Published online: 01 September 2026
Glossary
Suggested citation
National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Glossary. In: Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline: Fourth Edition. Emily Haesler (Ed.). 2026. [cited: download date]. Available from: https://internationalguideline.com.
Terms and Definitions
Abrasion: A loss of the epidermis through some mechanical process, such as friction or trauma.
Abscess: A localized collection of pus surrounded by inflamed tissue, usually due to an infective process.
Active support surface: A powered support surface, with the capability to change its load distribution properties, independent of applied load (1).
Acute wound: A surgical or traumatic wound that heals by primary or secondary intention and which proceeds through an orderly and timely reparative process that results in sustained restoration of anatomical integrity. (2).
Adjunct therapy: A substance (or therapy) that aids or heightens the action of another therapy, thereby maximizing prevention or treatment.
Adjuvant therapy: See adjunct therapy.
Albumin: Albumin makes up 60% of total protein in the blood. It decreases with stress, age, and impaired liver function. Albumin serves to maintain colloid osmotic pressure and as a transport protein for certain ions, hormones, medications, enzymes, fatty acids, amino acids, and bilirubin. It decreases with over-hydration, stress, infection, impaired renal function, and liver disease, among other causes. Normal albumin blood level is 3.5 to 5.4 gm/dL. Normal values may vary depending upon the laboratory performing analysis. Low albumin is considered a risk factor for pressure injury development. Low albumin is no longer considered a valid measure of nutritional status.
Air fluidized: A design feature of a support surface that utilizes air flow through a medium (e.g., beads) producing a fluid like state. The intent is to provide pressure redistribution, microclimate and shear management (1). The National Pressure Injury Advisory Panel (NPIAP) Standards Committee subcommittee, Support Surface Standards Initiative (S3I), coordinates the development of uniform terminology and education for support surfaces.
Alternating pressure: A design feature of a support surface that utilizes cyclic changes in loading and unloading as characterized by frequency, duration, amplitude, and rate of change parameters. It provides active pressure redistribution (1). Review the material provided by the NPIAP Standards Committee subcommittee, S3I for detailed definitions.
Anasarca: Diffuse, systemic edema arising from an accumulation of fluid in the interstitial space. Anasarca often occurs in congestive heart failure, liver failure, renal disease, or after fluid resuscitation in septic or other types of shock.
Angiogenesis: The process of developing new blood vessels from pre-existing blood vessels within the wound space; an integral part of wound healing.
Antibacterial: A term used to encompass antibiotics, antiseptics and disinfectants. A substance that inhibits the growth of, or eradicates bacteria (3).
Antibiotic: A natural or synthetic substance administered systemically or topically that has the capacity to destroy or inhibit bacterial growth. Antibiotics target specific sites with bacterial cells while having no influence on human cells, thus they usually have low toxicity (4).
Antimicrobial: A substance that acts directly on a microorganism to destroy bacteria, fungi, spores or viruses and prevents the development of new growth (5). An antimicrobial is a broad term that includes antiseptics, disinfectants, antibiotics, antiparasitics, antivirals and antifungals (6).
Antiseptic: a topical agent with broad spectrum activity that inhibits multiplication of, or sometimes kills, microorganisms. Depending upon its concentration, an antiseptic may have a toxic effect on human cells. Development of resistance to topical antiseptics is uncommon (4, 6, 7).
Area under Receiver Operator Curve (AUROC): see Receiver Operator Curve.
Artificial nutrition: Artificial nutrition is a medical intervention through which nutrition and hydration are delivered by a route other than oral (i.e., enterally or parenterally) when an individual is unable to take nutrition and hydration by mouth. Both parenteral and enteral nutrition require the consent of the individual or his or her family.
Enteral nutrition is nutrition therapy given via a tube or stoma into the intestinal tract distal to the oral cavity. The tube could be inserted via the nose; i.e. naso-gastric, naso-jejunal or naso-post pyloric tube feeding; or via a stoma that is inserted endoscopically into the stomach; i.e. percutaneous endoscopic gastrostomy (PEG) or with a jejunal extension (PEG-J) or into the jejunum (percutaneous endoscopic jejunostomy [PEJ]). Finally, the tube may also be placed surgically; i.e. surgical gastrostomy or jejunostomy (8).
Parenteral nutrition is a type of nutrition therapy provided through intravenous administration of nutrients such as amino acids, glucose, lipids, electrolytes, vitamins and trace elements. PN can be delivered centrally through a central venous line, or peripherally through a peripheral intravenous line (8).
Asepsis: A state of being free from infectious (pathogenic) agents (4).
Aseptic technique: A practice framework to prevent microorganism cross-infection when performing a wound dressing procedure (9). There are two accepted frameworks of aseptic technique ( sterile/surgical aseptic technique and clean/standard aseptic technique) that are described in topic-specific clinical guidance (6). Selection of an aseptic technique is guided by a risk assessment of the individual, their wound and environmental factors; local policies and resources and the context of care (7, 10).
Autolysis: see Debridement.
Avascular: having few or no blood vessels.
Barrier film/cream/ointment: Substance or leave-on product used as a protective layer (barrier) to prevent skin irritation.
Biofilm: Aggregate microorganisms that have unique characteristics and enhanced tolerance to treatment and host defences. Wound biofilms are associated with impaired wound healing and signs and symptoms of chronic inflammation (4, 6, 7). Also see Microbial burden.
Biophysical agent: An agent used to deliver a specific treatment substance to a wound, e.g., oxygen, negative pressure wound therapy, pulsatile lavage with suction, electrical stimulation or whirlpool, among many others (11).
Blanchable erythema: see Erythema.
