Sacral Pressure Injuries: Offloading and Dressing Choice in LTC
A sacral pressure injury is treated at the point where the resident meets the mattress, and everything that happens at the dressing is secondary to that. Care homes that improve only the dressing and leave the surface unchanged usually watch the wound return.
What makes the sacrum different from other pressure sites?
The sacrum combines three risk factors that rarely appear together elsewhere. There is almost no soft tissue between the bone and the skin, so load concentrates. It is a site where moisture from incontinence sits against the skin. And it is the pivot for shear, because a resident who slides down a raised bed creates opposing forces across that tissue.
How do you offload the sacrum?
| Intervention | What it changes | Practical check |
|---|---|---|
| Repositioning schedule | Duration of load on the sacrum | Is it documented, and does it happen at night? |
| 30-degree lateral positioning | Removes direct pressure from the sacrum | Is the wedge or pillow actually under the resident? |
| Head of bed elevation reduced | Cuts shear from sliding | Is the clinical reason for elevation still needed? |
| Support surface matched to risk | Distributes load over a larger area | Does the surface match the resident's mobility and weight? |
| High-absorbency underpads | Removes moisture and reduces friction | Is the pad flat and unwrinkled under the resident? |
The last line is the one most often missed. An underpad that is bunched or wrinkled adds friction exactly where the tissue is most vulnerable, and a saturated pad keeps the skin wet. Choosing an underpad for absorbency and fit is part of pressure injury prevention, not a housekeeping decision.
How do you choose a dressing for a sacral wound?
Start with the wound bed, then work outward to fixation. An intact or blistered surface is managed with protection and moisture control. A partial-thickness wound needs a non-adherent interface so that the dressing lifts without tearing new tissue, with an absorbent cover above it. A full-thickness or cavity wound needs packing by a clinician, with the product and the change schedule written into the care plan.
Fixation is the sacral-specific problem. Adhesive dressings on a sacrum sit under shear and near moisture, and repeated removal strips fragile skin. Where the surrounding skin is thin or already damaged, the fixation method should be the mildest one that holds, and the dressing choice should assume frequent checking rather than long wear.
What does an audit actually ask for?
What should be stocked together?
The supplies that travel together for sacral care are a non-adherent interface layer in the sizes the home uses, an absorbent cover, a mild fixation tape, sterile gauze for cleansing, and a fitted high-absorbency underpad. Keeping them as one reorder group means a dressing round never stops because one component ran out, and it keeps the par level honest across all of the components rather than only the visible one.
The supplies that travel together for sacral care are a non-adherent interface layer in the sizes the home uses, an absorbent cover, a mild fixation tape, sterile gauze for cleansing, and a fitted high-absorbency underpad. Three underpad formats cover most resident profiles: the 60 x 90 cm five-layer underpad with SAP for full bed coverage, the 30 x 36 inch heavy-absorbency underpad for chair and repositioning use, and the PLA biodegradable underpad where the facility has a sustainability target alongside its absorbency specification. Homes that reprocess wound care instruments need a released load behind every tray, and a five-pack trial of CliniEco biological indicators keeps the weekly spore test on the supply room shelf rather than on a reorder list.
References
- Public Health Ontario - infection prevention and control guidance (checked 17 September 2026)
- Wounds Canada - Canadian wound care resources (checked 17 September 2026)
Ordering for a clinic, lab or care home? Wholesale and multi-site ordering covers case pricing and account setup, and the B2B wholesale collection lists the lines stocked for institutional buyers.
Related Reading
- Incontinence care supplies for Canadian long-term care homes
- Learning Hub - clinical and procurement guides for care teams
- Underpad selection checklist for pressure injury prevention
- Pressure injury prevention: choosing the right underpad for LTC
- Request bulk pricing for incontinence and wound care supplies
- long-term care supplies
Frequently Asked Questions
Why is the sacrum so prone to pressure injury?
It is a bony prominence with very little soft tissue over it, and it carries load the moment a resident lies supine, reclines in a chair or slides down in bed. Shear adds to the pressure: when the head of the bed is raised and the resident slides, the skin and the underlying tissue move in opposite directions and the vessels feeding that area are stretched and compressed.
Does a sacral wound need a special dressing?
It needs a dressing that matches the wound, not a dressing chosen because of the location. A shallow, intact-skin injury is managed with moisture and shear protection; a partial-thickness wound needs a non-adherent contact layer with an absorbent cover; a deeper cavity needs packing by a clinician with the correct product and a documented change schedule. The location changes the fixation and the offloading, not the wound care principle.
How often should a sacral dressing be checked?
At every repositioning round, without lifting the dressing. The check is for strikethrough, lifting edges, odour and a change in the resident's pain or behaviour. The dressing itself is changed on the schedule the clinician set and whenever the check finds a failure, rather than on a fixed facility-wide interval.
What supplies should an LTC home keep for sacral injuries?
A working set covers cleansing, protection and offloading: sterile gauze for cleansing, a non-adherent interface layer for partial-thickness wounds, an absorbent cover, a fixation product chosen for fragile skin, and a high-absorbency underpad for residents who are incontinent. Underpads are part of pressure management here, not just hygiene, because a wet surface under a sacrum increases friction and maceration.
Last updated: September 2026. CliniEco Medical holds MDEL #35334 issued by Health Canada, and supplies clinics, long-term care homes and home-care programs across Canada.
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