The impact of care practices and health demographics on the prevalence of skin tears and pressure injuries in aged care.

Abstract

To determine whether differences in care practices and demographics between two long-term aged care facilities affected the incidence of residents' skin wounds. A retrospective analysis of care plans and clinical outcomes was conducted for a 6-month period in 2016 at two aged care facilities, N=39 Home 1 and N=45 Home 2. Skin tears, pressure injuries and usual care practices and associated health demographics were recorded. Over the 6-month period, 84 residents were found to have a total of 206 aged care acquired skin wounds (skin tears, pressure injuries, haematomas, rashes, infections). The frequency of skin tears or total wounds did not differ between the homes. Several factors were identified that influenced the skin wounds. A reduction in skin tears was associated with the use of heel protectors and antiembolic stockings, whilst a diagnosis of vascular dementia was associated with increased prevalence of skin wounds. Pressure injuries were significantly higher at Home 2. Increased use of strategies to moderate-risk activities, such as tray tables and bed rails, and impaired cognitive function were associated with higher pressure injury prevalence. A number of care factors and health demographics influenced the rate of skin wounds. A holistic approach to skin management is needed. Practices, such as repositioning and skin hygiene, are well known to reduce the incidence of pressure injuries and skin tears; however, there are other care practices that take place in homes as part of usual care that also impact skin wounds that have been largely ignored. This study highlights those care practices, as well as resident characteristics and comorbidities that may increase the risk of skin wounds, requiring further monitoring/mitigating strategies.