Body configuration: The general form and appearance of the individual’s body and body parts. Body configuration can be influenced by any factor that influences ability to maintain posture and balance, including but not limited to contractures, spasticity, deformities, amputation and paralysis.
Body mass index (BMI): Defined as an individual’s weight in kilograms divided by the square of his height in meters.
Bolster pad: A pad used as a support. Frequently used in beds with lateral rotation features to keep the patient from sliding during rotation and sustaining shear injuries.
Bony prominence: A bony elevation or projection on an anatomical structure.
Bottoming out: The state of support surface deformation beyond critical immersion whereby effective pressure redistribution is lost (1).
Bridging: The presence of strands of tissue across the ulcer bed.
Callus: Reactive hyperkeratosis, usually due to friction and/or pressure, leading to skin color changes (12) .
Carer (also referred to as informal carer or caregiver): Terms used in this guideline to refer to the individual’s support network who are involved in decision-making, advocacy, education and care delivery. These individuals are usual part of the individual’s inner support network and include family, neighbours, friends and may extend to religious and cultural leaders.
Category/Stage: Terms used to describe the subclassifications of pressure injuries/ulcers. Stage is preferred by some; despite the fact it may erroneously imply a “progression of Category/Stage 1 through 4” and “healing from Category/Stage 4 through 1”. Category is preferred by others because the term does not convey the erroneous impression of “stages” of progression or deterioration.
Cellulitis: An acute, diffuse and spreading infection of the skin and subcutaneous tissues that occurs when bacteria (13) and/or their products have invaded surrounding tissues (4, 6, 14).
Certainty of evidence: The certainty of evidence refers to the confidence that effect estimates fall within a specific range or above/below a particular threshold of interest. It is closely tied to the use of effect thresholds or certainty ranges for the estimated effect (15).More information is provided in the guideline methodology.
Chronic/hard-to-heal wound: A wound that makes slow progression through the healing phases or displays delayed, interrupted or stalled healing. Inhibited healing may be due to intrinsic and extrinsic factors that impact on the person, their wound and their healing environment (4).
Circumscribed: Distinct demarcation between involved and uninvolved skin (12).
Cleansing (also called therapeutic cleansing): Wound cleansing is actively removing surface contaminants, loose debris, non-attached non-viable tissue, microorganisms and/or remnants of previous dressings from the wound surface and its surrounding skin (6, 7).
Clinical judgement: An overarching concept integrating all reasoning tasks and actions performed by health professionals to describe and assess a health condition of interest (16). It describes the sum of cognitive actions carried out by health professionals to interpret and synthesize information to derive a diagnosis and management plan for an individual. The term, informed clinical judgement, indicates clinical judgement is informed by evidence-based practice.
Coefficient of friction: A ratio between the parallel force that is needed to start or maintain motion between two objects in contact with each other and the perpendicular force holding them together (1).
Collagen: The most abundant protein of the dermis, accounting for 70 to 80% of its dry weight; the main supportive protein of the skin and connective tissue.
Cohen’s kappa (κ): A statistical index of reliability between two nominal measurements, often used to assess interrater or intrarater reliability (17).
Confidence interval (CI): A measure of the uncertainty around the main finding of a statistical analysis. Estimates of unknown quantities, such as the RR (relative risk) comparing an experimental intervention with a control, are usually presented as a point estimate and a 95% confidence interval. This means that if someone were to keep repeating a study in other samples from the same population, 95% of the calculated confidence intervals from those studies would include the true underlying value. Conceptually easier than this definition is to think of the CI as the range in which the truth plausibly lies. Wider intervals indicate less precision; narrow intervals, greater precision (18).
Consistency (of skin and tissue on palpation): degree of firmness, density, viscosity, or resistance to movement or separation of constituent parts. see Induration, Crepitus.
Contraction: Pulling together wound edges in the healing process.
Contour seating: A seating product that increases contact area with the body by providing a contour that resembles the typical human form.
Crepitus: A cracking, crunchy, or popping sensation upon palpation of soft tissue related to underlying gas in the tissue released by anaerobes; indicative of the presence of air bubbles in the tissue. Depending on the anaerobic organism involved, tissue damage can progress rapidly.
Cross infection: Transfer of microorganisms (e.g. bacteria, virus) from one person, object or location (e.g. anatomical location) to another person, object or location (4).
Culture (wound): A sample of tissue or fluid taken from the wound bed for laboratory testing. In the laboratory the sample is placed in a substance that promotes growth of organisms and the type and quantity of organisms that grow is assessed by microscopy (4). The sensitivity of the organism to various antibiotics can also be tested.
Cytokine: see Proinflammatory cytokines.
Cytotoxic: Refers to a substance that has a toxic effect on an important cellular function. In the context of wounds, cytotoxicity generally refers to the potential adverse effect of destroying cells that are involved in tissue healing, including fibroblasts, macrophages and neutrophils that may be a risk associated with applying substances to the wound (4).
Dead space: An area of tissue loss in a cavity or tract.
Debridement: The removal of devitalized (non-viable) tissue from or adjacent to a wound. Debridement also removes exudate and bacterial colonies (e.g. biofilm) from the wound bed and promotes a stimulatory (4) Review relevant topic-specific clinical guidance for more information on debridement techniques and their appropriate selection (6, 19, 20).
