Incidence Of Skin Tears Research Articles

Assessing Skin Tear Knowledge Among Nurses: A Multicentre Cross-Sectional Survey.

To assess the knowledge of nurses in Chinese hospitals regarding skin tears, focusing on evaluating their understanding and proficiency in managing and preventing skin tears, exploring the impact of demographic and professional factors on their knowledge levels and identifying specific areas where additional training or education is needed. This study is a multicentre cross-sectional survey conducted in the Henan province of China using a stratified cluster sampling method. The study utilised the Chinese version of the Skin Tear Knowledge Assessment Instrument (OASES) for evaluating nurses' knowledge levels based on a questionnaire comprising 22 questions on the online platform Wenjuanxing (www.wjx.cn). All questions had to be answered, with only one option selectable per question. Response validity was ensured by excluding questionnaires that showed a clear response pattern, were completed in under 60 s, or scored 0 points. Descriptive analysis, item-level analysis and multiple linear regression analysis were performed. A total of 1675 clinical nurses participated in this study. Age was a significant factor influencing skin tear knowledge, with older nurses (age, 41-60 vs. 18-40 years) demonstrating higher knowledge scores. Additionally, female nurses exhibited higher average knowledge scores compared to male nurses. Further, different departments, education levels, job titles and having completed relevant courses significantly influenced skin tear knowledge among nurses. However, on multivariate analyses, we found that working in the intensive care unit, having a higher education background and job title and having studied courses on wound, ostomy or incontinence were independent factors influencing knowledge on skin tear, indicating the need for targeted educational interventions. In conclusion, targeted educational interventions and continuous professional development are essential to bridge the identified knowledge gaps among nurses in Chinese hospitals regarding skin tear management. The Strengthening the Report of Observational Studies in Epidemiology checklist guidelines were followed. Enhancing nurses' knowledge and skills in skin tear management through targeted educational programmes could improve patient care quality, reduce the incidence of skin tears and promote better wound care outcomes in clinical settings. This study addresses the problem of knowledge gaps in skin tear management among nurses. The main findings indicate varied understanding and significant factors influencing this knowledge. The research impacts nurses and patients in Chinese hospitals, emphasising the need for specialised training and professional development to improve skin tear management and patient care. No patient or public contribution.

Clinical Outcomes of Collagenase Injections in Management of Dupuytren Contracture of the Proximal Interphalangeal Joint

Dupuytren contracture is characterized by the formation of cords and nodules in the palm. Surgical release has historically been the definitive treatment. Collagenase clostridium histolyticum (CCH) has been used successfully as an alternative to surgery. The treatment of proximal interphalangeal (PIP) contractures is the most challenging. The purpose of this study was to evaluate CCH treatment for Dupuytren contracture of the PIP joint. A retrospective chart review was performed for CCH treatment of Dupuytren contracture at a single institution from January 2010 to April 2023. Data collected included pretreatment/posttreatment total flexion contracture and adverse events. Contractures were analyzed both by severity (high >40° and low <40°) and type (isolated PIP; combined metacarpophalangeal and PIP). A total of 304 patients with 470 PIP joints treated were included. Digits with isolated and combined contractures each had an average pre-CCH treatment contracture of 51 (±23) degrees. Postmanipulations the contractures were 6 (±13) and 7 (±16) degrees, respectively. Clinical success (<5° residual contracture) and improvement (>50% correction of contracture) were associated with low severity contractures at postmanipulation. There were 256 adverse events recorded (54.5%), including 187 skin tears (39.8%), 68 cases of lymphadenopathy (14.5%), and one injection site infection (0.2%). High severity and combined contractures were independently associated with an increased incidence of skin tears upon manipulation. Collagenase clostridium histolyticum treatment is effective for isolated or combined PIP joint contractures. Adverse events were associated with more severe contractures. Given the degree of improvement based on contracture severity, earlier intervention may provide better correction of contracture. Therapeutic III.

Effects of a leave-on product on the strength of the dermoepidermal junction: An exploratory, intraindividual, randomized controlled trial in older adults with dry skin.

