure injuries are preventable, they continue to affect millions of patients each year and place significant strain on clinicians, health systems and patients themselves.
In hospital settings across North America, the pooled hospital-acquired pressure injury rate has been reported at 8.4%, or 5.1% when Stage 1 injuries are excluded, with nearly two-thirds (61.8%) of all pressure injuries being hospital-acquired (Li et al, 2020).
In the United States alone, an estimated 2.5 million people develop a pressure injury in acute care facilities each year. The average cost per patient is $10,708, resulting in total annual costs estimated to exceed $26.8 billion (Padula and Delarmente, 2019).
The burden of pressure injuries extends beyond direct treatment costs. Nursing time accounts for approximately 41% of the total cost associated with hospital-acquired pressure injury care (Posnett et al, 2009). In intensive care settings, the cost of a single hospital-acquired pressure injury may reach $32,000 per patient (Wassel et al, 2020). When pressure injuries do occur, they can have a profound impact on patient well-being and may be painful, debilitating and, in severe cases, life-threatening (Moore et al, 2011; Sullivan, 2013).
While prevention guidelines are well established, variation in practice remains common. Differences in staffing, workflow, access to prevention technologies and interpretation of recommendations continue to contribute to gaps between evidence and routine care.
As such, in November 2025, a multidisciplinary group of clinicians, researchers and healthcare leaders convened in Boston, Massachusetts, United States, to review current evidence, share clinical experience and develop consensus-based recommendations for pressure injury prevention within the United States healthcare context.
The purpose of this document is to:
- Establish an understanding of pressure injury etiology, with particular focus on sustained soft tissue deformations and the roles of pressure, shear and exposure time
- Evaluate and contextualize the evidence for two prevention modalities: remote patient monitoring sensors and prophylactic dressings, within a pressure injury prevention framework
- Provide an implementation-focused toolkit that translates evidence into action through structured quality improvement tools.
Pressure injury prevention is inherently multifactorial. While many interventions and system-level factors contribute to effective prevention, this document focuses on two elements, the LEAF™ Patient Monitoring System (Smith+Nephew) and prophylactic dressings, as examples of targeted interventions that can be integrated into comprehensive prevention programs.
The accompanying toolkit includes example frameworks, driver diagrams and standardized processes designed to help health systems understand their current state, identify contributing factors, test targeted changes and sustain improvement over time. The suggested tools presented are not intended to be exhaustive or prescriptive but rather to demonstrate how evidence-informed tools can be applied within structured frameworks to address local challenges. The most appropriate approach will depend on the care setting, the team involved and the specific improvement goals.
Ultimately, this document aims to support healthcare teams to consistently deliver evidence-based, proactive and effective pressure injury prevention, improving outcomes for patients while supporting clinicians and health systems in meeting the growing demands of care.
Cathy Milne, Co-Chair, MSN, APRN, CWOCN-AP, ANP/ACNS-BC, WOCNF
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