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Understanding Pressure Ulcer and Pressure Sore Grading

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Understanding Pressure Ulcer and Pressure Sore Grading

Pressure sores are a very common problem for individuals in long term care. Also known as ‘bed sores’, they are caused by staying in one position for too long, so they often affect residents who spend long periods of time in a bed or wheelchair.

The parts of the body that are most at risk of developing pressure ulcers and sores are bony areas which are in direct contact with supporting surfaces – for example, shoulders, elbows, knees, ankles and heels. Read on below to find out more about different types of pressure sore, and what you can do to help treat them for those in your care.


How are pressure sores graded?

The severity of pressure sores varies in each individual case but there is a grading system created by the European Pressure Ulcer Advisory Panel. It is divided into four grades as follows:

Grade one

This is the most superficial type of pressure ulcer. The area of skin appears discoloured, often red or purple. It does not turn white when pressure is applied and the skin remains intact. These ulcers may hurt or itch, could feel warm, and may feel either firmer or softer than the surrounding skin. 

Grade two

With an ulcer of this type, some outer layers of the skin will be damaged, with possible damage to the deeper layers in some cases. A grade two ulcer will cause some skin loss, which makes the wound appear open or blistered. 

Grade three

With a grade three ulcer, damage will have occurred through the entire thickness of the skin and some of the underlying tissue will also be damaged. The bone will not have been affected but the ulcer will appear deep, much like a cavity wound. 

Grade four

This is the most severe type of pressure ulcer. The skin will be heavily damaged and some of the tissue around the ulcer may have started to die in a process called tissue necrosis. There may even be some damage to the underlying muscles and bones. This can put patients at risk of developing life-threatening infections. 


How to treat pressure sores

Once you’ve assessed that an individual is suffering from a pressure sore or ulcer, medical advice from a doctor is essential. Pressure sores can cause a range of problems, and the care required may involve a number of different healthcare professionals.

This multi-disciplinary team may include a tissue viability nurse (who specialises in wound care and prevention), physiotherapists, OTs, dieticians and even surgeons – depending on the severity of the case.

As well as getting the right professionals on board, care staff can help individuals with pressure sores in a number of ways, as outlined below.

Changing position

One of the main ways to treat pressure sores is by ensuring that individuals regularly change the positions of their bodies. This can help prevent ulcers from developing, as well as preventing existing ulcers from getting more severe. This may involve creating a repositioning timetable depending on the person’s needs. 

Additional support such as dynamic mattresses and cushions can also help to reduce the impact of pressure sores.


You will also need to consider the types of bandages and dressings you’ll need to protect the ulcer and encourage healing. The type of dressing required will depend on each individual case, but some of the main types used are hydrocolloid dressings and alginate dressings.

Hydrocolloid dressings contain gels that encourage the growth of new skin in the ulcer whilst protecting the area around it. Alginate dressings contain sodium and calcium which are derived from seaweed, and they help to speed up the natural healing process. Antibiotics, creams and ointments may also be used to treat the ulcer.


As well as administering treatments to the wound itself, carers should also think about nutrition and changes to diet. Certain dietary supplements such as protein, zinc and vitamin C have all been shown to help.

Other treatments

In some cases, there may be a need for debridement to remove dead tissue and, in some extreme cases (usually grade 4 ulcers), individuals may even require surgery.


We hope you’ve found this guide to pressure sore grading and treatment useful. Here at Care Shop, we offer a wide range of products to help treat and manage pressure sores, including a dedicated range of pressure care products, so you can find everything you need to bring comfort and relief to those you care for. 

Pressure sores are a very common problem for individuals in long term care. Also known as ‘bed sores’, they are caused by staying in one position for too long, so they often affect residents who spend long periods of time in a bed or wheelchair . The parts of the body that are...

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