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Background: Although skin tears are among the most prevalent acute wounds in nursing homes, their recognition as a unique condition remains in its infancy. Elderly patients are at risk of developing skin tears due to increased skin fragility and other contributing risk factors. In order to provide (cost-) effective prevention, patients at risk shou...
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... 1,2 In this context, skin tears (STs) are an important issue concerning patient safety. [3][4][5] The International Skin Tears Advisory Panel (ISTAP) defines STs as "traumatic wounds caused by mechanical forces, including removal of adhesives. Severity may vary by depth (not extending through the subcutaneous layer)." ...
... 6 Skin tears usually occur as a result of a fall, immobility, friction on the skin caused by equipment (bed, furniture, wheelchair, etc), or mechanical trauma during the removal of adhesive bandages or wound dressings. 4,5 Generally, older adults, newborns, children, and individuals with fragile skin for various reasons (medications, chronic diseases, etc) are considered high-risk groups for STs. 4 In the observational study by van Tiggelen et al, 5 which was conducted in 10 nursing homes in Belgium (N = 795), the point prevalence of STs was 3.0%. The authors categorized STs into three types according to the level at which the epidermis and dermis were affected: type 1, no skin loss; type 2, partial flap loss; and type 3, total flap loss. ...
... 6 Skin tears usually occur as a result of a fall, immobility, friction on the skin caused by equipment (bed, furniture, wheelchair, etc), or mechanical trauma during the removal of adhesive bandages or wound dressings. 4,5 Generally, older adults, newborns, children, and individuals with fragile skin for various reasons (medications, chronic diseases, etc) are considered high-risk groups for STs. 4 In the observational study by van Tiggelen et al, 5 which was conducted in 10 nursing homes in Belgium (N = 795), the point prevalence of STs was 3.0%. The authors categorized STs into three types according to the level at which the epidermis and dermis were affected: type 1, no skin loss; type 2, partial flap loss; and type 3, total flap loss. ...
Objective:
To determine nurses' knowledge level about skin tears (STs).
Methods:
This cross-sectional study included 346 nurses working in acute care hospitals in Turkey who completed web- or paper-based surveys in September and October 2021. Researchers used the Skin Tear Knowledge Assessment Instrument, which consists of 20 questions across six domains, to assess nurses' level of ST knowledge.
Results:
The mean age of the nurses was 33.67 (SD, 8.88) years, 80.6% were women, and 73.7% had an undergraduate degree. Nurses' mean number of correct answers on the Skin Tear Knowledge Assessment Instrument was 9.33 (SD, 2.83) of 20 (46.66% [SD, 14.14%]). The mean numbers of correct answers by domain were as follows: etiology, 1.34 (SD, 0.84) of 3; classification and observation, 2.21 (SD, 1.00) of 4; risk assessment, 1.01 (SD, 0.68) of 2; prevention, 2.68 (SD, 1.23) of 6; treatment, 1.66 (SD, 1.05) of 4; and specific patient groups, 0.74 (SD, 0.44) of 1. Significant associations were found among the nurses' ST knowledge scores and whether they had graduated from a nursing program (P = .005), their working years (P = .002), their working unit (P < .001), and whether they provided care to patients with STs (P = .027).
Conclusions:
Nurses' level of knowledge of the etiology, classification, risk assessment, prevention, and treatment of STs was low. The authors recommend including more information about STs in basic nursing education, in-service training, and certificate programs to increase nurses' ST knowledge.
... In contrast, a previous study in Germany revealed a lower prevalence of 6.3% in a similar setting but with fewer participants and a different study focus (Hahnel et al., 2017). The prevalence of skin tears in Belgium was likewise lower, with only 3.0% in long-term care settings (Van Tiggelen et al., 2019), whereas Canadian studies report an occurrence between 14.7% and 20.8% (LeBlanc et al., 2021). In the present sample, skin tears were associated with higher age, lower weight, and physical and cognitive impairments, which is supported by previous findings (Strazzieri-Pulido et al., 2017;Rayner et al., 2015). ...
