This statement refers to all editions of the International Pressure Injury/Ulcer Guideline.
This statement applies to all users of the guideline material including (but not limited to) clinicians, researchers, educators, product developers and industry.
The NPIAP/EPUAP/PPPIA does not give approval for use of its organization logos or guideline branding on any material for which permission has not been sought in writing. Permission will not be granted for inclusion of logos or branding in any product advertisements.
The NPIAP/EPUAP/PPPIA reserve the right to request modification or discontinuation of any advertisement or promotional material that, in the judgement of the organizations, inaccurately represents guideline content or implies endorsement.
The NPIAP/EPUAP/PPPIA will take the necessary steps to ensure that copyright will be retained at all times by NPIAP, EPUAP and PPPIA.
Free downloads
All chapters of the full fourth edition of the Clinical Practice Guideline (2026) and the Quick Reference Guide (2026) are available for free download on the International Guideline (2026) website. Free access to the full third edition of the Clinical Practice Guideline (2019) is still available. Access to the second edition of the Clinical Practice Guideline (2014) is available in certain circumstances (e.g., by legal teams) by Contacting Us.
Product advertisements
The NPIAP/EPUAP/PPPIA does not give approval for reproduction of chapters or significant sections of the guideline, by industry groups for sale or distribution as educational material. Company advertisements may quote the exact wording of the guideline with proper citation; but should not state or imply NPIAP/EPUAP/PPPIA endorsement of any specific product. For company product advertisements:
Do not state or imply that the guideline or its sponsoring organizations endorse, support or recommend your product.
Do not state or imply that the guideline prefers one product over another; the guideline does not endorse or disparage any product.
If your product was used in the studies that support any guideline statement, that fact can be noted in advertisements.
Citing the guideline recommendations or good practice statements
When referencing or quoting recommendations or good practice statements in any context/media include the following information:
The exact guideline statement (including any clarifiers). In situations where word limits are imposed (i.e. publications and educational slides), clarifiers may be summarized.
Whether it is a strong recommendation, conditional recommendation or good practice statement.
Both recommendations and good practice statements are interventions that the guideline panel approves for clinical practice, believing that these interventions will result in more good than harm for individuals with or at risk of pressure injuries.
Include a statement indicating how a strong recommendation, a conditional recommendation or good practice statement can be interpreted:
i. Strong Recommendation: The guideline panel is confident that the desirable effects of the intervention outweigh its undesirable effects. Most or all individuals will be best served by the recommended course of action. Requires Tier 1, 2 or 3A level evidence.
ii. Conditional Recommendation: The guideline panel identifies some uncertainty concerning values and preferences or their variability among patients. The recommendation is a judgement that a majority of well-informed people would make, but a substantial minority would not. Requires Tier 1, 2 or 3A level evidence.
iii. No Recommendation: Trade-offs between risk and benefit are unclear or there is a lack of agreement among voting participants. The advantages and disadvantages are equivalent, and/or the target population has not been identified, and/or there is insufficient evidence on which to formulate a strength of recommendation.
iv. Good Practice Statements: Good Practice Statement (GPSs) answer important clinical questions that are not answered by recommendations. Without GPSs, the guideline would not provide comprehensive clinical guidance. Most GPSs are supported by Tier 3B and 3 C evidence, others are based on expert opinion or practice norms. All are approved by the guideline panel as interventions that can improve quality of care.
v. The interpretation can be provided once in a publication or slide presentation and does not need to be repeated with every recommendation/GPS. For advertisements, the abbreviated interpretation in the advertisement examples should be included with every statement as a footnote.
For journals and scholarly publications/presentations, the certainty of evidence is also required.
A summary of interpretation of guideline statements is available to assist in preparation of material.
Endorsements
The NPIAP/EPUAP/PPPIA does not endorse any products, materials or educational materials published by industry groups. The guideline content cannot be considered an endorsement of any specific product or educational materials.
