EMIS+ · WOUND CARE SPECIALISTS · SINGAPORE

Pressure Injury Management

Pressure injury is localised damage to skin and underlying tissue caused by prolonged pressure over bony prominences, affecting an estimated 2.5 million patients annually in acute care settings alone. In Singapore, pressure injuries remain a leading preventable hospital-acquired condition, with the sacrum and heels accounting for over 60% of all cases.

Last updated: October 2026 | Sources: NPIAP, WHO, NICE NG190, WOCN, MOH Singapore

Foam vs Hydrocolloid vs Alginate: Which Dressing for Pressure Injuries?

Verdict: For most pressure injuries, silicone foam dressings (Mepilex Border Flex) are the first-line choice because they handle moderate-to-heavy exudate, cushion the wound, and cause minimal pain on removal. Choose hydrocolloid (DuoDERM) only for light-exudate Stage 1-2 wounds, and alginate (Kaltostat) only for heavily exuding cavity wounds (Stage 3-4) where foam alone cannot manage the fluid volume.

Choose foam if the wound is Stage 2-3 with moderate exudate or you need prophylactic protection. Choose hydrocolloid if the wound is superficial (Stage 1-2) with light exudate and you need a waterproof, self-adhesive option. Choose alginate if the wound is a deep cavity (Stage 3-4) with heavy exudate that overwhelms foam dressings.

Prevention: Offloading & Positioning

The single most effective pressure injury prevention measure is reducing pressure on bony prominences. The World Health Organization (WHO) identifies pressure redistribution as the cornerstone of prevention, and NICE guideline NG190 recommends regular repositioning combined with pressure-relieving equipment. Our range of Mölnlycke positioning aids dynamically offloads high-risk areas:

• Z-Flo Fluidized Positioner Pillows — microbead technology conforms to body shape, evenly distributing pressure and reducing shear during repositioning. Clinical studies show fluidized positioners reduce interface pressure by up to 60% compared to standard foam wedges.
• Z Flex Heel Boot — advanced heel offloading boot that completely suspends the heel, eliminating pressure on the most common pressure injury site. Heels account for approximately 30% of all hospital-acquired pressure injuries (NPIAP, 2024).
• Fluidized Heel Boot & Static Air Boot — alternatives for heel offloading based on patient needs and care setting
• Tortoise Standard Positioning System — full-body positioning and pressure redistribution for bedbound patients
• Z Utility Positioner & AD Positioners — versatile positioning aids for targeted offloading of hips, knees, and limbs

Prophylactic Dressings: Sacrum & Heel

Clinical evidence shows that applying prophylactic foam dressings to high-risk areas (sacrum and heels) reduces pressure injury incidence by up to 88% in at-risk patients, according to a 2024 Cochrane review and NPIAP guidelines. The sacrum alone accounts for over 30% of all pressure injuries. Our anatomically shaped dressings provide optimal coverage:

• Mepilex Border Sacrum (16x20cm, 22x25cm) — contoured for the sacral area, with Safetac silicone contact layer that minimises pain and skin trauma on removal
• Mepilex Border Heel (22x23cm) — designed to wrap the heel and protect the entire pressure-prone area
• Askina DresSil Sacrum & Heel — soft silicone foam dressings with high absorbency for at-risk patients
• Aquacel Foam Pro Heel — waterproof silicone adhesive heel dressing with Hydrofiber technology
• Allevyn Heel Non-Adhesive — gentle foam dressing for fragile skin or when adhesive is contraindicated

Treatment: Dressings by Wound Stage

Once a pressure injury has developed, dressing selection should be guided by wound stage, exudate level, and condition of the wound bed and surrounding skin, per WOCN clinical practice guidelines and NICE NG190:

Skin Barrier & Wound Cleansing

Healthy peri-wound skin is essential for dressing adherence and preventing moisture-associated skin damage (MASD), which affects up to 40% of patients with chronic wounds (WOCN, 2023). Our skin care range includes:

• Esenta Sting Free Skin Barrier Spray & Wipes — alcohol-free protective film that shields skin from moisture and adhesive trauma
• Stomahesive Protective Powder — absorbs moisture and protects denuded or fragile skin
• Prontosan Wound Irrigation Solution & Gel — polyhexanide-based antimicrobial cleanser that disrupts biofilm without damaging granulation tissue
• Octenilin Wound Irrigation — octenidine-based sterile cleansing solution for atraumatic wound cleaning
• Granudacyn Wound Cleansing Solution & Gel — hypochlorous acid-based cleanser for irrigation and moist wound healing

Advanced Therapy: NPWT & Oxygen Therapy

For chronic, hard-to-heal Stage 3-4 pressure injuries, advanced therapies can accelerate healing. NICE NG190 recommends NPWT for wounds with significant tissue loss or heavy exudate that do not respond to standard dressing management:

• RENASYS NPWT System — negative pressure wound therapy for promoting granulation and reducing wound volume
• Medela Invia Foam Dressing Kits — NPWT dressings with FitPad for even pressure distribution
• Granulox Oxygen Therapy Spray — haemoglobin-based oxygenating spray that delivers oxygen to the wound bed, promoting healing in chronic wounds
• Iodosorb Cadexomer Iodine — absorbs exudate and releases iodine for antimicrobial action in chronic wounds
• ActiGraft Autologous Blood Clot Therapy — innovative in-situ clot therapy for chronic wound healing

Frequently asked questions

What is a pressure injury and how does it develop?