Background:
The number of elderly and care-dependent people is increasing, leading to increased risks of adverse skin conditions. Skin care, including prevention and treatment of vulnerable skin, is an essential part of daily nursing practice in long-term residential settings. For many years, the research focus has been on individual skin problems including xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers, and intertrigo, although people may be affected by several at the same time.
Objectives:
Aim of the present study was to describe the prevalence and associations of skin conditions relevant to nursing practice in aged nursing home residents.
Design:
Analysis of baseline data of a cluster-RCT in long-term residential settings.
Setting:
The study was conducted in a representative sample of n = 17 nursing homes in the federal state of Berlin, Germany.
Participants:
Care dependent nursing home residents being 65+ years.
Methods:
A random sample of all eligible nursing homes was drawn. Demographic and health characteristics were collected and head-to-toe skin examinations conducted by dermatologists. Prevalence estimates and intracluster correlation coefficients were calculated, and group comparisons conducted.
Results:
Three hundred fourteen residents with a mean age of 85.4 (SD 7.1) years were included. The majority was affected by xerosis cutis (95.9%, 95% CI 93.6 to 97.8), followed by intertrigo 35.0% (95% CI 30.0 to 40.1), incontinence-associated dermatitis 21.0% (95% CI 15.6 to 26.3), skin tears 10.5% (95% CI 7.3 to 13.8), and pressure ulcers 8.0% (95% CI 5.1 to 10.8). In total, more than half of the nursing home residents were affected by two or more skin conditions at the same time. Several associations between skin conditions and mobility, care dependency, or cognitive impairment were observed. There were no associations between xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers or intertrigo.
Conclusions:
The adverse skin and tissue conditions xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers and intertrigo are very common in long-term residential settings, placing a high burden on this population. Although care receivers share similar risk factors and may be affected by several skin conditions at the same time, there are no associations indicating separate aetiological pathways.
Registration:
This study is registered at the German Clinical Trials Register (registration number: DRKS00015680; date of registration: January 29th, 2019) and ClinicalTrials.gov (NCT03824886; date of registration: January 31st, 2019).
... It was reported a varying prevalence with 3.0%-20.8% in long-term care [4][5][6][7][8], 6.2%-22% in acute care [9][10][11][12], and 3.3%-14.3% in palliative care [1,13]; can be found on all areas of the body, especially the extremities [6]. ...
Background:
Skin tear knowledge is an important predictor of the decreased incidence and management of skin tears, and the knowledge level among Chinese nurses is unknown so far. A validated instrument for measuring skin tear knowledge is urgent.
Objective:
To culturally adapt the skin tear knowledge assessment instrument (OASES) into Chinese and verify its validity and reliability in the Chinese context.
Methods:
The cultural adaptation process for OASES into Chinese was established on Beaton's translation model. Content validity was determined by the 8-expert group in wound care. A nationwide psychometric validation study was performed on a convenience sample of 3333 nurses from 113 tertiary hospitals, of whom 98 nurses finished the test-retest procedure for reliability analysis. Item validity (item difficulty and discriminating index) and construct validity (known-groups technique) were tested.
Results:
The content validity index was 0.88-1.00. The item validity was as follows: Item difficulty ranged from 0.16 to 0.86, with an average value of 0.52; the discriminating index varied between 0.05 and 0.61. The known-group technique demonstrated excellent construct validity with a significant difference between predefined groups with theoretically expected higher knowledge scores and theoretically expected lower knowledge scores (P < 0.001). For the test-retest reliability, the Intraclass correction coefficient (ICC) during a 14-day interval for the overall tool was 0.79 (95% CI = 0.71-0.86), and Cohen's kappa value for each item varied from 0.17 to 0.62.
