In the United Kingdom, the Royal College of Nursing has<unk> blished guidelines in<unk>  Risk Assessment and Prevention that call for identifying people at risk and taking preventive action; the UK National Standards for Care Homes to do so as well. Recent efforts in the United States and South Korea have sought to automate risk assessment and classification by training machine learning models on electronic health records. Internationally, the NPIAP, EPUAP and Pan Pacific<unk>  Injury Alliance, together with wound organizations from 15 countries around the world,<unk> blished updated the international evidence-based clinical practice guideline in 2019. The 2019 guideline was developed by an international team of over 180 clinical specialists and updates the 2009 EPUAP/NPUAP clinical guideline and the 2014 NPUAP/EPUAP/PPPIA clinical guideline. The guideline includes recommendations on strategies to treat<unk> s, including the use of bed rest,<unk>  redistributing support surfaces, nutritional support, repositioning, wound care (e.g. debridement, wound dressings) and biophysical agents (e.g. electrical stimulation). Reliable scientific evidence to support the use of many of these interventions, though, is lacking. More research is needed to assess how to best support the treatment of<unk> s, for example by repositioning. Also, the benefit of using systemic or topical antibiotics in the management of<unk>  is still unclear. Redistributing<unk>  The most important care for a person at risk for<unk> s and those with bedsores is the redistribution of<unk>  so that no<unk>  is applied to the<unk> . In the 1940s Ludwig Guttmann introduced a program of turning paraplegics every two hours thus allowing bedsores to heal. Previously such individuals had a two-year life-expectancy, normally succumbing to blood and skin infections. Guttmann had learned the technique from the work of Boston physician Donald Munro. There is lack of evidence on prevention of<unk>  whether the patient is<unk> t in 30 degrees position or at the standard 90 degrees position. Nursing homes and hospitals usually set programs in place to avoid the development of<unk> s in those who are bedridden, such as using a routine time frame for turning and repositioning to reduce<unk> . The frequency of turning and repositioning depends on the person's level of risk. Support surfaces A 2015 Cochrane review found that people who lay on high specification or high density foam mattresses were 60% less likely to develop new<unk> s compared to regular foam mattresses. Sheepskin overlays on top of mattresses were also found to prevent new<unk>  formation. There is unclear research on the effectiveness of alternating<unk>  mattresses.<unk> -redistributive mattresses are used to reduce high values of<unk>  on prominent or bony areas of the body. There are several important terms used to describe how these support surfaces work. These terms were standardized through the Support Surface Standards Initiative of the NPUAP. Many support surfaces redistribute<unk>  by immersing and/or enveloping the body into the surface. Some support surfaces, including antidecubitus mattresses and cushions, contain multiple air chambers that are alternately<unk> mped. Methods to standardize the products and evaluate the efficacy of these products have only been developed in recent years through the work of the S3I within NPUAP. For individuals with paralysis,<unk>  shifting on a regular basis and using a wheelchair cushion featuring<unk>  relief components can help prevent<unk>  wounds. Controlling the heat and moisture levels of the skin surface, known as skin microclimate management, also plays a significant role in the prevention and control of<unk> s. Nutrition In addition, adequate intake of protein and calories is important. Vitamin C has been shown to reduce the risk of<unk> s. People with higher intakes of vitamin C have a lower frequency of bed sores in those who are bedridden than those with lower intakes. Maintaining proper nutrition in newborns is also important in preventing<unk> s. If unable to maintain proper nutrition through protein and calorie intake, it is advised to use supplements to support the proper nutrition levels. Skin care is also important because damaged skin does not tolerate<unk> . However, skin that is damaged by exposure to urine or stool is not considered a<unk> . These skin wounds should be classified as Incontinence Associated Dermatitis. Organisational changes There is some suggestion that organisational changes may reduce incidence of<unk> s. Cochrane systematic reviews on organisation of health services, risk assessment tools, wound care teams, and education have concluded that evidence is uncertain as to the benefit of these organisational changes. This is largely due to the lack of high-quality research in these areas. Other prevention therapies A Cochrane systematic review found use of creams containing fatty acids may be more effective in reducing incidence of<unk> s compared to creams without fatty acids. Silicone dressings may also reduce<unk>  incidence. There is no evidence that massage reduces<unk>  incidence.
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