Deep tissue pressure injury (DTPI): (also called suspected deep tissue injury [sDTI]): Persistent non-blanchable deep red, maroon or purple discoloration. Intact or non-intact skin with localized area of persistent non-blanchable deep red, maroon, purple discoloration or epidermal separation revealing a dark wound bed or blood-filled blister. Pain and temperature change often precede skin color changes. Discoloration may appear differently in darkly pigmented skin. This injury results from intense and/or prolonged pressure and shear forces at the bone-muscle interface. The wound may evolve rapidly to reveal the actual extent of tissue injury or may resolve without tissue loss. If necrotic tissue, subcutaneous tissue, granulation tissue, fascia, muscle or other underlying structures are visible, this indicates a full thickness pressure injury (Unstageable, Category/Stage 3 or Category/Stage 4). Do not use DTPI to describe vascular, traumatic, neuropathic, or dermatologic conditions (21).
Delayed wound healing: Wound healing that progresses at a slower rate than expected (4). Chronic wounds without infection can be expected to show signs of healing within two weeks (11).
Devitalized tissue: Dead tissue presenting as necrotic tissue or slough (4).
Direct current: A term describing a feature of electrical stimulation, direct current is the continuous, unidirectional flow of charged particles.
Dressings (for wounds): A material applied to a wound for a variety of reasons, including promotion of healing, protection, absorption of exudate, moisture balance, control of malodor and minimization of pain. The selection of a dressing is dependent on the condition of the wound, the preferences of the patient and provider and the availability of various wound dressing products (6).
Early mobilization: A systematic approach to initiating resumption of physical activity and movement following illness-related immobilization. Physical activity and movement are incrementally increased according to the patient’s tolerance and physiological responses. Originally developed as part of a protocol to prevent delirium in critically ill patients, it has been extended to other settings and populations based on positive patient outcomes such as shortened length of stay, improved functional outcomes, decreased one-year mortality rates, enhanced quality of life and fewer pressure injuries (22).
Ecchymosis (bruise): Hemorrhage into the skin, usually due to trauma (12). Should not be confused with sDTI/DTPI.
Effectiveness study: A clinical trial designed to test the effectiveness of an intervention under standard real-world conditions, often with an intervention already found to be efficacious in an efficacy study; sometimes called pragmatic trials (23).
Efficacy study: A tightly controlled trial (e.g., randomized controlled trial [RCT]) designed to establish the efficacy of an intervention under ideal conditions, using a design that maximizes internal validity; sometimes called an explanatory trial (23).
Electrical stimulation: The use of an electrical current to transfer energy controlled by an electrical source. In the prevention and treatment of pressure injuries, electrical stimulation is used as a wound healing therapy and is emerging as a therapy to stimulate muscles in individuals who are unable to reposition (11).
Electromagnetic spectrum (EMS): is an energy source that affects living systems. The EMS comprises infrared (thermal radiation), ultraviolet light (invisible light), laser (coherent and monochromatic light) and electrical/electromagnetic stimulation (11).
Emollient: Cosmetic ingredient remaining on and in the skin surface to retain water within the stratum corneum.
Enhanced food: see Fortified food.
Enteral nutrition: see Artificial nutrition.
Envelopment: The ability of a support surface to conform (fit or mold) around the body (1).
Epibole: A condition that exists when epithelialization fails; the edges of the top layers of epidermis have rolled down; and healing stops. Also described as a “rolled wound edge” (24).
Epidermis: The outermost layer of skin.
Epithelialization (re-epithelialization): The process of resurfacing a skin wound with new epithelium (25).
Eschar: Necrotic, devitalized tissue that appears black or brown, can be loose or firmly adherent and hard or soft, and may appear leathery (4, 11).
Eschar (stable): Eschar should be debrided in most situations. A notable exception/contraindication is in situations where perfusion to the debrided area is so impaired that the larger wound created by debridement cannot heal (e.g., heels in individuals with arterial vascular disease). In these situations, maintaining a “stable eschar” is recommended. A stable eschar is intact eschar without signs of infection (i.e., purulent drainage, increased exudate, fluctuance when touched, inflammation or increased pain).
Erosion: Loss of either a portion of or the entire epidermis (12).
Erythema: Superficial reddening of the skin. It should be noted that erythema does not occur as ‘red’ across all skin tones. In darker skin tones, it may not be visible or may appear as a local variation in skin color.
Blanchable erythema: An area of reddened skin that temporarily turns white or pale when light pressure is applied to the skin and reddens when pressure is relieved. Over a pressure site, this is due to a normal hyperemic response (26).
Nonblanchable erythema: Skin redness that persists following the application of pressure, usually over a bony prominence. This is a sign of a Category/Stage I pressure injury. Darkly pigmented skin may not have visible blanching.
Excoriation: A loss of the epidermis and a portion of the dermis due to scratching or an exogenous injury (12).
External validity: The extent to which results provide a correct basis for generalizations to other circumstances. For instance, a meta-analysis of trials of elderly patients may not be generalizable to children. Also called generalizability or applicability (18).
Extrinsic factors: Originating outside of the body.
Exudate: Fluid that is released from tissue and/or capillaries in response to injury, inflammation and/or microbial burden. It is mainly comprised of serum, fibrin, proteins and white blood cells (7).
Fascia: A sheet or band of fibrous tissue that lies deep below the skin or encloses muscles and various organs of the body.
Fatigue (of a support surface): The reduced capacity of a surface or its components to perform as specified. This change may be the result of intended or unintended use and/or prolonged exposure to chemical, thermal, or physical forces (1).
Fistula: Abnormal congenital or acquired passage from an abscess or hollow organ to the skin surface (12).
Flap: A flap is a surgical relocation of tissue from one part of the body to another part in order to reconstruct a primary defect. Flaps may be skin flaps, cutaneous flaps or composite flaps. The flap is often cut and rotated to a neighboring site.
Float: A method used to off-load a body part, such as the heel, of pressure.
Focal edema: Swelling or edema that occurs in an injured area of the body as a result of inflammatory processes.