Conclusions:
The Chinese version of OASES was validated to be suitable for skin tear knowledge assessment with acceptable psychometric properties, through which the knowledge and training priorities of skin tear among Chinese nurses can be quantified.
... Accidental falls are an additional extrinsic factor to consider, as falls can cause trauma to the skin [1]. Other extrinsic risk factors for the development of skin tears are the use of adhesives, aids (orthoses/prostheses), wheelchairs, and feeding tubes [7,9,12]. Among the extrinsic factors related to care by nurses or even family members, it is necessary to distinguish risk factors from protective factors. ...
... The included studies were seven reviews [19][20][21][22][23][24][25], eight observational studies [4,12,[26][27][28][29][30][31], and two interventional studies [2,32]. The methodological quality of the included articles overall was between moderate and high. ...
... All studies were published in the English language. Populations included in the studies were adult and older people [25], older people [19,20,23,24], older people in nursing homes/aged care facilities [2,12,31], older people in acute care settings [26,27,32], older people in long-term care [28][29][30], and older people in hospital and residential care settings [21]. Two studies explored healthcare professionals' practices [4] and actions [22]. ...
Background
Skin tears are a significant problem for patients and healthcare professionals. They can cause pain, impact quality of life, and become chronic and infected. The risk of skin tears is associated with dependence in daily life activities and with nursing interventions.
Objectives
To examine which nursing interventions increase the risk of skin tears.
Design
Systematic review. Data sources: The MEDLINE, CINAHL, Scopus, and Cochrane Library databases were searched in March 2022.
Publication years
Publications included were from 2012 to 2022.
Results
Seventeen articles were included in the final analysis reporting nursing interventions associated with the risk of skin tears. Hygiene with cold water and soap, not applying leave-on products to moisten/protect dehydrated skin, and wearing short sleeves were found to be associated with skin tears. Transferring patients into and out of bed in a rough manner and wearing jewelry or long nails can increase the risk of skin tears. Removal of adhesive dressings or bandages can also cause skin tears.
Conclusion
Nursing staff need to know which interventions put their patients at risk of skin tears and which interventions are recommended to prevent skin tears. Nursing care can affect the health of the patient's skin.
... Our findings concur with Van Tiggelen and colleagues' study, which found age was significantly associated with skin tears in nursing home residents. 18 Intrinsic factors, such as changes in the epidermis and dermis (e.g., epidermal thinning, lower epidermal stem cells, the longer turnover time of the epidermis) 24,25 or age-related comorbidities may contribute to these higher rates. Extrinsic factors (e.g., hydration status, bathing frequency, medical adhesive product use) may be another element. ...
... The location of skin tears aligns with findings from smaller-scale studies, which showed that these injuries frequently occur on the outer aspect of the limbs. 3,17,18,21 Requiring assistance with ADLs, falling and resisting care are known risk factors for skin tears 16 , which highlights the impact of mobility and immobility. Turning and repositioning, getting skin caught on assistive devices (e.g., walkers) or doorknobs may also contribute to skin tears in these areas. ...
... among international studies on skin tears. 3,4,16,18,26 The expansion of standardised tools like wound management solutions into international practice settings would help in comparing differences at the national level. ...
Background Ageing populations are at risk of skin tears due to changes in their skin. Real-world data sets offer the ability to see current prevalence rates and practice changes to understand the size of the problem and glean practice insights. Aim Leveraging Swift Medical's big data set, a point-prevalence analysis was conducted over five years on skin tears in skilled nursing facilities (SNF) in North America, to better understand time to heal and explore the frequency of commonly used treatments and cleansing solutions for skin tears. Methods This descriptive prevalence study used a subset of an anonymised big dataset from participating SNFs across North America. Data from 188,675 skin tears in patients aged 20 years of age or older from 2017-2021 were included. Relative prevalence compared to other wounds was analysed, and healing times based on skin tear classification and frequency of primary, secondary and cleansing solutions were reported. Results More than 1.5 million wounds were included in this dataset, and skin tears accounted for 10.3-12.8% of skin tears in SNFs over the five-year period. The prevalence of skin tears increased with age. Median healing time ranged from 15-27 days, based on skin tear classification. Conclusion Big data sets can provide insight into current wound prevalence and practice patterns. The high prevalence of skin tears highlights the need for standard-ised tools to assess risk and prevent skin tears, and to educate clinicians on classifying and treating skin tears effectively.
