How do you prevent skin tears or shearing when moving a resident?

Skin tears are among the most common and preventable wounds in older adults, with incidence rates often higher in long-term care settings. Understanding the mechanics of fragile skin is the first step toward effective care. This guide will walk through proper techniques and tools for how you prevent skin tears or shearing when moving a resident, ensuring their safety and comfort.

Quick Summary

Preventing skin tears and shearing requires minimizing friction and supporting delicate skin during movement. Caregivers should use proper lifting techniques, assistive devices like transfer sheets and mechanical lifts, and ensure the resident's skin is well-hydrated and protected. Avoiding dragging motions and planning transfers thoroughly are critical steps.

Key Points

• Use Lift, Not Drag: Always lift or glide the resident during transfers using assistive devices like draw sheets to prevent friction and shearing.

• Prepare the Environment: Before any movement, clear obstacles, adjust bed height, and use soft linens to ensure a safe transfer space.

• Utilize Assistive Devices: Incorporate equipment such as transfer sheets, slide boards, and mechanical lifts to minimize strain and protect delicate skin.

• Maintain Skin Health Daily: Keep skin moisturized with gentle, pH-balanced products and ensure adequate hydration and nutrition to improve skin elasticity.

• Employ Teamwork: When a resident is at high risk or heavy, use a two-person assist to distribute weight and ensure a smoother, safer transfer.

• Educate All Caregivers: Ongoing training on proper handling techniques and device usage is critical for maintaining consistency and safety standards.

Understanding the Risks: Skin Tears and Shearing

Fragile, thin skin, common in older adults, is highly susceptible to injury from friction and pressure. Skin tears are wounds caused by friction, bumping, or scraping that separates the skin layers. Shearing is a different but equally damaging force, occurring when the skin remains stationary while the underlying tissue and bone move, causing the inner layers of skin to stretch and tear from within.

The Importance of Gentle, Strategic Movement

Manual lifting and improper transfer methods are primary culprits behind these injuries. Simply pulling or dragging a resident across a bedsheet creates immense friction and shearing forces. The key to prevention is to eliminate or significantly reduce these forces by using the right tools and a systematic approach to movement. Protecting the resident’s dignity and comfort is also a crucial part of providing respectful care that minimizes anxiety and potential for resistance, which can increase injury risk.

Essential Techniques for Safer Transfers

Mastering gentle handling techniques is the cornerstone of preventing skin injury. Caregivers should be trained in and consistently use these methods to protect both the resident and themselves from harm.

Proper Body Mechanics

Using your body correctly is vital for a smooth, safe transfer. The principle is to lift and glide, never drag. Key steps include:

• Bend at your knees and hips, not your back, to use your leg muscles for lifting.
• Keep the resident’s body close to yours to maintain a better center of gravity and control.
• Pivot your feet instead of twisting your spine when changing direction.
• Use a wide, stable stance for balance.

Pre-Transfer Preparation

Before any move, preparation is essential. This includes:

• Clear the path: Remove any obstacles, cords, or rugs that could cause a trip or snag.
• Explain the process: Clearly and calmly inform the resident what you are doing, which helps them feel secure and potentially assists with the move.
• Hydrate and moisturize: Ensure the resident’s skin is moisturized to maintain elasticity and prevent dryness. Gentle, pH-balanced lotions are best.
• Protect vulnerable areas: Consider protective sleeves, pants, or pads for residents with particularly fragile skin on their arms and legs.

Utilizing Assistive Devices and Equipment

Assistive devices are not a sign of weakness but a hallmark of safe, modern caregiving. They significantly reduce the physical strain on both the caregiver and the resident.

Transfer Sheets and Pads

• Lift and reposition: Use a draw sheet or sliding sheet to reposition a resident in bed. Two caregivers can lift and slide the resident rather than pulling them, distributing the resident's weight and minimizing friction.
• Lateral transfers: For moving between a bed and a stretcher, a slide board or transfer board provides a smooth surface for a seamless lateral transfer.

Mechanical Lifts

For residents with limited mobility, mechanical lifts (like a Hoyer lift) are the safest option. These devices completely eliminate the need for manual lifting, protecting both the resident and the caregiver from injury. They are particularly vital for transfers involving a high risk of falls or for heavier residents.

