Why is Microclimate Management important in Pressure Ulcer/Injury Prevention & Management?
by Sharon Maris, Director Global Medical Affairs for Pressure Injury Prevention
Microclimate - the temperature and humidity at the skin’s surface - is a critical yet often underestimated factor in Pressure Ulcer/Injury Prevention. When heat and moisture build up, the skin becomes more fragile, less tolerant to pressure, shear and friction, and more prone to breakdown. Effective microclimate management, supported by evidence‑based guidelines, helps create a healthier skin environment and plays an essential role in both preventing injuries and supporting healing.
Elevated temperature and humidity can affect the structure and function of the skin⁴ and reduce the tolerance of the skin and tissues to the damaging effects of pressure, shear and friction⁵. It has been suggested that an elevated skin temperature:
- Increases the metabolic demand of local tissues
- Increases the tissues requirement for oxygen
- Increases the susceptibility of the tissues to the ischaemic effects of pressure and shear⁵
- Weakens the stratum corneum⁶.
Excessive moisture against the skin causes maceration which reduces stiffness, and connective tissue strength and increases the susceptibility to shear forces⁷. Friction at the skin interface with the support surface is also increased promoting adhesion to the sheet or bedclothes and increasing the risk of mechanical damage and superficial pressure injury/ulceration.
Managing Microclimate
There are numerous ways to normalise the local skin microclimate, the simplest being to reposition the patient. However, this is not always possible, and many patients may require additional interventions. The International Guidelines¹ discuss how managing microclimate can provide an environment conducive to injury prevention and tissue repair. As such the guidelines recommend the need for additional features such as the ability to control moisture and temperature when selecting a support surface.
Why do support surfaces play an important role in management?
Support surfaces play a significant role in an individualised comprehensive management plan for pressure injury prevention and treatment¹. The International Pressure Ulcers/Injuries Prevention and Treatment Guideline* recommends that where the individuals risk assessment indicates, by design a low air loss (reactive) support surfaces may also assist in managing heat and humidity (microclimate) of the skin, especially when moisture and heat at the skin-surface interface are contributing factors⁸.
Find the right support surface – explore the guide
*In the guideline, a low air loss (reactive) support surface refers to a support surface construction that uses a flow of air to assist in pressure redistribution.
References
- National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Emily Haesler (Ed). Cambridge Media: Perth, Australia; 2019.
- Kottner J, Black, J, Call, E, Gefen, A, Santamaria N (2018) Microclimate: a critical review in the context of pressure ulcer prevention
- Clark M, Black J (2011) Skin IQTM Microclimate Made Easy. Wounds International 2011; 2(2). Available from http://www.woundsinternational.com
- Clark M, Romanelli M, Reger S et al (2010). Microclimate in context. In: Baharestani M, Black J, Carville K et al (2010). International Review. Pressure ulcer prevention: pressure, shear, friction and microclimate in context. Wounds International.
- Reger S, Ranganathan VK, Sahgai V (2007). Support surface interface pressure: an analysis of the literature. Ostomy Wound Management 53(10): 50-58.
- National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Full Body Support Surfaces for Prevention of Pressure Injuries. In: Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline: Fourth Edition. Full Body Support Surfaces For Prevention Of Pressure Injuries. Emily Haesler (Ed.).2025.[cited: 15/01/2026]. Available from: https://internationalguideline.com