Skin tears are a serious challenge, but we can improve care by raising awareness, collecting data and implementing prevention programmes.
Did you know that the skin is the largest organ in the body? It is also a vital barrier against infection. That is why it is so important to reduce the prevalence of skin tears and to care for them when they occur.
Skin tears can occur at any age but are most commonly associated with older people in hospitals or long-term care. In one study of long-term care institutions in Canada, 26% of people had had a skin tear. Most skin tears occur on the arms and legs, often caused by blunt trauma or scratching.
However, they can also occur in neonates or critically ill patients. I can personally attest, based on the experience my husband had in an intensive care unit (ICU), that patients with serious illnesses can be highly vulnerable to tears. At one point, my husband had around 200 skin tears.
Skin tears occur frequently in the community – although more data is needed to help understand the true scale of their impact. Most older people prefer to live independently at home for as long as possible.
As we age, our skin can become thinner and more fragile making us susceptible to tears. Imagine getting up in the night to visit the bathroom – either in a care setting or at home. It is essential that the path is well lit and free of hazards that may lead to falls or blunt trauma. Practical measures like this can help to reduce the burden of skin tears. That’s why it is so important that individuals, health professionals and institutions are aware of the risk.
Critically ill patients require the administration of fluids and may need intravenous lines or endotracheal tubes inserted. In many cases, these are taped to the arm – but this can increase the risk of skin tears when the tape is removed.
Technological advances are helping to reduce the risk of skin tears and improve the management of tears. For example, using strong adhesives on dressing can be problematic for patients vulnerable to skin tears. Silicon-border dressings or wraps can help to protect the limbs without adding a risk of tearing the skin. These skin-friendly products can control the risk. Other practical measures – like wearing long sleeves and avoiding sharp nails and jewellery – also help.
The International Skin Tear Advisory Panel (ISTAP) was founded to help reduce the global burden of skin tears. Significant progress has been made in recent years and we are now gathering real momentum. New best practice recommendations have been developed to help prevent and manage skin tears. (Visit their website for more)
We would like to see clinicians and health agencies do more to identify and classify skin tears. Just was many care facilities monitor pressure injury prevalence, they should do more to determine the prevalence of skin tears. The use of appropriate pH-balanced cleansers, soft cloths, warm water and modern dressings would also help significantly.
Organisations should implement a skin tear prevention programme based on available guidelines. Educating the public and the health workforce will also contribute to better care.
While there is much work to do to improve the care of skin tears, ISTAP is confident that, together, we can make significant progress in this under-appreciated field.