Gait Belts

When a resident can bear some weight but needs assistance, a gait belt provides a secure handhold for the caregiver. It should be placed around the resident's waist, over their clothes, and grasped firmly. This prevents grabbing the resident's limbs or clothing, which can cause skin damage.

Daily Skin Care and Environmental Modifications

Prevention extends beyond the moment of transfer and into daily routines and environmental management. A holistic approach significantly reduces risk.

Daily Skin Care Routine

• Use mild, pH-balanced cleansers and warm water, avoiding harsh, drying soaps and hot water.
• Pat the skin dry instead of rubbing vigorously.
• Apply a quality, emollient-rich moisturizer twice daily to keep the skin supple.

Environmental Adjustments

• Bed height: Adjust the bed to a comfortable working height for the caregiver to prevent back strain and ensure a smooth transfer. Always lower it for the resident to enter or exit safely.
• Bed linen: Use soft, smooth, non-wrinkled sheets. Rough or bunched-up linen can cause friction.
• Padding: Pad bedrails, wheelchair arms, and other hard surfaces with foam or sheepskin to protect against bumps and scrapes.

Comparison of Transfer Techniques

Feature	Improper 'Drag' Technique	Proper 'Lift' and 'Glide' Technique
Friction	High; causes skin abrasion	Low; minimizes surface friction
Shearing	High; skin and bone move in different directions	Low; coordinated movement reduces internal tissue damage
Injury Risk	High; for both resident (skin tears) and caregiver (back strain)	Low; safer for both parties involved
Tools	Often no equipment used	Uses draw sheets, transfer boards, or mechanical lifts
Resident Comfort	Low; can be painful and frightening	High; smoother, more controlled movement
Number of People	Often attempted by one person, increasing risk	Often requires two people for safety, especially with assistive devices

Conclusion

Preventing skin tears and shearing is a team effort that relies on knowledge, proper technique, and the right tools. By understanding the underlying causes and implementing a comprehensive care plan, caregivers can drastically reduce the risk of injury for residents with fragile skin. The investment in proper training and assistive equipment not only improves resident outcomes but also enhances caregiver safety and job satisfaction. For more information on health and aging, you can visit the official National Institutes of Health website.

Frequently Asked Questions

What is the primary difference between skin tearing and shearing?

Skin tearing is a visible wound caused by friction, such as dragging, which pulls the skin apart. Shearing is damage to the inner layers of the skin, caused when the outer skin stays put but the underlying tissue shifts, which is often a result of sliding down in a bed or chair.

Are there specific techniques to move a resident in bed without causing injury?

Yes, always use a draw sheet or slide sheet. With a partner, roll the resident onto their side, place the sheet underneath them, and then gently lift and slide them back into the desired position. Never pull directly on the resident's limbs or torso.

What kind of lotion should be used for fragile skin?

For fragile skin, use a pH-balanced, fragrance-free, and emollient-rich moisturizer. Apply it twice daily, especially after bathing, to keep the skin hydrated and supple. Avoid lotions containing alcohol, which can dry out the skin.

Can protective garments help prevent skin tears?

Yes, wearing long sleeves, pants, or specific padded arm and shin protectors can create a barrier that shields delicate skin from accidental bumps and scrapes during transfers and daily activity.

How can I prevent a resident from sliding down in a chair?

Ensure the resident's feet are flat and firmly planted. Use a non-slip mat or cushion in the chair to prevent sliding. Also, consider a tilt-in-space wheelchair that can change position without creating shearing forces.

Is a mechanical lift always necessary?

Mechanical lifts are necessary for residents who cannot bear their own weight or for whom manual lifting poses a significant risk of injury. A proper assessment of the resident's mobility level will determine the safest transfer method.

What should I do if a skin tear occurs despite precautions?

If a skin tear occurs, gently clean the wound with saline or tap water, try to realign the skin flap, and cover it with a non-adherent dressing, such as a silicone-based foam dressing. Do not use standard adhesive tape. Immediately inform a supervisor or medical professional.