When it comes to preventing pressure injuries, beds play a more active role than most people think. An intelligently designed bed isn’t just about comfort, it’s a clinical tool that can either support or sabotage skin integrity. But using beds effectively requires more than just plug-and-play functionality. Misuse, or underuse, of key features can quickly turn a win into a warning.
In this article, we break down how beds can prevent pressure injuries and the clinical pitfalls to avoid.
Why Bed Design Matters in Pressure Injury Prevention
Pressure injuries form when prolonged pressure or shear impedes blood flow, especially over bony areas like the sacrum, heels, and shoulders. For patients spending extended time in bed, especially those with limited mobility, the bed becomes a central player in either managing or compounding this risk.
A well-suited bed supports:
- Frequent repositioning
- Pressure redistribution
- Improved carer access
- Safer, more independent transfers
But when beds lack critical functionality, like height adjustment or auto-regression, they may inadvertently increase risk.
Wins: What to Look for in Pressure Injury Prevention Beds
1. Auto-Regression to Reduce Shear
Beds with auto-regression shift the backrest backwards while elevating. This motion prevents patients from sliding down the bed, which is a major cause of sacral shear injuries.
A UK clinical study found that beds with auto-regression (like the Empresa® bed with BodyMove™ tech) reduced sacral pressure by 23% compared to non-regression beds.
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This feature doesn’t just protect the skin, it also reduces how often carers need to reposition patients, easing manual handling demands.
Auto-Regression vs. Hinge Systems: Why It Matters
Not all beds are created equal when it comes to movement. Many standard beds operate on a simple hinge system—the head section rises like a folding board, pivoting at a fixed point near the hips. But this doesn’t match how the human body actually moves.
The Human Body Isn’t a Hinge
When you sit up from lying down, your body doesn’t fold at a single point. Instead:
- Your spine elongates
- Muscles in your torso and legs lengthen and shorten
- Your pelvis tilts
This natural movement involves dynamic lengthening — not just bending.
Auto-Regression Mimics Real Movement
Auto-regression is an advanced bed function that moves the head and knee sections backward and downward as they rise. This allows the bed base to effectively lengthen, following the natural biomechanics of the body.
So instead of the patient sliding downward (as with hinge beds), auto-regression helps:
- Reduce shear and friction
- Prevent sacral loading
- Improve comfort and postural alignment
“Think of it this way: when the bed sits you up, it shouldn’t just fold you like a deck chair—it should open out and follow your body’s natural lines. That’s what auto-regression does.”
What Happens with Hinge-Only Beds?
- Patient slides downward as the backrest rises
- Increased sacral pressure and shear
- Discomfort and frequent repositioning needed
- Carers must manually adjust patients more often
This mismatch between body mechanics and bed movement is a leading contributor to deep pressure injuries, especially in the sacrum and lower back.
2. Four-Section Profiling Platforms
These allow for customised positioning of the back, knees, legs, and head. It helps:
- Redistribute pressure evenly
- Support postural alignment
- Minimise heel and sacral pressure
When paired with a pressure care mattress, this setup offers a holistic solution.
3. Height Adjustment
Raising the bed to carer height reduces bending and lifting, lowering carer injury risk. Lowering the bed supports safe exit and fall prevention.
Our Empresa Bed offers ultra-low positioning and smooth transitions for high-risk patients.
4. Tilt-in-Space & Lateral Tilt
Tilt functions offload pressure by shifting weight to different parts of the body, especially useful in patients unable to reposition themselves.
- Lateral tilt supports passive repositioning.
- Modified Trendelenburg (Semi fowler with tilt-in-space) aids perfusion and comfort.
5. Mattress Integration
The right bed and mattress combination is essential. Even with the best bed, a poor mattress negates benefits.
Enable Lifecare offers a wide selection of pressure care mattresses designed to complement profiling beds.
Take a look here: Enable Lifecare Pressure Care Mattress Range
Shear Explained: The Hidden Force Behind Pressure Injuries
Shear is one of the most damaging but least visible contributors to pressure injuries. Unlike vertical pressure, which compresses the skin and tissue downward, shear occurs when the skin stays in place while the internal tissues and bones shift in opposing directions.
