Stage 3 pressure ulcers—also called stage 3 bedsores or decubitus ulcers—are serious skin injuries that involve full-thickness skin loss and exposure of the fatty tissue beneath. These wounds can be painful, slow to heal, and prone to infection. They commonly affect elderly or immobile individuals in nursing homes, hospitals, or long-term care settings.
Preventing and properly treating stage 3 pressure ulcers is essential to protect patient safety and maintain skin integrity. Below, we’ll explore a real-life case, followed by key facts on symptoms, causes, treatments, and facility-wide prevention strategies.
An 89-year-old female long-term resident in a nursing home developed fever, chills, and cough. Diagnosed with pneumonia but not requiring oxygen, she was treated in the facility with IV antibiotics. One month later, she reported ongoing fatigue, shortness of breath, and depression. These symptoms continued for two more months, and she eventually became bedbound.
Four months after her initial illness, she was found to have a stage 3 pressure ulcer (or stage 3 decubitus) on her sacrum—a serious skin breakdown likely related to immobility and prolonged pressure on vulnerable areas.
A stage 3 pressure ulcer is tissue damage that results in full-thickness loss of skin and the layer of fat under the skin may be visible. The ulcer may present with:
At this stage, the ulcer is deep but does not expose muscle, tendon, or bone, which would classify it as a stage 4 pressure ulcer.
Pressure ulcers typically begin as stage 1 (red, non-blanching skin) or stage 2 (partial skin loss or blistering). Without proper care, they can worsen into stage 3 ulcers. Warning signs include:
Recognizing and addressing early stages is key to preventing severe wounds.
It is important to prevent pressure ulcers from developing, but once a stage 3 pressure ulcer is diagnosed there are a few key steps to follow to allow for optimal healing. Treating a stage 3 pressure ulcer involves a multi-step wound care plan, including:
Facilities should prioritize implementing strategies to prevent pressure ulcers from developing. Preventing pressure ulcers is a team effort that includes:
Facility leadership plays a crucial role in reducing pressure ulcer rates. To support better outcomes:
Stage 3 pressure ulcers are a significant health concern for older adults, especially in long-term care. With full-thickness skin loss and exposure of fatty tissue, they require immediate and consistent care. Preventing pressure ulcers through regular assessment, proper positioning, good nutrition, and staff training can drastically reduce complications.
When ulcers do occur, a team-based, evidence-informed approach is essential for healing and avoiding progression to stage 4 wounds.
Q: Can stage 3 pressure ulcers heal on their own?
A: Not usually. These open wounds require clinical care, including pressure relief, moisture control, and sometimes antibiotics or debridement.
Q: How long does it take to heal a stage 3 pressure ulcer?
A: Healing can take several weeks to months, depending on wound size, infection, and the resident’s overall health.
Q: What’s the difference between stage 3 and stage 4 pressure ulcers?
A: Stage 3 ulcers expose fat tissue but not bone, tendon, or muscle. Stage 4 ulcers extend deeper, exposing these critical structures.
Q: What role do CNAs play in prevention?
A: CNAs are essential in repositioning residents, noticing early skin changes, and ensuring nutrition and hydration needs are met.
Q: How can leadership support pressure ulcer prevention?
A: Facility leadership can play a role in creating a culture that prioritizes skin integrity. Leadership should ensure that policies and procedures are in place for resident screenings that determine pressure ulcer risk as well as regular skin assessments. Leadership should also ensure that success stories and improvement in pressure ulcer rates are highlighted.