Mary P. Evans, M.D., CMD, CWSP, Certified Medical Director and Certified Wound Specialist Physician

What can we do to prevent skin tears in our nursing facility?

Skin tears are most common in the elderly as a result of thinning of skin that occurs with age.

Certain conditions, such as chronic steroid use, a history of smoking, dry skin and malnutrition, increase the risk of them. 

Skin tears usually result from trauma such as bumping into furniture, shear trauma during transfers or from tape from briefs or wound dressings.

Tears can be minimized by gentle handling and using draw sheets to reposition residents in beds. Excellent general skin care such as bathing with a pH-balanced skin cleanser, blotting skin dry and moisturizing with an emollient cream and adequate hydration also helps. Protective sleeves and securing dressings with an elastic wrap instead of tape also minimizes risk.

Most skin tears are partial thickness, involving separation of the upper layer of skin. It is important to gently clean a new skin tear with wound cleanser and to reapproximate the skin flap into place. Larger or deeper skin tears may require wound closure strips.

Covering the skin tear with either Vaseline gauze and a foam dressing or a transparent, vapor-permeable dressing protects the wound as it heals.

The healthcare practitioner should be notified of skin tears, and a wound nurse or specialist may be required if the skin tear is more than a few centimeters in size or if the wound is deeper than the uppermost layer. 

You should monitor the skin tear as it heals and alert the healthcare practitioner if there is an increase in the amount of drainage, if the area bleeds or if there is pus or a foul odor.

The timing of dressing changes also should be done according to the type of dressing selected.

— Mary P. Evans, M.D., CMD, CWSP