Skin aging is associated with dry skin and a decrease of the strength of the dermoepidermal adhesion, which increases the risk for lacerations (skin tears). Application of leave-on products improves dry skin and seems to reduce skin tear incidence. The aim of this study was to measure the effects of a humectant containing leave-on product on the strength of the dermoepidermal junction in older adult participants with dry skin. A randomized controlled trial using a split body design was conducted. One forearm was randomly selected and treated with a lipophilic leave-on product containing 5% urea for 8 weeks. The other forearm was the control. The parameters stratum corneum hydration (SCH), transepidermal water loss, pH, roughness, epidermal thickness and skin stiffness were measured at the baseline, Weeks 4 and 8. At Week 8, suction blisters were created and time to blistering was measured. Blister roofs and interstitial fluid were analyzed for Interleukin-1α, 6 and 8. Twelve participants were included. After 8 weeks treatment, SCH was higher (median difference 11.6 AU), and the overall dry skin score (median difference -1) and median roughness (Rz difference -12.2 µm) were lower compared to the control arms. The median group difference for Interleukin-1α was -452 fg/µg total protein (TP) in the blister roofs and -2.2 fg/µg TP in the blister fluids. The median time to blister formation was 7.7 min higher compared to the control arms. The regular application of humectant containing leave-on products improves dry skin and seems to lower inflammation and contribute to the strengthening of the dermoepidermal adhesion. This partly explains how the use of topical leave-on products helps to prevent skin tears.

Enhancing skin health and safety in aged care (SKINCARE trial): A cluster-randomised pragmatic trial

BackgroundOlder nursing home residents are prone to develop different skin conditions at the same time, including xerosis cutis, skin tears, pressure ulcers, incontinence-associated dermatitis or intertrigo. Guidelines and recommendations mainly address these skin conditions separately. The overall aim of this study was to measure the effects of the implementation of a skincare and prevention package. Trial designA two-arm cluster-randomised controlled trial was conducted. MethodsIn nursing homes being assigned to the intervention group, an evidence-based and structured skincare and prevention programme was implemented for six months. Nursing home residents in the control group received standard care as usual. Blinded dermatologists conducted head-to-toe skin assessments, and the researchers assessed skin barrier parameters including stratum corneum hydration and transepidermal water loss at the upper and lower extremities after three and six months. Outcomes included the cumulative incidence of incontinence-associated dermatitis, skin tears, pressure ulcers and intertrigo, and were presented as intention-to-treat and per protocol analysis. Skin dryness and resident-reported outcomes (pain, itch, quality of life) were assessed. ResultsA random sample of 17 nursing homes in the federal state of Berlin, Germany, was drawn and randomised in intervention (n = 9) and control groups (n = 8). In total, 165 participants were allocated to the intervention, and 149 participants were allocated to the control group. The cumulative incidence of skin tears (19.2 %, 95 % CI 12.8–27.8), pressure ulcers (13.6 %, 95 % CI 8.1–21.9) and intertrigo (27.0 %, 95 % CI 18.4–37.7) was lower in the intervention compared to the control group, with cumulative incidences of 27.2 % (95 % CI 19.3–36.9) for skin tears, 16.9 % (95 % CI 10.6–25.9) for pressure ulcer, and 37.8 % (95 % CI 27.5–49.4) for intertrigo. The incidence of incontinence-associated dermatitis was higher in the intervention group (26.3 %, 95 % CI 17.9–36.8) compared to the control group (23.1 %; 95 % CI 14.6–34.5). Mean skin dryness was lower in the intervention group but showed variation. The impact on pain, itch, and quality of life was trivial. ConclusionsThe present study results indicate that the implementation of tailored and evidence-based nursing routines improves skin health and safety in residential long-term care. Evidence suggests that multiple adverse skin conditions can be prevented by regular skin assessments and individually tailored skincare routines. Positive effects on skin dryness were observed, but skin physiology parameters did not indicate changes of the skin barrier function. Trial registrationThis 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).

What is the impact of skincare bundles on the development of skin tears in older adults? A systematic review.

This review explores the impact of skincare bundles on the development of skin tears in older adults (≥65years). A systematic search of publications using MEDLINE, CINAHL and Cochrane databases was conducted in July 2020. The evidence-based librarianship (EBL) checklist assessed the methodological quality of the included studies. Data were extracted using a pre-designed extraction tool, and a narrative analysis was undertaken. Following the search, 71 records were returned, with seven satisfying the inclusion criteria. The studies were conducted between 2003 and 2015, and 57% (n=4) of these employed a pre-post study design. The mean sample size was 155 participants (SD=±117.6). All the included studies (100%, n=8) identified that there was a direct relationship between the use of skincare bundles and the reduction in the incidence of skin tears in the elderly. The EBL scores varied between 65% and 91%. In total, 85.7% (n=6) of the studies scored ≥75%, reflecting validity. This systematic review highlights the connection between skincare bundles and the reduction of the number of skin tears in the older population (≥65years). Further research with larger sample sizes and longer study duration to validate these findings, which will provide a comprehensive insight into the prevention of the incidence of skin tears. Further studies are justified given that skin tear bundles can reduce the rate of injuries that are easily acquired by the elderly due to the nature of their frail skin, they also can help prevent skin tears from turning into chronic wounds and can decrease hospital admissions associated with hospital-acquired infections.