Fortified foods: Normal food enriched with specific nutrients, in particular with energy and /or protein, minerals, vitamins, or trace elements.
Frequent small shifts: Frequent shifts in the position of the individual, which may be only 10° to 15° at a time; a procedure used to gradually reposition an individual who may be hemodynamically unstable allowing time for stabilization after each incremental shift (11).
Friable: Fragile tissue that bleeds easily (4, 7).
Frailty: a state of vulnerability and non-resilience with limited reserve capacity in major organ systems. This leads to reduced capability to withstand stress (8).
Friction (frictional force): The resistance to motion in a parallel direction relative to the common boundary of two surfaces (1).
Friction blister: A blister within the skin caused by repeated friction.
Full body support surface: A head to foot device (i.e. mattress) or system (e.g. mattress and mattress overlay combination) which is designed for pressure redistribution and may or may not be designed for microclimate management, shear management, and/or other therapeutic functions (1). Review the material provided by the NPIAP Standards Committee subcommittee, S3I for detailed definitions.
Full thickness tissue loss: Tissue loss that extends through the epidermis and dermis to involve the subcutaneous tissue (Category/Stage 3 and 4 pressure injuries) and, if a Category/Stage 4 PI, may extend into the muscle and possibly down to the bone (11).
Functionality: This refers to the intended, proper use and function for which the product was designed.
Functional life span: The designated time period for which medical devices such as support surfaces were designed and intended to fulfill its original function. Also referred to as life expectancy in relation to support surfaces (1).
Grading of Recommendations Assessment, Development and Evaluation (GRADE): A methodology that is considered the gold standard in systematic review and guideline development (15, 18, 27). Application of this method to developing this guideline is described I the methodology protocol and website resources (28).
Granulation tissue: The pink/red, moist, shiny tissue that glistens and is composed of new blood vessels, connective tissue, fibroblasts, and inflammatory cells that fills an open wound when it begins to heal. It typically appears deep pink or red with an irregular, granular surface (11).
Growth factors: Naturally occurring proteins or hormones that stimulate cell growth.
Healable wound: Healing is possible and feasible (29, 30). The patient has the physiologic capacity to heal and is adherent to the plan of care; there is adequate blood supply and the cause of the wound has been corrected (31). See non-healable, maintenance wound, palliative wound.
Healed pressure injury is one that is completely closed, fully epithelialized, covered completely with epithelial tissue, or resurfaced with new skin, even if the area continues to have some surface discoloration (32). This is a useful definition for clinical practice and as an endpoint for clinical studies; however, the healing process for full-thickness wounds continues for months to years after the wound has completely closed.
Health related quality of life: Health related quality of life (HRQoL) is an individual’s perceived physical or mental health (33).
Hematoma: Circumscribed, usually palpable hemorrhage into the skin or soft tissues (12).
Hemorrhage: Bleeding (may be internal or external).
Hospital Acquired Pressure Injury (HAPI) (also called facility acquired pressure injury [FAPI]: The proportion of individuals with pressure injuries at specific point in time that were acquired within the facility. Facility acquired pressure injuries rates are often determined at conjunction with cross-sectional point prevalence study. Existing pressure injuries are documented to determine prevalence rates. Admission documentation is then examined to identify the cases with pressure injuries that were present on admission (POA). In some settings, sDTI/DTPI discovered within 72 hours of admission are considered POA. Essentially, cases with POA pressure injuries are subtracted from both the numerator and denominator. The population, category/stage of pressure injuries considered and criteria for determining POA status should be specified. HAPI/FAPI rates are an estimate of incidence that can be used to evaluate the effectiveness of prevention protocols in the facility (11). The third edition of the International Guideline includes a chapter on prevalence and incidence measurement (11).
(No. of individuals with pressure injury at time point) – (No. of individuals with POA pressure injury)
(No. of individuals in population at time point) – (No. of individuals with POA pressure injury) x100
Host response: The reaction of the individual to the invasion of the microorganism.
Hybrid (support surfaces): A support surface that combines two or more support mediums such as air, gel, foam, and others (1). Review the material provided by the NPIAP Standards Committee subcommittee, S3I for detailed definitions.
Immersion: Penetration (sinking) into a support surface, measured by depth (1).
Incidence: The proportion or rate of occurrence of a given medical condition (i.e. pressure injuries) in a population within a specified duration of time, Incidence is the proportion of pressure injury free individuals that develop a pressure injury over a specific duration (e.g., 5% in a given month). The population should be defined as all patients in a facility, ward or service or “at risk” subjects with the criteria for determining risk specified. The categories of pressure injuries considered should also be specified (e.g., Category/Stage 2 and higher). Incidence rates are used to evaluate the effectiveness of pressure injury prevention (11). The third edition of the International Guideline includes a chapter on prevalence and incidence measurement (11).
Cumulative incidence (%): The proportion of a pressure injury free population that develops a new pressure injury over a specified period of time (usually weeks to months). Data is collected on a cumulative basis (11).
Number of individuals developing a new PI during the specified time period___
Total number of individuals in study population over the specified time period X 100
Incidence density (e.g., number of new PI cases per 1,000 patient days): The denominator is the total patient-days without pressure injury. Adjusts for variations in length of stay (11).
Number of individuals developing a new PI
Total patient-days without a PI X 1000
Incontinence-associated dermatitis (IAD): Irritant contact dermatitis from prolonged contact with urine or faeces as a result of incontinence (34).
Induration: Firm texture in the absence of calcification or bone formation (12).
Infection: When the quantity of microorganisms in a wound become imbalanced such that the host response is overwhelmed and wound healing becomes impaired. Transition from non-infected to infected is a gradual process determined by the quantity and virulence of microbial burden and the individual’s immune response. The presence of bacteria or other microorganisms in sufficient quantity to damage tissue or impair healing. Clinical signs of infection may not be present in the immunocompromised individual or the individual with a chronic wound (4, 6).
