New International Pressure Ulcer Prevention and Treatment guidelines will shortly be published by the European Pressure Ulcer Advisory Panel (EPUAP) and the US National Pressure Ulcer Advisory Panel (NPUAP). This major initiative has taken almost four and a half years from the initial discussions regarding the value of standardised prevention and treatment guidelines between the US and Europe to their release. With over 1000 individuals participating directly in the process of guideline development this has been the largest project attempted by both organisations.

One keenly awaited area is the guideline's recommendations upon pressure ulcer classification. Within Europe a four category classification has been proposed where the four categories are-

Category I: Non-blanchable redness of intact skin
Category II: Partial thickness skin loss or blister
Category III: Full Thickness loss (fat visible)
Category IV: Full thickness loss (bone visible)

Within the United States two further categories will be used - suspected deep tissue injury and an unstageable category.

There is considerable scope for national and regional groups to begin work to tailor the overall guideline to meet local circumstances. Two other opportunities exist for gaining involvement in the implementation of the new international pressure ulcer guidelines - the first of these lies in the translation of the guideline documents into languages other than English and the EPUAP and the NPUAP would welcome offers of assistance with this important process.

The second opportunity lies in the creation of patient and carer versions of the guidelines with these important documents resting on the previous refinement of the guidelines to meet local circumstances.

While the international pressure ulcer guidelines project may have taken a long time to come to fruition and has involved many people in its creation it stands as an important landmark in pressure ulcer area care - for the first time we have unified evidence based clinical practice guidelines that will be followed in the US and in Europe. From the extensive literature reviews and summaries of the available evidence there is a clear statement of what we know today. The challenges, as ever, is keeping the guidelines up-to-date as new knowledge emerges. With over 300 new pressure ulcer publications each year this will be a major challenge for clinicians, policy makers and for the many volunteers who contributed to the guideline project from the EPUAP and the NPUAP.

Michael Clark
Editor