Nursing Care Spotlight: Preventing Skin Tears

First of all, a skin tear is defined as a wound or laceration caused by trauma, friction and/or shearing forces. Skin tears rip through the upper layer of the sufferer’s skin, but not the lower layer that contains the various glands and nerve endings. Skin tears happen to be the most frequently occurring type of wound in older persons due to a number of reasons related to the aging process.

The likelihood of getting a skin tear increases dramatically as the elder’s skin becomes more weakened, drier, thinner and with less elasticity due to reduced subcutaneous fat, collagen, lessened elastin fiber deposition and sebacious (oil) gland production that occurs with advanced age (Aitken, 2018). In other words, skin tears are much more common as people age due to the fact that elderly skin undergoes predictable changes.

There are two distinct types of skin tears. A partial thickness wound happens when the epidermis, also known as the top layer of skin, becomes separated from the dermis (bottom skin layer). Meanwhile, a full thickness wound is a skin tear in which both the epidermis and the dermis layers become separated from the underlying skin (Ratliff and Fletcher, 2007).

Prevention of skin tears must be a priority for a number of compelling reasons. Firstly, the majority of people who seek care from the healthcare system are 65 years of age or older, so these patients are at increased risk of developing skin tears. Secondly, skin tears do have the potential to become infected. Third, skin tears can result in pain and suffering for the afflicted person. Finally, skin tears cost money to treat and heal.

The following is a list that merely scratches the surface regarding the various ways to prevent skin tears. Keep in mind that it is far more optimal to prevent a skin tear from happening in the first place since treating and healing this type of wound can turn into a time-consuming, somewhat expensive process.

• Utilize draw sheets when moving immobile patients in bed to reduce the chances of developing skin tears from shearing and friction forces.
• Apply barrier creams and lotions to patients’ extremities (arms, legs, hands and feet). Dry skin is a risk factor for skin tear development, so direct care members of staff should keep the skin moisturized often.
• Educate nurses, nursing assistants, patient care technicians, transporters, and other healthcare personnel who regularly come into contact with patients about proper transfer methods, shearing, friction, risk factors, and preventive measures.
• If possible, remove equipment with sharp edges that might cause injury to patients’ skin. If the removal of equipment is not possible, sharp edges should be covered with padding to minimize the chances of skin tears to peoples’ skin.
• Implement a plan to identify all inpatient populations in hospitals, extended care facilities, personal care group homes, and other healthcare centers who are at increased risk of skin tear development.

REFERENCES

Aitken, C. (2018). Skin Tears in the Elderly. Western Alliance. Retrieved March 17, 2019, from https://www.westernalliance.org.au/2018/08/skin-tears-in-the-elderly

Ratliff, C., and Fletcher, K. (2007). Skin tears: a review of the evidence to support prevention and treatment. Ostomy Wound Management, 53(3), pp. 33-42.