Interface pressure: The force per unit area that acts perpendicularly between the body and a support surface. This parameter is affected by the stiffness of the support surface, the composition of body tissue, and the geometry of the body being supported (1).
Integrated bed system: A bed frame and support surface that are combined into a single unit whereby the surface is unable to function without the bed frame (1).Review the material provided by the NPIAP Standards Committee subcommittee, S3I for detailed definitions.
Internal validity: The extent to which the design and conduct of a study are likely to have prevented bias. Variation in methodological quality can explain variation in the results of studies. More rigorously designed (better quality) trials are more likely to yield results that are closer to the truth.(18).
Intertrigo (intertriginous dermatitis): Intertriginous dermatitis (intertrigo) is a form of irritant contact dermatitis of the skin folds (axillary, submammary, genitocrural, abdominal apron) caused by repetitive shearing forces of skin on skin. Sweat, other body fluids, occlusion and obesity all contribute to its development (35).
Intrinsic factors: Originating within the body.
Kaplan-Meier survival curves: A curve plot that is generated in a survival analysis. A survival analysis is used to investigate the amount of time it takes until participants in a trial develop a specific clinical outcome or end point (e.g., development of a pressure injury) (36).
Laser: Coherent and monochromatic light, a phototherapeutic agent that is part of the electromagnetic spectrum (11).
Lateral rotation: A feature of a support surface that provides rotation about a longitudinal axis as characterized by degree of patient turn, duration, and frequency (1).
Lift (pressure relief lift): The lifting of oneself or the body from a seated surface to temporarily relieve pressure.
Likert Scale: A type of scale using with a set of items that the respondents rate for their degree of agreement with each item. Items can be analyzed individually using statistics appropriate for ordinal data (if a range of responses is provided) or the sum of the scores may be analyzed as a composite score (23).
Local protocol: Procedures and professional practice expectations developed by a local facility or healthcare organization. Local protocols should be based on current evidence-based practices while allowing for implementation strategies appropriate to the clinical culture and context.
Long wave infrared thermography (LWIT): An imaging technology that measures the body heat produced by tissue metabolism and blood distribution, which reflects the presence or absence of perfusion of dermal and subcutaneous tissues under intact skin or open wound. The temperature pattern provides an objective measurement of the tissue that can be identified by an increased temperature (e.g., inflammation) or decreased temperature (e.g., ischemia or tissue death) when compared with adjacent area. LWIT could be used for early PI detection by quantifying the temperature changes at the pressure area as warmer or cooler to adjacent tissue (37).
Low air loss: A support surface construction providing pressure redistribution utilizing constant airflow through bladder(s) with an intentional escape of air. Low air loss is not a performance characteristic of heat and moisture removal. LAL is frequently a misused term for microclimate management. See microclimate management (1). Review the material provided by the NPIAP Standards Committee subcommittee, S3I for detailed definitions.
Low friction fabric: Low friction fabrics are designed with properties that decrease friction between the individual and the support surface, for example through promoting more rapid absorption and evaporation of moisture (e.g., from perspiration or secretions) than traditional cotton fabrics. These textiles are described in the literature as silk-like ‘linen’, specialty ‘linen’ or low friction fabric, and are used for bedding (e.g., sheets and draw sheets) and wearable items such as gowns and bootees (11).
Maceration of skin: softening and breaking down of skin resulting from prolonged exposure to moisture. When caused by excessive wound exudate, it typically presents as swollen, pale, wrinkled or fragile periwound tissue that can compromise healing (38, 39).
Maintenance wound: Healing is possible, in theory, but may not be feasible.(29, 30) The patient has the physiologic capacity to heal, but external factors (patient or healthcare system) are present that impede healing.(31).
Malnutrition (also known as undernutrition): A state resulting from lack of intake or uptake of nutrition that leads to altered body composition (decreased fat free mass) and body cell mass leading to diminished physical and mental function and impaired clinical outcome from disease. Malnutrition can result from starvation, disease or advanced ageing (e.g., >80 years), alone or in combination (8). It is important to note that malnutrition can occur in individuals at any weight profile (40).
Matrix metalloprotease (MMP): A family of zinc-dependent extracellular matrix (ECM) remodeling endopeptidases that have the capacity to degrade almost every component of the ECM. The degradation of the ECM (under normal wound healing conditions) facilitates angiogenesis, cell migration, contraction of the wound matrix with myofibroblasts, removal of damaged ECM, and the remodeling of tissues. When the expression of MMPs is excessive, it can generate the abnormal degradation of the ECM resulting in tissue damage (41).
Manual handling techniques: Strategies designed to ensure the safety of both health care provider/carer and the individual during patient manual handling. Patient manual handling is any action that necessitates the use of physical force by the caregiver to lift/lower carry, transfer, move, reposition, shift or roll patients during the process of care. Safety for the caregiver can be enhanced with safe ergonomic techniques, adequate staff and lifting equipment or other mobility aids (42).
Mechanical load: Force distribution acting on a surface.
Medical grade sheepskin: A sheepskin that complies with the Australian Standard AS4480.1-1998 (43).
Meta-analysis: A technique for quantitatively integrating the results of multiple studies addressing the same research question (23).
Microbial burden: The quantity of microorganisms present (e.g., planktonic bacteria or biofilm) (3, 4, 6).
Microorganism: An organism that is microscopic in size (i.e. too small to see with the naked eye) including bacteria, fungi, yeasts, archaea and parasites. Although viruses are not considered to be living organisms, they are often included when using the general term ‘microorganism’ (4).