This commonly happens when:
- A patient is in a semi-upright position
- The backrest is elevated without appropriate pelvic support
- There is no auto-regression
- The patient slides down the bed due to gravity
The result is tissue deformation, particularly at the sacrum and heels, where blood vessels are stretched or pinched, reducing perfusion and increasing deep tissue injury risk.
Cake Analogy: Friction vs. Shear
To make this clearer, imagine your skin like a multi-layered cake:
- The top layer is your epidermis (outer skin)
- The middle is the dermis
- The bottom is your subcutaneous tissue (fat and muscle)
- Between each layer is a soft filling, like cream — this is similar to the fascia and connective tissue that hold skin layers together
Friction = Rubbing the Top of the Cake
“Imagine gently rubbing the top icing of the cake with a knife. You're disturbing only the surface. That’s like friction — it damages the outer skin. It might cause redness or surface irritation.”
Friction occurs when skin rubs against bedding or cushions — common during transfers or when patients reposition themselves without lifting fully.
Shear = Sliding the Top Layer Sideways
“Now imagine pushing the top layer of cake sideways while the bottom stays still. The creamy middle gets pulled and distorted. That’s what shear does — it pulls the deeper tissue layers apart under the surface.”
This is especially dangerous because the damage occurs deep beneath intact skin — often going unnoticed until a serious injury develops.
Shear occurs when the pelvis and heels slide down the bed with gravity while the skin stays in place due to friction with the bedding.
How to Reduce Shear
- Use beds with auto-regression to shift the backrest backward as it elevates
- Adjust the knee break first to anchor the body before raising the backrest
- Reposition regularly and use low-friction aids when moving patients
- Avoid high backrest angles unless clinically essential
Simple Summary to Use with Patients or Families:
“Think of your skin like a layered cake. Friction is like rubbing the top with a knife — it damages the surface. Shear is like pushing the layers in different directions — it tears the inside. That’s why we need to be careful how we move and position your body, so we don’t damage the skin from the inside out.”
Warnings: Common Bed-Use Mistakes that Undermine Pressure Care
1. No Auto-Regression = Increased Sacral Load
Beds without auto-regression force the patient's body downward during backrest elevation, increasing shear and pressure concentration on the sacrum.
Avoid using older or basic models that don't accommodate spinal elongation during profiling.
2. Incorrect Profiling Angles
Raising the backrest too high without knee break support creates a jackknife position, intensifying pressure on the lower back, heels and sacrum. It also increases shear forces from the patient sliding down the bed.
Always use the knee break before raising the backrest to keep the pelvis stable.
3. Poor Repositioning Practices
Even the best bed is ineffective if patients aren’t regularly repositioned. Failing to reposition:
- Increases pressure duration
- Negates equipment benefits
- Raises risk of deep tissue injury
Educate caregivers to reposition at intervals aligned with clinical guidelines.
4. Beds Not Matched to Clinical Needs
Using fixed-height or basic electric beds for high-risk clients restricts care access and movement, undermining pressure care.
Select beds that suit the mobility level and clinical complexity of the patient. For example, beds like the Empresa Bed are ideal for clients needing dynamic pressure redistribution.
Enable Lifecare offers a variety of beds to suit different bodies, needs, and clinical settings: Empresa Beds
Key Takeaways for Clinicians & Carers
- Choose beds with auto-regression, 4-section profiling, and height adjustment.
- Always integrate beds with suitable pressure care mattresses.
- Use tilt functions for passive repositioning especially when regular active turning isn't possible.
- Avoid elevating the backrest without adjusting the knee break first.
- Regularly reposition, assess skin, and document care actions.
Your Equipment Choices Matter
Beds are not just furniture, they’re frontline tools in pressure injury prevention. When used intelligently, they reduce harm, support carer safety, and improve outcomes. But when misused or misunderstood, even high-end beds can cause avoidable injuries.
Want to explore clinically intelligent beds?
Browse our Empresa bed range to find solutions designed for real-world clinical challenges.
Or reach out to our team for a tailored recommendation. Contact us at support@enablelifecare.com.au or 1300 370 370
Download our Clinical Guide Preventing Pressure Injuries With Beds for best practice recommendations.