... in hospital [3,[7][8][9], 14.3% in palliative care [10], and 3.0%-20.8% in long-term care facilities [11][12][13][14]. In a study, it was determined that the most common wounds after pressure injuries (3.0%-10.0%) ...
... Although skin tears can occur on any location of the body, they are particularly common on the upper and lower extremities (Strazzieri-Pulido et al., 2017; LeBlanc et al., 2018a; Serra et al., 2018).The prevalence of skin tears varies across countries, healthcare settings, and patient populations(Chaplain et al., 2018;LeBlanc et al., 2018a). Studies report skin tear prevalence between 3.3% and 19.8% in acute care(McErlean et al., 2004;McLane et al., 2004;Santamaria et al., 2009;Hsu & Chang, 2010;Lopez et al., 2011;Amaral et al., 2012;Chang et al., 2016;Bermark et al., 2018), 14.3% in palliative care(Maida et al., 2012), 5.5% -19.5% in the community(Carville & Lewin, 1998;Carville & Smith, 2004), and 3.0% -26.0% in long-term care(LeBlanc et al., 2013b;Strazzieri-Pulido et al., 2015a;Koyano et al., 2016;LeBlanc, 2017;Skiveren et al., 2017;Woo et al., 2017;LeBlanc et al., 2018a;Van Tiggelen et al., 2019a) ...
... and 3.0 -26.0% in long-term care(LeBlanc et al., 2013b;Strazzieri-Pulido et al., 2015a;Koyano et al., 2016;LeBlanc, 2017;Skiveren et al., 2017;Woo et al., 2017;LeBlanc et al., 2018a;Van Tiggelen et al., 2019a). They are associated with pain and distress for theindividuals affected, prolonged hospitalisation, diminished quality of life, and extensive healthcare costs (Strazzieri-Pulido et al., 2015a; LeBlanc et al., 2018a). ...
... According to recent epidemiological studies, skin tears are reported across all healthcare settings and mostly found in neonates, the elderly population, and people who are critically and chronically ill (LeBlanc & Baranoski, 2017). Skin tear prevalence has been shown to vary between 3.3 -19.8% in acute care (McErlean et al., 2004; McLane et al., 2004; Santamaria et al., 2009; Hsu & Chang, 2010; Lopez et al., 2011; Amaral et al., 2012; Chang et al., 2016; Bermark et al., 2018), 14.3% in palliative care(Maida et al., 2012), 5.5 -19.5% in the community(Carville & Lewin, 1998;Carville & Smith, 2004), and 3.0 -26.0% in long-term care(LeBlanc et al., 2013b;Strazzieri- Pulido et al., 2015a;Koyano et al., 2016;Ayello, 2017;LeBlanc, 2017;Skiveren et al., 2017;Woo et al., 2017;LeBlanc et al., 2018a;Van Tiggelen et al., 2019a).Despite their high prevalence and considerable impact, skin tears are often under-recognised and misdiagnosed, resulting in suboptimal prevention and delayed or inappropriate managementLeBlanc et al., 2018a). A crucial requirement to be able to lower the occurrence of skin tears or reduce their severity is the integration of best practice recommendations for the prevention and management of skin tears into practice. ...
... Moreover, the age of participants in both studies ranged from 50 years and over. In a crosssection observation study of 1153 aged care residents, Van Tiggelen et al. 39 found that in univariate analysis participants with skin tears were significantly (p=0.001) more likely to have a haematoma than participants without a skin tear. None of these studies evaluated the impact of a haematomas under a skin tear flap on healing time or dressing costs. ...
