Problem My resident has very thin skin and is getting skin tears on a regular basis. Can anything be done to prevent this?
Answer from Gail Dereczyk, BSN, RN, CWOCN, Medline Clinical Nurse Educator
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Answer
The 2025 ISTAP( International Skin Tear Advisory Panel) Best Practice Recommendations list the causes of skin tears as mechanical forces( e. g., shear and friction), trauma( e. g., bumping into objects and / or dressing or adhesive removal) and improper patient handling. A skin tear prevention care plan should be based on the patient’ s general health, mobility, skin, skin care practices and handling. 1
The ISTAP recommendations to prevent skin tears involve holistic assessments of the individual, the environment they live in, medications and care providers.
Determine if any of the following factors put the individual at risk for alterations of their skin integrity and skin tears:
• Comorbidities
• Nutritional status
• Medications
• Cognitive status
• Mobility and fall risk
Other factors to consider: Assistive devices. Educate the individual on proper use of any assistive devices and modify their surroundings when able to minimize risk of traumatic injuries.
Adhesives. If wound dressings or products that have medical adhesives need to be used during patient care, apply an appropriate skin protectant to the area prior to applying the dressing. Review with staff proper removal techniques to prevent medical adhesive related skin injuries( MARSIs).
ADLs. Individuals who need assistance with their activities of daily living( ADL) have a greater risk for skin tears. 2 Encourage use of protective sleeves, long-sleeved garments and long-legged pants if the extremities are vulnerable, and encourage neatly trimmed or filed fingernails with minimal jewelry for both the individual and staff.
Cleansing. Be sure tepid water and pH-balanced cleansers are utilized for routine hygiene and bathing by the individual and / or caregivers. Always follow bathing with an application of a moisturizer. 3 Regardless of bathing, apply one ounce of moisturizer daily at minimum for individuals with at-risk skin. 1, 3
Repositioning. If the individual is dependent on caregivers for transfers and positioning, ensure they use gentle handling techniques and effectively use lifts and transfer sheets to promote safe patient handling. miodrag ignjatovic / E + via Getty Images
As you may now see, there are many components to a skin tear prevention program.
References 1 Nokaneng E et al. ISTAP Best practice recommendations for the prevention and management of skin tears in aged skin. Wounds International 2025. 2 Wound, Ostomy and Continence, Nurses Society ® Core Curriculum Wound Management, 2nd Ed., 2022 Chapter 18 Prevention and Management of Moisture-Associated Skin Damage( MASD), Medical Adhesive- Related Skin Injury( MARSI), and Skin Tears 3 Coalition for At-Risk Skin( 2022) At-Risk Skin: 21 Consensus Statements from the Coalition for At-Risk Skin.
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