Skin tears are a relatively common issue, particularly affecting elderly people and those who are dependent on carers, especially those over the age of 80.
Treating skin tears effectively is very important in your care home, as they can be a traumatic and painful injury. Related to a range of risk factors, including the thinning of the skin due to age or use of steroids, poor nutrition or hydration, and conditions that affect blood flow to the skin, skin tears occur when fragile skin is knocked, stretched or bumped.
The injury usually occurs during routine care activities, making it all the more important for care staff to be aware of the best treatment for skin tears. One study found that 41.5% of known wounds were found to be skin tears in elderly care residents, showing just how prevalent such injuries can be. Read on below to find out more about how to identify, treat and prevent skin tears.
As skin tears occur when the dermis or epidermis becomes detached from the tissue underneath, staff should always be aware of looking for such injuries when working with care home residents.
There are several different classification systems used to identify and categorise skin tears. The most commonly used system is the Payne and Martin system, which classifies wounds by degree of severity. The system uses three main categories, along with sub-categories:
When assessing skin tears, staff should be aware of how to use this system effectively in order to facilitate effective skin tear treatment.
Treating skin tears effectively is vital in preventing infection and further damage to the skin. Carers should first look to control any bleeding by applying gentle pressure to the wound and elevating it if appropriate. Staff should then follow best practice for wound care, cleaning the wound using warm saline solution or water and gently patting dry. If there is a skin flap, this should be gently eased back into place using a dampened cotton tip or gloved finger. A wound assessment should then be performed and documented.
Following this, a skin tear dressing should be applied carefully, first by selecting the appropriate bandage type. If using adhesive wound closure strips, carers should be sure to leave space between each strip to facilitate drainage and avoid tension in the skin. Tissue glues may be used to secure the skin flap, but sutures and staples are not recommended as they are likely to cause further damage to the skin.
Dressings should be left in place for several days if possible, to encourage the skin flap to heal. When changing the dressing, gently lift and remove, working away from the attached skin flap. If suitable, use saline soaks or silicone-based adhesive removers to minimise trauma to the skin during removal. The skin tear wound should be monitored for changes and reassessed at regular intervals to ensure that an infection does not develop.
Carers can help to prevent skin tears by creating an environment in which risks of bumps or knocks to the skin are avoided. Lighting should be adequate, furniture should be spaced out sufficiently, and sharp edges should be padded. Care staff should use appropriate aids when moving patients, such as a lifting device or slide sheet instead of a bed sheet. They should also keep fingernails trimmed and jewellery at an absolute minimum to ensure the complete safety of those in their care. Those who are at risk of skin tears should be kept well hydrated and adopt a skin care routine that promotes elasticity and prevents dryness.