Pressure injuries can be devastating and costly. But preventing them isn’t just about choosing a high-tech mattress. It’s about how that mattress is used, how it fits the individual needs of the person, and whether it's supported by the right practices.
With the release of the 2025 International Pressure Injury Guidelines, clinicians are reminded that a mattress alone doesn’t prevent skin breakdown. Even the most advanced surface can lose effectiveness if it's poorly set up, incorrectly layered, or selected without a clear clinical rationale.
This blog unpacks what’s essential to getting pressure care right, starting with the surface, but never ending there.
The Mattress Matters, But So Does the Method
Pressure injuries often develop on bony areas like the sacrum, heels, elbows, and scapulae, especially in bed-bound patients. High-quality medical mattresses help by:
- Distributing pressure
- Allowing immersion and envelopment
- Managing moisture and heat
- Reducing friction and shear
But their performance is directly influenced by how they’re set up and used.
Figure: Pressure points distributed across the body.
3 Warnings: Common Missteps That Undermine Pressure Care
1. Excessive Layering (Including Sheepskins)
The 2025 Guidelines are clear: avoid unnecessary layers like extra sheets, incontinence pads, and non-clinical sheepskins. These can interfere with immersion, trap heat and moisture, and compromise microclimate management.
Only medical-grade sheepskins should be used and never on top of high-spec pressure care mattresses. Layers reduce how effective the pressure redistribution of the surface will be.
2. Incorrect Pump Settings on Dynamic Systems
For air mattresses, using the wrong settings can reduce their ability to offload pressure. Always set pump values based on patient weight and clinical need, and ensure staff are trained to make safe adjustments.
3. One-Size-Fits-All Thinking
Not everyone needs an alternating air mattress. In fact, some patients may benefit more from high-spec foam or hybrid surfaces, especially if they’re mobile or find air mattresses uncomfortable.
Pressure injury prevention is personal. Match the surface to the person, not the product.
3 Wins: What to Get Right from the Start
| Wins | Why It Matters |
| Auto-Weight Adjustment | Helps maintain correct immersion and reduces bottoming out risk |
| Individualised Selection | Choose a surface based on mobility, Pressure Injury risk, pain level, and microclimate needs |
| Heel Offloading Design | Heels are one of the most at-risk sites, offloading zones or devices can prevent and heal Stage 3–4 injuries |
Key Features That Make a Difference
| Feature | Clinical Benefit |
| Responsive Foam | Has good immersion and envelopment but still allows bed mobility/repositioning for more mobile clients |
| Alternating Pressure Cells | Cycles pressure to offload high-risk areas and stimulate bloodflow to pressure injuries to heal |
| Hybrid Foam + Air | Combines stability with dynamic pressure relief |
| Anti-Shear Layer | Reduces sliding during bed adjustments, protecting sacrum and coccyx |
| Breathable Stretch Covers | Maintains skin-friendly microclimate and improves envelopment |
The Heel is High-Risk: Protect It Early
According to the 2025 Guidelines and Medline, up to 38.5% of Stage 4 pressure injuries occur at the heels. Offloading is not optional, it’s essential.
Read more here: Medline's article on preventing heel pressure injuries
Heel Relief can include a heel relief slope design that redistributes pressure away from the heels and rather over the calves. There are also mattress designs that completely offload the heels for cases where the client has a pressure injury on the heels.
Best Practice: Match the Surface to the Situation
The 2025 guidelines urge clinicians to move beyond product preference and focus on clinical compatibility:
- Reposition patients every 2–4 hours
- Use validated risk tools like the Braden, Waterlow or Purpose T Tool to determine the clients pressure injury risk
- Avoid excessive, especially non-stretchable, layers on support surfaces (e.g. sheepskin)
- Conduct twice-daily skin assessments
Let the Surface Do the Work, When It’s Set Up to Succeed
Too often, well-intended layering or guesswork in mattress selection undoes the benefits of a carefully engineered surface. The key message from the 2025 Guidelines is simple:
Don’t just choose the right surface, use it right, for the right person.
Ready to Get Pressure Care Right?
Explore our range of Pressure Care Mattresses or contact us for help matching the right surface to your care environment.
Enable Lifecare – Fast. Intelligent. Care.
Download the Whitepaper on Preventing Pressure Injuries with Beds.