The effect of a basic skin care product on the structural strength of the dermo-epidermal junction: An exploratory, randomised, controlled split-body trial.

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.

Applying Skin Barrier Film for Skin Tear Management in Patients with Central Venous Catheterization.

To examine and compare different methods of dressing change on skin tears at the periductal wound for ICU patients with central venous catheterization (CVC). This research used a quasi-experimental design. Participants included 98 patients from the ICU of a medical center in Taiwan using a convenience sampling technique from April 1, 2017 to March 31, 2018. Applying skin barrier film at the CVC insertion site effectively protected the skin and significantly reduced the risk of skin tears among ICU patients (P < .01). This study showed that use of skin barrier film at the site of CVC insertion can increase skin strength, maintain skin integrity, and decrease the incidence of skin tears. Skin barrier film is thus recommended for routine use in peripheral skin care for patients receiving CVC.

The influence of skin tears following collagenase treatment of Dupuytren's disease on treatment outcomes.

This study investigated influence of skin tears on patient-reported outcomes of injection of collagenase clostridium histolyticum for Dupuytren's disease and association between extension deficit of digits before injection and skin tear after the injection. From 2016 to 2018, 391 Dupuytren's cords were treated in 184 patients in a prospective cohort study and the patients were evaluated before injection and six months after injection. Skin tears occurred in 50% of these patients. We found no significant differences in the patient-reported outcomes between patients with or without skin tears. A higher extension deficit before treatment was associated with significantly increased frequency of skin tears. We conclude that the incidence of skin tears after injection does not affect patient reported outcomes six months after collagenase injection, but the incidence of skin tears is significantly associated with the severity of pre-treatment finger extension deficits.Level of evidence: II.

Skin tear prevalence and incidence in the long-term care population: a prospective study.

The World Health Organization estimates that between 2015 and 2050 the proportion of the world's population over 60 years old will nearly double from 12% to 22%. An often overlooked byproduct of ageing is the skin changes associated with it, which heighten the risk of developing skin tears. Despite this presumed increased risk, the true impact of skin tears across age groups and care settings is poorly understood. The purpose of the present study was to establish the prevalence and incidence of skin tears in the Ontario long-term care population. A prospective study design was used to explore the prevalence and incidence of skin tears. Individuals from four long-term care facilities in Ontario were followed over four weeks. The participants were examined for skin tears at the beginning of the study and at week four to determine whether skin tears had occurred and to record the skin tear type and location. A total of 380 individuals, aged 65 years and over, took part. The study found a skin tear prevalence of 20.8% and an incidence of 18.9% within four weeks. These results provide much needed data on the burden of skin tears in the long-term care population. Conclusion: The present study is an important first step towards developing a prevention programme targeting individuals at risk for skin tears in long-term care.

Risk Factors for Skin Tears Following Collagenase Clostridium histolyticum to Treat Dupuytren Contractures

Skin tears are an unpleasant complication that may occur after collagenase Clostridium histolyticum (CCH) administration to treat Dupuytren contractures of the fingers. The purpose of this study was to determine risk factors for the development of this complication. Over a 6-year period, patients with a measurable metacarpophalangeal or proximal interphalangeal joint Dupuytren contracture and a palpable cord treated with CCH were prospectively observed. Patients were assessed for the development of skin tears immediately on the day of manipulation as well 30 days or more after manipulation. A total of 117 patients (174 cords) met inclusion criteria. There was a 25.6% incidence of skin tears (30 of 117 patients; 33 skin tears). Multivariable regression analysis revealed that patients with a combined digital flexion contracture (total combined metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joint contracture) of 75° and greater and those treated with 2 simultaneous doses of CCH in the same hand were more likely to sustain a tear. All skin tears healed with nonsurgical management at short-term follow-up. Although a relatively minor complication, skin tears are not well-tolerated by all patients and may change the postinjection course of orthosis use, wound care, and manual activity. Based on these results, patients with digital contractures 75° or greater and those treated with 2 simultaneous doses of CCH in the same hand may be counseled that they have a higher likelihood of developing a skin tear during manipulation. Pretreatment education may reduce anxiety experienced by patients who otherwise unexpectedly develop a skin tear at the time of manipulation. Therapeutic II.

Hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings.

Hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings.

Skin tears: prevention and management.

