International Guideline Reform: New Preventive Care Strategies

In 2025, the European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance released the fourth and latest edition of their International Guideline: A substantive, evidence-based framework for pressure injury management strategies, peer-reviewed by more than 240 clinical experts.

The document provides an up-to-date overview of how clinicians should be approaching pressure injury care. In the healthcare industry, facilities can be slow to adopt new approaches, so it is imperative to understand which methods are most effective today. Outdated methods fail to provide consistent ongoing care, overlook personal needs, and incur high incidence costs.

In this blog, we’ll look at the key takeaways from the new International Guideline, how they can prevent healthcare shortcomings, and how solutions like LenexaCARE® can achieve this goal.

1. Prevention and Treatment of Pressure Injuries: Key Takeaways

1.1 Repositioning is an important action that prevents pressure injuries. This involves moving an individual to a different position to redistribute or remove pressure on a body part prone to injury. The Guidelines broadly suggest repositioning:

Is required, regardless of the mattress,
Should optimally offload pressure points,
And should be individualised to each person.

Repositioning is essential for all individuals at risk of pressure injuries – no surface can replace it, including air mattresses.[R1] Common key areas to offload pressure include the heels, sacrum (lower back), and trochanter (hips), which will also minimise friction and shear.[R2–R3, R10]

Repositioning plans should be individualised where possible. Decide intervals based on mobility, risk profile, skin tolerance, clinical condition, and support surface.[R4–R5]

Regular skin checks can help identify early damage and guide more frequent repositioning if required.[R6]

For most people, 2–3 hourly repositions are recommended; critically ill individuals may require small, frequent shifts, while palliative care should prioritise comfort.[R7–R9]

Also, encourage early movement wherever possible – even small amounts of activity based on individual tolerance.[R16]

1.2 Support surfaces also play an important role in the prevention of pressure injuries. While these measures provide some relief, repositioning is ultimately required to relieve the pressure. It is the same as sitting on a comfortable chair – despite how nice it may feel initially, eventually you will feel sore after a prolonged time and naturally will want to shift.

As per the Guidelines:

Pressure-relieving foam mattresses are strongly recommended,
Whereas air mattresses are only a conditional recommendation.

No matter how good the support surface, mattresses cannot entirely replace repositioning. This is merely an additional preventive measure. Evaluating repositioning through regular reminders, education, and sensor systems is more effective.[R14–R15]

Healthcare facilities should maintain access to a range of different full-body support surfaces suited to different clinical contexts and patient characteristics.[SS1–SS2]

When selecting or changing mattresses, no single surface suits all people – take into account the individual’s risk level, skin and tissue health, mobility, posture, and care preferences. Consider features that manage heat and moisture and reduce shear.[SS2–SS4]

For most at-risk individuals, pressure-redistribution foam mattresses are recommended. Air mattresses or alternating pressure systems can also be used, depending on compliance, risk level and tolerance.[SS3, SS5–SS7]

Use air mattresses only for those who are generally non-compliant with pressure care or cannot be repositioned. For instance, air mattresses are most beneficial in ICUs because many cannot be repositioned due to instability in condition (Nixon et al., 2019).

Low-air-loss surfaces are recommended for people with skin heat or moisture issues. Meanwhile, air-fluidised surfaces are reserved for those at very high risk or with significant existing pressure injuries.[SS10–SS11]

Medical-grade sheepskin can be considered where available, but should never replace or interfere with a proper pressure-redistribution surface.[SS8] Fibre surfaces are not recommended unless no other pressure-redistributing full-body support surfaces are available.[SS9]

Pressure-redistributing surfaces should be used during medical procedures and transport. Patients should be transferred off hard spinal boards as soon as safely possible.[SS12–SS13]

2. The Future of Aged Care: A New Approach

As healthcare industries worldwide face the challenge of an ageing population, the integration of cutting-edge technologies such as LenexaCARE® into everyday care practices will be pivotal.

LenexaCARE® helps teams reduce burdens and effectively target their care, prioritising the recommendations from the latest Guidelines in acute and residential care settings.

2.1 Increasing Turn Effectiveness

LenexaCARE® includes a dashboard that displays real-time information of a patient’s position (i.e., where the pressure is being applied) and how long they’ve been there (i.e., the accumulated pressure exposure over time).

The live LenexaCARE® data encourages carers not to reposition people excessively. Therefore, carers can be confident in their decision-making. This empowers clinicians and carers to verify comfort, rather than relying on the mattress, which is usually a supplementary measure.[R1]

People’s comfort will also be maintained by leaving them undisturbed. Clinicians can plan their care based on what is required, provided they offload the right areas and leave sufficient time to let people’s pressure be relieved.

2.2 Tracking and Measuring Risk Objectively

LenexaCARE® offers real-time, continuous data that can be utilised for compliance duties by supporting people who require regular turning.

By following the latest Guidelines, facilities can implement strategic interventions and best practices of pressure injury management and resident care. For most people, 2–3 hourly repositions are recommended; critically ill individuals may require small, frequent shifts, while palliative care should prioritise comfort.[R7–R9]

2.3 Supporting Personalised Care

The latest Guidelines strongly encourage individualised repositioning since each person is different. A one-size-fits-all approach with set turns is no longer effective because this puts people at risk of being underturned and overturned.

This data guides care teams on how to assess which patients require repositioning, ensuring their care is targeted. They can intervene early before an injury arises, guiding additional repositioning if necessary.[R6] As evidenced by the Guidelines, repositioning should be individualised where possible.[R4]

Reference

International Guideline. (2025a). Repositioning. International Guideline. https://www.internationalguideline.com/repositioning

International Guideline. (2025b). Support surfaces. International Guideline. https://www.internationalguideline.com/surfaces

National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, & Pan Pacific Pressure Injury Alliance. (2026). Prevention and treatment of pressure ulcers/injuries: Quick reference guide. The International Guideline: Fourth Edition. https://internationalguideline.com/

Nixon, J., Brown, S., Smith, I. L., McGinnis, E., Vargas-Palacios, A., Nelson, E. A., Brown, J., Coleman, S., Collier, H., Fernandez, C., Gilberts, R., Henderson, V., McCabe, C., Muir, D., Rutherford, C., Stubbs, N., Thorpe, B., Wallner, K., Walker, K., & Wilson, L. (2019). Comparing alternating pressure mattresses and high-specification foam mattresses to prevent pressure ulcers in high-risk patients: The Pressure 2 RCT. Health Technology Assessment, 23(52), 1–176. https://doi.org/10.3310/hta23520