How are skin tears caused?
When skin tears are reported to healthcare professionals, the cause of the injury often is not known. When the cause is known, they are often linked to the following events: wheelchair injuries (25%), blunt trauma from accidentally bumping into objects (25%), transfers (18%), and falls (12.4%). It has also been concluded that the key times when skin tears occur are during peak activity hours, from 6:00 to 11:00 am and from 3:00 to 9:00 pm. Skin tears result from shearing, friction, or blunt trauma that causes separation of skin layers. The subsequent wounds are partial- or full-thickness, depending on the degree of tissue damage. Subtle skin changes associated with aging increase the risk of skin tear development and interfere with the healing of the skin tear. Aging skin undergoes a process in which it experiences dermal and subcutaneous tissue loss, epidermal thinning, and serum composition changes, which cause decreased skin surface moisture. The skin's elasticity and tensile strength decrease as these other changes occur. Dehydration, poor nutrition, cognitive impairment, altered mobility, and decreased sensation can also increase skin tear risk.
Skin tears are a painful, yet preventable problem. In the United States, reports show that 1.5 million skin tears occur each year in institutionalized adults. These types of wounds pose a potentially serious and painful problem for the older adult population, who are at a higher risk for skin tears. Such wounds can cause stress to both patients and their families. The result of the physical changes associated with aging and coexisting illnesses can be very difficult to manage. Thus, it is imperative that healthcare professionals identify those at risk for skin tears and establish plans of care that will address prevention, as well as evidence-based management of these wounds. Compared with more extensive and costly chronic ulcers, skin tears are often seen as minor, inconsequential wounds. But in reality, these wounds are painful and can lead to potential complications if not treated appropriately.
How can skin tears be prevented?
Following should be considered if patient is at risk of having a skin tear:
• Educate staff on the importance of carefully handling elderly patients with
frail skin. Any harsh movement or pulling can create a skin tear.
• Encourage proper positioning, turning, lifting, and transferring techniques
to prevent friction or shear. A lift sheet should be used to move and
turn patients. If the patient is being cared for at home, make sure the
home health care assistants and the patient's family caregivers understand
these techniques.
• Provide padding to bed rails, wheelchair arm and leg supports, and any
other equipment that may be utilized to protect the patient from
accidentally bumping into a hard surface.
• Use pillows and blankets to support arms and legs.
• Recommend that patients wear long sleeves and pants for added protection.
• Use paper tape or a non-adherent dressing on frail skin and gently remove it.
Or use stockinet, gauze wrap, or any other similar type of wrap instead of
tape to secure dressings and drains.
• Apply a moisturizing agent to dry skin to keep it adequately hydrated. Creams
and topical gels are better than lotions.
• Provide a well-lit environment to minimize the risk of patients bumping
into equipment or furniture.
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Wound-Be-Gone Blog
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