Skin tears commonly occur at the extremes of age and are associated with skin changes in ageing skin. They are considered to be acute wounds caused by mechanical forces, such as blunt trauma. While the true prevalence and incidence of skin tears is unknown, the available evidence suggests that these wounds occur in all healthcare settings. Importantly, skin tears are preventable with the implementation of a risk-reduction programme, which includes twice-daily skin moisturisation. Where these injuries do occur, it is important to categorise the extent of damage as well as to choose the most appropriate dressing to avoid adding any risks for further trauma.

Pilot parallel randomised controlled trial of protective socks against usual care to reduce skin tears in high risk people: \u2018STOPCUTS\u2019

BackgroundSkin tears are common in older adults and those taking steroids and warfarin. They are traumatic, often blunt injuries caused by oblique knocks to the extremities. The epidermis may separate from the dermis or both layers from underlying tissues leaving a skin flap or total loss of tissue, which is painful and prone to infection. ‘Dermatuff™’ knee-length socks containing Kevlar fibres (used in stab-proof vests and motorcyclists’ clothing) aim to prevent skin tears. The acceptability of the socks and the feasibility of a randomised controlled trial (RCT) had not been explored.MethodsIn this pilot parallel group RCT, 90 people at risk of skin-tear injury from Devon care homes and primary care were randomised to receive the socks or treatment as usual (TAU). The pilot aimed to estimate parameters to inform the design of a substantive trial and record professionals’ views and participants’ acceptability of the intervention and of study participation.ResultsParticipants were randomised from July 2013 and followed up until February 2015. Community participants were easier to recruit than care homes residents but were 10 years younger on average and more active. To recruit 90 participants, 395 had to be approached overall as 77% were excluded or declined. Seventy-nine participants (88%) completed the trial and 27/44 (61%) wore the socks for 16 weeks. There were 31 skin tear injuries affecting 18 (20%) of the 90 participants. The TAU group received more injuries, more repeated episodes, and larger tears with greater severity. Common daily diary reasons for not wearing the socks included perceived warmth in hot weather or not being available (holiday, in hospital, bed rest). Resource use data were obtainable and indicated that sock wearing gave a reduction in treatment costs whilst well-completed questionnaires showed improvements in secondary outcomes.ConclusionsThis pilot trial has successfully informed the design and conduct of a future definitive cost-effectiveness RCT. It would need to be conducted in primary care with 880 active at-risk, elderly patients (440 per arm). Skin tear incidence and quality of life (from EQ5D5L) over a 4-month period would be the primary and secondary outcomes respectively.Trial registrationISRCTN, ISRCTN96565376.

The Use of Residual Collagenase for Single Digits With Multiple-Joint Dupuytren Contractures

Standard 0.58 mg (0.25 mL) collagenase Clostridium histolyticum (CCH) preparations result in unused CCH that is often discarded. Our purpose was to assess the results on Dupuytren contractures affecting both the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints in the same digit utilizing an injection containing the maximum CCH volume that can be withdrawn from a single vial. A consecutive series of patients with MCP and PIP cords in the same digit received a single treatment with 2 injections totaling 0.30 mL distributed between the MCP and the PIP cords and underwent manipulation approximately 24 hours later. Reduction in contracture, clinical success, and complications were assessed 30 days after manipulation. Thirty-one patients (34 digits) had a mean preinjection flexion contracture of 50° at the MCP joint and 53° at the PIP joint. Clinical success (reduction in joint contracture to 0°-5° of full extension 30-days postmanipulation) was noted in 65% of MCP cords and 38% of PIP joint cords. We had a 24% incidence of skin tears, which correlated with the degree of preinjection contracture. For Dupuytren contractures involving the MCP and PIP joints in the same digit, distributing the maximum amount of CCH that can be withdrawn from a single vial provides efficacy at both joints that is similar to that reported in previously published series, with a comparable complication rate. Utilizing excess CCH typically discarded may provide cost savings. Therapeutic IV.

Incidence of Skin Tears and Risk Factors: A Systematic Literature Review.

Skin tears are traumatic wounds resulting from friction and shearing forces. Clinical practice strongly indicates that skin tears are a prevalent problem but their incidence is not well established in the literature. This systematic literature review identified and evaluated the available literature on the incidence and risk factors for skin tears in adults and the elderly. Inclusion criteria were epidemiological studies published in English, Spanish, or Portuguese languages from January 1990 through June 2014 and available in full text. Study quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the Guidelines for Critically Appraising Studies of Prevalence or Incidence of a Health Problem. Five studies reporting incidence of skin tears met the selection criteria. Reported incidence rates of skin tears ranged from 2.23% to 92% in long-term care facilities and varied from 2.1% among men to 4.6% among women living in the community. The most prevalent risk factor for skin tears was old age, followed by impaired mobility, falls and accidental injuries, previous skin tears, cognitive deficit/dementia, dependence in transfers, and upper limbs. Further epidemiological studies on skin tears are necessary to elucidate the cause of these injuries and identify the profile of people at risk for skin tears, contributing to the development and implementation of appropriate preventive interventions.