Microclimate: The temperature and humidity/moisture in a specified location at the body interface (1).
Microclimate management (in support surfaces): The impact of a support surface on the temperature and humidity/moisture in a specified location at the body interface (1).
Micronutrient: A micronutrient is a chemical element or substance required in very small amounts for normal growth and development.
Mobility: The ability to move oneself from one position to another.
Moisture Associate Skin Damage (MASD): An umbrella term for deterioration of skin integrity due to prolonged exposure to body fluids and often associated physical-irritative and/or chemical irritation. Sources of moisture can include but are not limited to urine and feces (i.e., incontinence associated dermatitis-IAD), wound drainage, ostomy leakage, mucous, saliva and sweat. Terms that fall under the IAD umbrella include IAD, periwound and peristomal dermatitis and intertriginous dermatitis (44).
Multivariable model: a statistical model that has multiple independent variables that investigates the independent relationships between variables (45).
Multivariate model: a statistical model that has two or more dependent or outcome variables, often derived from longitudinal studies in which outcomes are measured on the same individual multiple times (45).
Near infrared spectroscopy (NIRS): An imaging technology that measures tissue oxygenation by penetrating near infrared (wavelength 750 to 2500 nm) and collecting the reflectance wavelength range (600 to 1000 nm) corresponding to oxygenated hemoglobin, deoxygenated hemoglobin and melanin. Tissue oxygen saturation (StO2) is the fraction of oxygenated hemoglobin to total hemoglobin. Changes in StO2 could reflect tissue viability and serve as early signs of PI (37).
Necrosis: Death of tissue (12).
Necrotic tissue: Dead (devitalized) tissue that is dark in color and comprised of dead tissue cells. Necrotic tissue acts as a barrier to healing by preventing complete tissue repair and promoting microbial colonization. It is usually managed with debridement, but only after a comprehensive assessment of the individual and their wound. Tissue that has died, also called devitalized or non-viable tissue (4).
Negative likelihood ratio: The probability of a patient testing negative who has a disease divided by the probability of a patient testing negative who does not have a disease (46).
Negative-pressure wound therapy (NPWT): A wound treatment modality that promotes healing through the removal of third space edema, thus enhancing nutrient and oxygen delivery; removal of wound exudates, which is the medium for bacterial colonization; promotion of granulation tissue; promotion of angiogenesis; and removal of wound inhibitory factors (11).
Non-healable wound: Wound that will not heal, regardless of treatment regimen.(30). The patient does not have the physiologic capacity to heal due to inadequate blood supply that cannot be treated and/or the cause of the wound cannot be corrected (31).
Odds ratio (OR): The ratio of one odds to another odds, for example, the ratio of the odds of an event in one group to the odds of an event in another group; an odds ratio of 1.0 indicates no differences between groups (23).
Offload: To remove pressure from any area.
Oral nutritional supplement (ONS): Commercial or other prepared food or beverage developed to provide energy and nutrient dense solutions; provided as ready to drink liquids, cremes or powder supplements that can be prepared as drinks or added to drinks and foods (8).
Osteomyelitis: Infection of the bone that occurs through infection of the bloodstream or from a wound that allows bacteria to directly reach bone (11).
Overlay: A supplementary support surface designed to be placed directly on, and used in conjunction with, a primary/base support surface (1).
P value (p): In statistical testing, the probability that the obtained results are due to chance alone; the probability of a Type 1 error (23, 47).
Palliative care: The active holistic care of individuals across all ages with serious health-related suffering because of severe illness and especially those near the end of life. It aims to improve the quality of life of patients, their families and their caregivers (48).
Palliative wound care: Person and family centered, holistic and interdisciplinary care of wounds that may heal, or not, or may be too onerous to treat; including but not limited to symptom control and management, for individuals who are often vulnerable and have impaired quality of life (49).
Pannus: A hanging flap of abdominal tissue in a bariatric individual.
Parenteral nutrition: see Artificial nutrition.
Partial thickness tissue loss: Damage that involves the epidermis and can penetrate into but not through the dermis. Includes Category/Stage 2 pressure injuries (11).
Pediatric population categories: Skin structure and function differ across the developmental stages of pediatric patients affect pressure injury risk and classification. The anatomic site(s) of pressure injury development vary with age and according to changing distributions of body mass. Pediatric pressure injury studies should report findings according to the following age categories:
(1) 20-week gestation and younger; (2) 21 to 29 week gestational age; (3) 30 to 40 week gestational age; (4) birth to one year; (5) 1 to 7 years; (6) 8-21 years (50, 51).
OR
six age categories to represent the developing child: (1) ≤28 weeks’ gestation; (2) 29-32 weeks’ gestation; (3) 33-37 weeks’ gestation; (4) full-term infants - 38 weeks’ gestation to 12 months; (5) prepuberty -1-7 years; and (6) children experiencing puberty - 8-21 years (52).
Periwound: The skin and tissue immediately adjacent to the wound edge extending out 4 cm and including any skin and tissue under the wound dressing (4, 6, 53).
pH: A measure on a scale from 0 to 14 of the acidity or alkalinity of an aqueous solution, with 7 being neutral, greater than 7 is more alkaline and less than 7 is more acidic.
Phototherapy: An agent that employs energy waves from the infrared, visible, and ultraviolet region of the electromagnetic spectrum. Combinations of these technologies are often used (11) .
Pocketing: Pocketing occurs when granulation tissue does not grow in a uniform manner across the entire wound base, leading to a dead space that can potentially harbor microorganisms (7).
Positive Likelihood Ratio (PLR): The probability that a positive test would be expected in a patient divided by the probability that a positive test would be expected in a patient without a disease (46).
