Articles Clinical Blog Downloads

Nutrition and Hydration in Pressure Ulcer Management

One of the most important factors in keeping the skin healthy is nutrition and hydration. The NHS Eatwell Guide (1) shows how much of what we do eat should come from particular food groups to ensure a balance over each day. Taking plenty of fluids is also vital with 6-8 glasses of water, lower-fat milks and lower-sugar or sugar-free drinks, including tea and coffee (1).

This year’s Nutrition and Hydration Week has a key message to ‘Reinforce, Focus and Energise’ (2). Following the COVID-19 pandemic and lockdowns, everyone has probably taken on some bad habits when it comes to diet and exercise, but as summer is here, restrictions are easing and the sun is shining, it is the right time to ‘Reinforce, Focus and Energise’ ourselves.

Dietary deficiencies are also recognised as a risk for developing pressure ulcers and international guidance recommends using a nutritional screening tool to assess risk of malnutrition and other risk factors (3) (European Pressure Ulcer Advisory Panel et al, 2019). People who are well nourished are at lower risk of developing pressure ulcers than malnourished individuals, but both may develop skin integrity issues under certain circumstances. Unplanned weight loss is a major risk factor for malnutrition and pressure ulcer development and suboptimal nutrition interferes with the function of the immune system, collagen synthesis, and tensile strength (4). There is also a risk to pressure ulcers if a person is overweight and has poor nutritional intake (5).

If a pressure ulcer has developed, nutrition plays a vital role in the healing process. This is because the body needs protein, energy (calories), vitamins and minerals (such as vitamin C, iron and zinc), and plenty of fluids to support the wound healing process (5).

The body may need more protein as a pressure ulcer develops. Foods high in protein include meat, fish, eggs, dairy products, nuts, beans, and pulses. Having at least one of these foods at each meal will benefit. In addition, to increase calories, one pint of milk per day or a variety of milk and dairy foods such as milk puddings, cheese or yoghurts is encouraged as a food first approach. It is important to develop care plans with patients in care homes, hospitals, hospices or in a patient’s own home; this can be achieved by simple adjustments to diet, and texture of food can be changed if swallowing problems are present.

NICE guidance (6) advice is not to provide nutritional supplements to people who have an adequate intake; the European Pressure Ulcer Advisory Panel (3) states if individuals are unable to have a usual intake, offer high calorie, high protein nutritional supplements in addition to the usual diets – this is in combination with the wider collaborative health care team including GPs and dieticians.

In clinical practice, we should ensure all aspects of care for pressure ulcer prevention and management are addressed using a framework such as aSSKINg from the NHSI core curriculum7. Combining assessment, incontinence, mobility, provision of the right equipment such as pressure care mattresses, beds and pressure care cushions, give the right information and advice with nutrition, should provide a robust care package.

Pressure ulcer prevention and management requires holistic assessment and interventions such as nutrition and hydration are a key component which should not be overlooked.

We are changing lives every day. We are OSKA – the Pressure Care Experts.


  1.{accessed 3/06/2021)
  2. {accessed 02/06/2021}
  3. European Pressure Ulcer Advisory Panel et al (2019) Prevention and Treatment of Pressure Ulcers /Injuries: Clinical Practice Guideline. The International Guidance 2019. EPUAP
  4. Saghaleini SH, Dehghan K, Shadvar K, Sanaie S, Mahmoodpoor A, Ostadi Z. Pressure Ulcer and Nutrition. Indian J Crit Care Med. 2018;22(4):283-289. doi:10.4103/ijccm.IJCCM_277_17. {Accessed 04/06/2021}
  5. BDA. Association of UK Dieticians.{accessed 4/06/2021}
  6. National Institute for Clinical Excellence. 2014. Pressure ulcers: prevention and management. Clinical guideline [CG179] {Accessed on 2/06/2021}
  7. NHS Improvement (2018) Pressure Ulcer Core Curriculum.