... An incorrect decision regarding the type of medical adhesive and its inadequate application or removal are factors that can cause harms to the superficial layers of the skin. When the skin layers are removed along with the device, there is a skin injury related to medical adhesive, internationally known as Medical Adhesive-Related Skin Injury (MARSI) (1)(2)(3)(4) . This injury is characterized by continuous erythema 30 minutes after removal of the medical adhesive and can be associated with the presence of vesicles, phlyctenas, erosions or ruptures in the skin (2) . ...
... The instrument that included the necessary information was elaborated by the researchers and The Braden scale score was considered to assess medical adhesive-related skin injuries, since both conditions share similar risk factors. It is suggested that pressure injury prevention is associated with the reduction of other types of injuries that affect the skin (1,10) . ...
... Regarding the critical cancer patients, multiple drug therapies have deleterious effects on them (1)(2)(3)(4)(5)(6)(7)(8) and the combination of chemotherapy with the specificities of the cancer disease makes the skin of critical cancer patients even more fragile, making them more susceptible to MARSIs (9) , which was proved in this study. ...
Objective:
to estimate the incidence of medical adhesive-related skin injury in the peripheral venous catheter fixation region in critical cancer patients, to identify risk factors, and to establish a risk prediction model for its development.
Method:
a prospective cohort study with a sample of 100 adult and aged patients hospitalized in an intensive care unit. The data were analyzed using descriptive, bivariate and multivariate statistics with Cox regression.
Results:
the incidence of medical adhesive-related skin injury was 31.0% and the incidence density was 3.4 cases per 100 people-days. The risk factors were as follows: alcoholism, smoking habit, hospitalization due to deep vein thrombosis, acute respiratory failure, immediate postoperative period, heart disease, dyslipidemia, use of antiarrhythmics, blood transfusion, friction injury, pressure injury, turgor, edema, hematoma, petechiae, low values in the Braden scale, clinical severity of the patient, elasticity, moisture, texture and color. The predictive model consisted in the following: decreased skin turgor, presence of hematoma and edema.
Conclusion:
medical adhesive-related skin injury at the peripheral venous catheter insertion site has a high incidence in critical cancer patients and is associated with decreased turgor, presence of hematoma and edema, evidence that can support the clinical practice.
... 6,[13][14][15][16] The prevalence of skin tears in aged care settings is 3% to 22%. [17][18][19][20] Empirical evidence indicates that basic skin care strategies may help to prevent skin tear development. 21 For example, Carville et al 22 showed that the application of a moisturiser twice a day reduced the skin tear incidence in residents living in aged care facilities by almost 50% compared to the control group. ...
Skin ageing is associated with various structural alterations including a decreased strength of the dermo‐epidermal adhesion increasing the risk for shear type injuries (skin tears). Topical applications of basic skin care products seem to reduce skin tear incidence. The suction blister method leads to the artificial and controlled separation of dermis and epidermis. Therefore, time to blister formation may be used as outcome measuring the strength of dermo‐epidermal adhesion. We conducted an exploratory, randomised, controlled trial with a split‐body design on forearms in healthy female subjects (n = 12; mean age 70.3 [SD 2.1] years). Forearms assigned to the intervention were treated twice daily with petrolatum for 8 weeks. Suction blisters were induced on forearms after 4 and 8 weeks and time to blister formation was measured. Stratum corneum and epidermal hydration were measured and epidermal thickness was assessed via optical coherence tomography. Time to blistering was longer and stratum corneum as well as epidermal hydration was consistently higher in intervention skin areas. We conclude that topical application of basic skin care products may improve mechanical adhesion of the dermo‐epidermal junction and that the parameter “time to blistering” is a suitable outcome to measure dermo‐epidermal adhesion strength in clinical research.