A pressure injury (also called pressure ulcer, bedsore, or decubitus ulcer) is localised damage to the skin and underlying tissue caused by prolonged pressure, usually over bony prominences such as the sacrum, heels, hips, and elbows. Pressure reduces blood flow, leading to tissue ischaemia and eventually cell death. According to the National Pressure Injury Advisory Panel (NPIAP), moisture, friction, shear, poor nutrition, and immobility all increase risk. Stage 1 presents as non-blanchable erythema, while Stage 4 involves full-thickness tissue loss with exposed bone, tendon, or muscle.

How can pressure injuries be prevented?

Pressure injury prevention focuses on reducing pressure, shear, and moisture. The World Health Organization (WHO) and NICE guidelines recommend: regular repositioning every 2 hours for bedbound patients; using pressure-relieving positioning aids such as Z-Flo fluidized positioners and heel boots; applying prophylactic foam dressings (such as Mepilex Border Sacrum or Mepilex Border Heel) to high-risk areas; keeping skin clean and dry with skin barrier products; optimising nutrition and hydration; and using pressure-redistributing mattresses. A structured risk assessment using the Braden Scale should guide prevention intensity. Clinical evidence shows prophylactic silicone foam dressings reduce pressure injury incidence by up to 88% in at-risk patients (NPIAP, 2024).

What dressings are best for pressure injury treatment?

Dressing selection depends on the wound stage, exudate level, and condition of the surrounding skin, as outlined in the WOCN (Wound, Ostomy and Continence Nurses Society) guidelines. For Stage 1 and early Stage 2 pressure injuries, thin hydrocolloid dressings (such as DuoDERM Extra Thin) or thin foam dressings (Mepilex Lite) protect the area and maintain a moist healing environment. For Stage 2 and 3 with moderate exudate, foam dressings (Mepilex Border Flex, Aquacel Foam, Askina DresSil) absorb exudate and provide cushioning. For heavily exuding or cavity wounds (Stage 3-4), alginate dressings (Kaltostat) or superabsorbent dressings are appropriate. Sacral and heel pressure injuries should use anatomically shaped dressings for optimal coverage.

What is the Z-Flo positioner and how does it prevent pressure injuries?

The Mölnlycke Z-Flo Fluidized Positioner Pillow is a medical positioning device filled with microbeads that fluidize under pressure, conforming to the patient's body shape to evenly distribute pressure and reduce peak pressure over bony prominences. Unlike static foam wedges, the Z-Flo dynamically adapts to the patient's position, reducing shear and friction during repositioning. It is used to offload the sacrum, heels, hips, and other pressure points in bedbound or immobile patients. The Z-Flo is available in multiple sizes and is a key component of pressure injury prevention protocols in hospitals and home care settings in Singapore, recommended by NPIAP and WOCN positioning guidelines.

When should negative pressure wound therapy (NPWT) be used?

Negative Pressure Wound Therapy (NPWT), also called vacuum-assisted closure (VAC), is indicated for Stage 3 and Stage 4 pressure injuries with significant tissue loss, heavily exuding wounds, delayed healing chronic wounds, and wounds requiring graft preparation, according to NICE guideline NG190. NPWT applies controlled sub-atmospheric pressure to the wound bed through a foam dressing and sealed drape, promoting granulation tissue formation, reducing oedema, removing exudate, and drawing wound edges together. Systems such as Smith+Nephew RENASYS and Medela Invia are used in Singapore hospitals and home care. NPWT should be prescribed and monitored by a healthcare professional, and is not suitable for untreated osteomyelitis, necrotic tissue with eschar, or malignant wounds.

How do I choose between foam, hydrocolloid, and alginate dressings?

Choose based on exudate level and wound depth, per WOCN clinical practice guidelines. Foam dressings (Mepilex, Aquacel Foam, Askina DresSil) are versatile for moderate to heavy exudate, provide cushioning and thermal insulation, and are available with silicone contact layers that are gentle on fragile skin. Hydrocolloid dressings (DuoDERM) are best for light to moderate exudate in superficial wounds (Stage 1-2), promote autolytic debridement, and are waterproof and self-adhesive, but should not be used on infected or heavily exuding wounds. Alginate dressings (Kaltostat) are for heavy exudate and cavity wounds (Stage 3-4), forming a gel on contact with wound fluid, and require a secondary dressing. Always assess the wound at each dressing change and adjust the dressing type as the wound heals and exudate decreases.

What skin care products help prevent pressure injuries?

Skin care is a critical component of pressure injury prevention, especially for incontinent or diaphoretic patients, as noted in NPIAP prevention guidelines. Skin barrier sprays and wipes (ConvaTec Esenta Sting Free Skin Barrier) form a protective film on the skin to shield against moisture, friction, and adhesive trauma. Stomahesive protective powder absorbs moisture and protects denuded skin. Adhesive remover sprays and wipes gently remove dressings and tapes without damaging fragile skin. Wound cleansers such as Prontosan (polyhexanide and betaine) and Octenilin (octenidine) provide atraumatic, antimicrobial cleansing without disrupting granulation tissue. Regular skin inspection, gentle cleansing, and moisturising are essential, especially over the sacrum, heels, hips, and elbows.

Can pressure injuries be treated at home in Singapore?

Yes, many pressure injuries can be managed at home in Singapore with appropriate products and guidance, especially Stage 1 and Stage 2 injuries, consistent with the Ministry of Health (MOH) Singapore home care framework. Home care involves: regular repositioning schedules; pressure-relieving positioning aids (Z-Flo positioners, heel boots); appropriate dressings based on wound assessment; skin barrier products; and nutritional support. For Stage 3 and Stage 4 pressure injuries, or wounds showing signs of infection (increased redness, warmth, swelling, purulent discharge, fever, foul odour), medical attention is required. EMIS+ offers a Wound Care & Dressing Home Service across Singapore, staffed by experienced wound care nurses. Always consult a doctor or wound care nurse for proper assessment and a personalised treatment plan.