Until recently, skin tears were an underappreciated wound that received very little attention or research. This article discusses standards and recommendations for the assessment, treatment, and prevention of skin tears developed by the International Skin Tear Advisory Panel (ISTAP) based on extensive literature reviews, international input from healthcare professionals, and expert opinion. ISTAP defines a skin tear as “a wound caused by shear, friction, and/or blunt force resulting in separation of skin layers. A skin tear can be partial-thickness (separation of the epidermis from the dermis) or full-thickness (separation of both the epidermis and dermis from underlying structures).” Skin tears have been reported in the literature as having prevalence rates equal to or greater than those of pressure ulcers. The role of identifying skin tears with a comprehensive skin assessment needs further study. Skin tears are common acute wounds in older adults; however, infants and children are also at risk. Besides those at extremes of age, populations at the highest risk for skin tears include the critically or chronically ill. These patients have a higher risk for developing secondary wound infections. Patients suffering from skin tears complain of pain and decreased quality of life. By recognizing which patients are at risk for skin tears, preventing skin injuries, and using appropriate nonadherent dressings, clinical nurses can save patients undue pain and suffering. Although preventing skin tears is the primary focus of nursing care, nurses must also be equipped to manage these wounds when they do occur.
Reference:LeBlanc, K. and Baranoski, S. (2014) Skin tears: Best practices for care and prevention. Nursing. 44(5), p.36-46.