Pounds per square inch (PSI): A unit of pressure exerted by a stream of fluid against one square inch of skin or wound surface.
Prealbumin: A body protein whose function is to transport thyroxine and complexes with retinol-binding protein for Vitamin A transport. The normal level is 15 to 36 mg/dL, but it can vary with the laboratory determining the level.
Pressure: The force per unit area exerted perpendicular to the plane of interest (1).
Pressure injury: Localized damage to the skin and/or underlying tissue, usually over a bony prominences or related to a medical or other devices, resulting from prolonged pressure or pressure in combination with shear. Pressure injuries usually occur over a bony prominence but may also be related to a medical device or other object. The guideline chapter Classification includes definitions of various categories or stages (11).
Pressure redistribution: The ability of a support surface to distribute load over the contact areas of the human body. Replaces the deprecated terms, pressure reduction and pressure relief (1).
Pressure ulcer: see Pressure injury.
Prevalence (%): The proportion/percentage of individuals within a defined population (e.g., individuals within a specific geographic region, a facility or ward) that have a pressure injury within a defined period of time regardless of whether it was present on admission or developed in the facility after admission. The population should be defined as all patients in a facility, ward or service or “at risk” subjects with the criteria for determining risk specified. The categories of pressure injuries considered should also be specified (e.g., Category/Stage 2 and higher). Prevalence provides insights into the burden of pressure injuries and the resources needed to address that burden (11). The third edition of the International Guideline includes a chapter on prevalence and incidence measurement (11).
Point prevalence (%): The proportion of individuals with a pressure injury at a specific point in time (usually on a specific day).
Number of individuals with pressure injury at a specific point in time
Total number of individuals in the population at a specific point in time x100
Period prevalence (%): The proportion of individuals with a pressure injury over a specific period of time (usually weeks or months).
Number of individuals with pressure injury over a specific period of time
Total number of individuals in the population over a specific period of time x100
Pressure point: a point on the body that is subjected to pressure (e.g., bony prominences or under medical devices).
Preventive dressing (also called a prophylactic dressing): A dressing that is placed onto the skin before any skin damage is evident with a goal of preventing skin breakdown due to pressure, shear and alternations in the skin’s microclimate. Features such as an elastic adhesive type (e.g. silicone), the number of dressing layers and their construction, and the size of the selected dressing all contribute to its ability to protect the skin (54). Although many types of dressings have been tested for the purposes of preventing pressure injuries, meta-analyses of effectiveness focus on multilayered soft silicone foam dressings. Testing standards for key characteristics such as cushioning, thermal performance, moisture management and adhesiveness are being developed through a collaboration between NPIAP and EPUAP (i.e., Prophylactic Dressing Standards Initiative – PDSI).
Proinflammatory cytokines: A body substance liberated in the presence of inflammation and infection, e.g., interleukin-1 and tumor necrosis factor, which in turn increases the levels of matrix metalloproteases (MMPs), decreases the level of inhibitors in tissue against the MMPs, and decreases the production of growth factors and fibroblast activity (55, 56).
Protease: A proteolytic enzyme.
Protein: A complex organic compound made up of chains of amino acid molecules. Proteins are responsible for the repair of injured tissue, fluid balance, antibody production, cellular function, and hormonal and enzymatic function. Proteins are a source of building material for muscle and for healing wounds.
Protectant (skin): A substance or product applied externally to the skin to protect it from harmful substances.
Protein-energy malnutrition (PEM): This occurs when both protein and energy intake are insufficient to meet an individual's metabolic demands (57).
Purpura: Hemorrhage into the skin due to pathological processes, primarily of blood vessels (12). Should not be confused with sDTI/DTPI.
Pulsed current: A term describing a feature of electrical stimulation, pulsed current is the brief unidirectional (monophasic pulsed current) or bidirectional (biphasic pulsed current) flow of electrons or ions in which each pulse is separated by a period with no current flow (11).
Pulsed electromagnetic field therapy: The delivery of magnetic field to the wound bed with a goal of delivering therapeutic effect (11).
Purulent: Containing pus.
Quality indicator: Standardized, evidence-based measures of health care quality that can be used with readily available facility data to measure and track clinical performance and outcomes, highlight potential quality concerns, identify area for further study and investigation, and track changes over time (58). Guidelines are frequently used as a source for quality indicator development.
Quality of life: An individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It is a broad ranging concept affected in a complex way by the person's physical health, psychological state, level of independence, social relationships, and their relationship to salient features of their environment (59).
Reactive hyperemia: A reddening of the skin caused by blood rushing back into hypoxic tissue after pressure offloading (11).
Reactive support surface: A powered or non-powered support surface with the capability to change its pressure redistribution properties only in response to applied load (1). Review the material provided by the NPIAP Standards Committee subcommittee, S3I for detailed definitions.
Receiver Operator Curve, Area Under (AUROC): A measure of overall accuracy of a specific test, with a value approaching 1.0 indicating a high sensitivity and specificity (45). A statistical tool that involve plotting specificity against sensitivity for different scores on a measure to determine the best cutoff score for use. It also serves an index (AUROC) that has relevance for assessing validity and responsiveness in some situations (23, 60).
Relative risk (risk ratio): The risk of a particular outcome (e.g., a pressure injury) occurring in the presence of a particular exposure (e.g., a pressure injury prevention program) compared to the risk without the particular exposure. A RR of 1.0 indicates no difference in outcome risk between exposure and non-exposure (11).
Reepithelialization: see epithelialization.
Reposition: A change in position in the lying or seated individual, with the purpose of relieving or redistributing pressure and enhancing comfort, undertaken at regular intervals. The position should be changed in a way that offloading of the bony prominences at recently loaded areas is achieved (11).