Use by healthcare facilities
The NPIAP/EPUAP/PPPIA permit replication of chapters or significant sections of the guideline in health facility organization local policy documents with appropriate citation where this falls within use permitted under regional copyright laws (e.g., consider the amount of material being replicated). The following disclaimer statement should accompany the citation:
"The use of NPIAP/EPUAP/PPPIA material does not imply endorsement of products or programs associated with the use of the material."
Educational presentations and handouts
The NPIAP/EPUAP/PPPIA permit use of guideline statements with category designation (i.e., strong recommendation, conditional recommendation or good practice statement), explanations of each category and certainty of evidence. Explanations can be provided once within the presentation (repetition for each recommendation/GPS is not required).Appropriate citation should be included in educational presentations and handouts conducted where this falls under acceptable use under regional copyright laws (i.e., consider the amount of material being replicated). Each guideline chapter has a suggested citation. The citation for the full Clinical Practice Guideline is:
National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline: Fourth Edition. Emily Haesler (Ed.). 2026.
Journals, book chapter, theses or other publications
The NPIAP/EPUAP/PPPIA does permit reprint of guideline statements, with the following conditions:
Use the appropriate citation (to the guideline chapter and/or full guideline)
Include the designation of strong recommendation, conditional recommendation or good practice statements
Always state the Certainty of Evidence Explanations of recommendations, GPSs and certainty of evidence should be included once within the document as a reference point and not repeated with each recommendation or GPS statement.
For written permission, Contact Us with your request. In general, permission should be sought if planning to reprint one or more chapters of recommendations, good practice statements and/or implementation considerations.
Reprinting, bulk distribution and limited distribution
The NPIAP/EPUAP/PPPIA does not permit reprinting and distribution of the Quick Reference Guide or the full Clinical Practice Guideline. These document can be downloaded for free from the 2026 international guideline website.
Use of illustrations, photographs and diagrams
1. The illustrations of pressure injury Classification/Stages in the chapter on Classification are copyrighted to NPIAP and available from the NPIAP website.
2. The photographs in the Classification chapter are used with permission from various photographers and are not for reprint.
3. The diagrams in the Repositioning and Mobilization chapter and the chapter on Pressure Injuries in Seated Individuals are copyrighted to NPIAP/EPUAP/PPPIA and available for free download for non-profit, educational purposes. Any use that is for profit or by an industry group requires purchase of the diagrams. Please Contact Us for more information on purchasing the diagrams.
Bulk distribution
IF hard copies of the Fourth Edition of the full Clinical Practice Guideline become available for sale, third parties may purchase printed versions in bulk for distribution to health professionals. Copies for distribution in this manner must include the following information printed on the back cover:
These evidence-based guidelines were developed by the National Pressure Injury Advisory Panel (NPIAP), European Pressure Ulcer Advisory Panel (EPUAP) and Pan Pacific Pressure Injury Alliance (PPPIA) without corporate support or influence. Nothing in this guideline is intended as an endorsement by the NPIAP, EPUAP or PPPIA of any organization, business, or product. A copy of this guideline is being provided as a public service by ___ , which was not involved in the publication's development and in no way influenced its contents.
(wherein the blank underlined portion is filled in with the appropriate name of the third party).
Limited distribution
The NPIAP/EPUAP/PPPIA agree that third parties distributing purchased bulk materials will not be entitled to charge for any guideline materials. For additional information, contact NPIAP.
Free pressure Injury/Ulcer classification posters
The NPIAP/EPUAP/PPPIA have made one page versions of commonly used classification systems available on the International Guideline website. These include photographs and 3D graphics. Four versions are available. These may be reproduced in their entirety without any changes to the appearance, formatting or content and without requesting specific permission. The NPIAP/EPUAP/PPPIA extends its gratitude to Dr Keryln Carville, Dr Joyce Black and the Wound Healing and Management (WHAM) Collaborative at Curtin School of Nursing, Curtin University, Perth, Australia for granting permission for reproduction of their copyrighted photographs and staging illustrations.
Free downloads
All Clinical Practice Guideline chapters and the Quick Reference Guide are available for free download on the international guideline website.