Occurrence of Skin Tears in a Long-Term Care Setting

The article titled ‘No-Rinse, One-Step Bed Bath: The Effects on the Occurrence of Skin Tears in a Long-Term Care Setting’ is authored by Coggins and Birch. It begins with providing information on how the cost of care of long term residents in medical institutions increases due to skin tears occurring specifically in elderly patients. These skin tears cause pain and irritation in the institutionalized patients.

Estimation has been made by the authors regarding the figure of the patients in the United States developing these wounds, to rise to 8.1 million by the year 2030. The article follows by stating the definition of skin tears and wounds, to be traumatic wounds that separate the epidermis of the skin from the dermis, due to friction, or cutting. The writers have informed us that there are many factors that may lead to epidermal thinning, one of them being the subcutaneous tissue loss in aging individuals. Other aspects leading to such a condition of the epidermis may include lesser moisture in skin due to change in sebum composition, decrease in elasticity and tensile strength of the skin due to aging, the removal of natural lipids from the skin due to excessive use of soap, and decrease of natural lubricants from the skin while bathing.

The aim of this study was to take an insight into the effects of bathing practices on skin tears of a 72-bed healthcare institution. The other assessments include nursing practices, patient care outcomes and costs of care. In the literature review section, Coggins and Birch have stated that there is very sparse literature present regarding the causes and cure for skin wounds, however, it is growing with time, and several risk factors are now being devised by researchers.

Some factors that have been mentioned by other researchers, that may cause skin wounds and tears, are included in this write-up, among which are, rising age, compromised nutrition, and sensory loss. One of the studies mentioned include a four month research on the effects of the use of emollient, i.e. containing moisturizers, and non-emollient soaps. The use of emollient soaps showed a lesser instance of skin wounds. Similarly, one other study has been included, which compared the use of a non-detergent, no-rinse cleanser to bathing with soap and water.

In this study, the patients were also given a non-detergent bath, because of the concern of soap residues on the skin causing wounds. A one-step, no-rinse bath was performed on the patients by the nurses, using a non-detergent cleanser. The skin is wiped clean with the cleanser sprayed onto a wash cloth. The dressings of the wounds of patients were changed regularly, and records of their conditions were constantly taken, in patient charts. In the results obtained, the staff was generally pleased with the use of the non-detergent cleanser. The incidence of skin tears has been found to be at a reduced level, as compared to when the patients were using soaps. The limitations of the study have been given, which is a good aspect for further research on this topic, aiding them to consider such points which have not previously been mentioned.

The study on the whole was a good piece of work, showing a positive impact of the use of this new method of cleansing for patients who suffer from skin wounds, and the negative aspects of excessive soap usage have also been discovered, and will be discouraged in healthcare institutions.


Birch, S. & Coggins, T. No-Rinse, One-Step Bed Bath: The Effects on the Occurrence of Skin Tears in a Long-Term Care Setting. Ostomy Wound Management Vol 49:1 (2009).