Semi-Fowler position: A position in which the individual is supine and the head of the bed is elevated 30°.
Sensitivity: the proportion of true positive tests out of all patients with a condition. In other words, it is the ability of a test or instrument to yield a positive result for a subject who has that disease (61).
True positive/ (true positive + false negative) x100
Seroma: A collection of fluid in an artificial cavity below the skin.
Shear: An umbrella term. See shear strain and shear stress.
Shear strain: Distortion or deformation of tissue as a result of shear stress (1).
Shear stress: The force per unit area exerted parallel to the perpendicular plane of interest (1).
Sinus tract: Tract leading from a deeper focus to the skin surface (12). A course or path of tissue destruction, sometimes called a tunnel, occurring in any direction from the surface or edge of a wound. It results in dead space with a potential for abscess formation. A sinus can be distinguished from undermining in that it involves only a small portion of the wound edge whereas undermining involves a significant portion of the wound edge (11).
Skin integrity: Skin integrity is the combination of an intact cutaneous structure and a functional capacity that is high enough to preserve it (62).
Skin lesion: A very broad term used to describe any alteration in cutaneous structure (12).
Slough: Nonviable tissue of varying color (e.g. cream, yellow, greyish or tan) that may be loose or firmly attached, slimy, stringy, or fibrinous (7). Recent analyses of slough taken from chronic wounds have found very different appearances and compositions of bacterial aggregates, devitalized tissue, both pro and anti-inflammatory mediators, immune cells, and proteins responsible for coagulation and extracellular matrix formation (63, 64). McGuire et al., (2021) (65) has classified slough by appearance and biological components.
Specialty support surface: Specialty support surfaces are support surfaces that have additional technology features designed to further redistribute pressure, reduce shear and influence the microclimate (e.g., alternating pressure, air fluidized or loss air loss features). Review the material provided by the NPIAP Standards Committee subcommittee, S3I for detailed definitions.
Specificity: Specificity is the percentage of true negatives out of all subjects who do not have a disease or condition In other words, it is the ability of the test or instrument to correctly identify those who do not have a disease (61).
True negative/ (true negative + false positive) x 100
Standard hospital mattress: A term used to describe the standard mattress provided within a facility and generally used as the comparative intervention in research trials investigating the effectiveness of pressure redistribution support surfaces. As such, the qualities of a standard hospital mattress vary according to historical and clinical context and are rarely reported in detail in clinical trials. In most cases it is assumed that a standard hospital mattress is a non-powered foam or spring-based mattress (66). There is no basic/standard mattress used consistently in healthcare facilities at this time. This term is used primarily in research trials as a control in support surface studies. The term “standard hospital mattress” should not be used without a full description of defined support surface properties (1).
Statistical significance: A term indicating that the results from an analysis of sample data are unlikely to have been the result of chance at a specified level of probability (23).
Strain: A measurement of relative deformation.
Stress: Force transferred per unit area.
Support surface: A device or system which is designed for pressure redistribution and may or may not be designed for microclimate management, shear management, and/or other therapeutic functions. Support surfaces include but are not limited to mattresses, integrated bed systems, overlays, and cushions (1). Review the material provided by the NPIAP Standards Committee subcommittee, S3I for detailed definitions.
Suspected deep tissue injury (sDTI): see Deep Tissue Pressure Injury (DTPI).
Systematic review: A review of a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant research, and to collect and analyse data from the studies that are included in the review. Statistical methods (meta-analysis) may or may not be used to analyse and summarise the results of the included studies (18).
Tensile strength: The maximum force or pressure that can be applied to a wound without causing it to break apart.
Thermography: see Long Wave Infrared Thermography.
Tilt-in-space (in a wheelchair): The tilt angle refers to the backward rotation of the entire seat and back support unit as a single unit, maintaining a constant seat-to-back angle. Varying the angle of the tilt redistributes pressure over different areas of the individual to seat interface. This contrasts to a recline position in which the upper torso is angled backward at the hip, leaning the individual backwards (67).
Tissue-interface layer: The point at which a dressing is in direct contact with the skin (wound bed).
Tissue ischemia: The reduction of oxygen levels to below normal.
Transfer aid: Any agent that aids in transferring an individual (e.g. a sheet, mechanical lift).
Transpire: A process through which moisture passes into the atmosphere as water vapour. Ability to transpire is a characteristic that may be used to describe wound dressing that have a semi-permeable or permeable quality that allows excess moisture to pass into the atmosphere as vapour.
Tunneling: See Sinus tract.
Turn: The act of changing position. Repositioning is the preferred term as it implies a true change in position that will redistribute pressure.
Turn assist: A support surface design feature that assists in lateral turning of the patient for routine care (1).
Ulcer: Full-thickness loss of the epidermis plus at least a portion of the dermis; it may extend into the subcutaneous tissue (12).
Ultrasound: A mechanical vibration (acoustic energy) transmitted in a wave formation at frequencies beyond the upper limit of human hearing. When applied as a therapeutic agent, its vibratory property affects the cells of biologic tissues. Ultrasound can be used to assess and treat soft tissues (11).
Undermining: An area of tissue destruction extending under intact skin along the periphery of a wound. It can be distinguished from a sinus tract in that it involves a significant portion of wound edge (4, 11).
Undernutrition: see Malnutrition.
Unintentional weight loss: Gradual, unintended weight loss over time.
Viscoelastic foam (memory foam): A type of porous polymer material which conforms in proportion to the applied weight. The material exhibits dampened elastic properties when load is applied. Review the material provided by the NPIAP Standards Committee subcommittee, S3I for detailed definitions.
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