Incidence of Skin Tears and Risk Factors: A Systematic Literature Review.

Journal of Wound, Ostomy and Continence Nursing 44(1):p E1, January/February 2017. | DOI: 10.1097/WON.0000000000000304

Is Twice-Daily Skin Moisturizing More Effective Than Routine Care in the Prevention of Skin Tears in the Elderly Population?

Skin-moisturizing routines are part of a bundle of interventions designed to prevent skin tears. This Evidence-Based Report Card reviews the effect of twice-daily moisturization of the skin on skin tear occurrence versus occurrence rates using routine skin care. The literature was systematically reviewed for studies that evaluated the use of standardized skin moisturizers on the rate of skin tears in the older adults (>60 years of age). A professional librarian performed the literature search, which yielded 446 articles. Following title and abstract reviews, we identified and retrieved 3 studies that met inclusion criteria. Evidence concerning the effectiveness of routine twice-daily skin moisturizing reducing the rate of skin tears is mixed. Routine twice-daily skin moisturizing did not significantly result in a lower incidence of skin tears in long-term care residents compared to usual care in one study. However, the occurrence of skin tears per 1000 occupied beds was 50% lower when a moisturizer applied twice daily was compared to usual care. Routine skin moisturizing is recommended as one component of a prevention program for skin tears among aged adults residing in long-term care facilities.

Incidence of skin tears in the extremities among elderly patients at a long-term medical facility in Japan: A prospective cohort study.

There is a lack of data from cohort studies for the incidence of skin tears among an elderly population in an Asian country. We estimated the cumulative incidence of skin tear, and identify its risk factor. The present prospective cohort study was carried out at a long-term medical facility in Japan. Participants included patients (n = 368) aged 65 years or older receiving hospital care. The 3-month cumulative incidence of skin tears was estimated by identifying them using direct inspection of the extremities. In order to find the risk factors for the skin tear incidence, odds ratios and their 95% confidence intervals of skin tear development in association with the factors were estimated using logistic regression analyses. A total of 14 patients developed skin tears, and their cumulative incidence was 3.8%. No patients with skin tears developed multiple wounds on their extremities. Half of the skin tears occurred on the outside of the right forearm, and just three skin tears were found in the lower legs. Multiple logistic analyses showed that pre-existing skin tears (odds ratio 15.42, 95% confidence interval 3.53-67.43, P < 0.001) and a 6-point decrease in the total score of the Braden Scale (odds ratio 0.10, 95% confidence interval 0.01-0.83, P < 0.033) were significantly associated with skin tear development. Patients with pre-existing skin tears and a low score of the Braden Scale have a higher risk of skin tear development during 3 months. These factors could be used to identify patients requiring prevention care for skin tears.

The effectiveness of a twice-daily skin-moisturising regimen for reducing the incidence of skin tears.

A cluster randomised controlled trial was conducted to evaluate the effectiveness of a twice-daily moisturising regimen as compared to 'usual' skin care for reducing skin tear incidence. Aged care residents from 14 Western Australian facilities (980 beds) were invited to participate. The facilities were sorted into pairs and matched in terms of bed numbers and whether they provided high or low care. One facility from each matched pair was randomised to the intervention group. Consenting residents in an intervention facility received a twice-daily application of a commercially available, standardised pH neutral, perfume-free moisturiser on their extremities. Residents in the control facilities received ad hoc or no standardised skin-moisturising regimen. Participant numbers were sufficient to detect a 5% difference in incidence rate between the two groups with 80% power and a significance level of P = 0·05, and the inter-cluster correlation coefficient was 0·034. Data were collected over 6 months. A total of 1396 skin tears on 424 residents were recorded during the study. In the intervention group, the average monthly incidence rate was 5·76 per 1000 occupied bed days as compared to 10·57 in the control group. The application of moisturiser twice daily reduced the incidence of skin tears by almost 50% in residents living in aged care facilities.

Skin Tears

Skin tears experienced by older adults require special skills to promote healing. Home healthcare providers are in key positions to manage skin tears and prevent further skin trauma. Several guidelines, risk assessments, classifications, and products exist to manage high-risk patients. Frequent evaluation of the effectiveness of the treatment and prevention strategies in an overall skin care protocol for home care patients is critical to reduce skin tear incidence and promote prompt healing when skin tears are present.