The Singapore General Hospital (SGH) is planning a survey on skin tears, after a pilot study found them under-reported and inadequately managed even though they can be extremely painful.
At their worst, they can lead to life-threatening infections in elderly patients.
Planned for the end of this year or the start of next year, the survey will look at how often such tears - or wounds usually caused by friction - occur in wards and how well they are documented and treated.
"This will help to further our understanding of the prevalence and impact of skin tears on patients, especially the elderly," said Ms Chang Yee Yee, a wound care nurse clinician at SGH and lead author of the earlier study.
The study, published in the International Wound Journal earlier this year, found that out of 144 patients surveyed in two hospital wards, 14 skin tears were identified, but only one had a wound dressing.
This type of wound, most common among the elderly as they have thin skin which is more prone to breaking, was usually disregarded unless massive in size.
The incidence of skin tears can be significantly reduced with awareness of the problem, better techniques in lifting and transferring of patients, and the use of technologies to aid these processes.
DR TEY HONG LIANG
Out of the 14 skin tears, only four were noted in nursing records in the 48 hours before the survey.
Ms Chang said skin tears are at times mistaken for pressure ulcers, which are often managed by using a pillow to keep the pressure off, when they should be protected with a wound dressing.
The surrounding dry skin should also be hydrated with a non-fragrant or non-alcohol moisturiser.
There is an "urgent clinical need" to introduce a system that has classification for skin tears, standardised protocols on how to prevent and manage them, and more education for hospital staff, she said.
Dr Gavin Ong, a dermatologist at The Skin Specialist under the Singapore Medical Group, said skin tears left untreated can lead to the loss of the outer skin layer or skin ulcers, which can cause delayed wound healing when infected.
As older people heal more slowly, in part due to a thinner collagen layer in the skin, an infection could be life threatening if it becomes widespread, he added.
One reason for the inadequate management of skin tears is that they are often not immediately apparent, said Dr Tey Hong Liang of the National Skin Centre.
Skin damage during the lifting and transferring of elderly patients can sometimes go unnoticed as many are unable to tell nurses about pain or skin changes such as bruising, which appear only after some time.
"The incidence of skin tears can be significantly reduced with awareness of the problem, better techniques in lifting and transferring of patients, and the use of technologies to aid these processes," said Dr Tey.
Dr Lawrence Khoo, a dermatology specialist at Farrer Park Medical Centre, said patients with dry skin are more susceptible to skin tears.
The dryness of their skin often causes itchiness, which leads to the inappropriate use of topical steroid medications, further worsening the problem of skin thinning.
Nurses from the National University Hospital and Parkway Pantai welcome a uniform system to prevent and manage skin tears across hospitals here.
"The proposed skin tear management protocol needs to be tested widely across different institutions and fine-tuned before adoption," said Ms Elaine Ng, group director of nursing at Parkway Pantai.
SGH said it has started using a skin tear classification tool that categorises the severity of the injury at five levels. Its nurses have gone for additional wound care courses and learnt how to tell skin tears and pressure injuries apart.
"The hospital-wide survey that we plan to conduct soon will let us know the effectiveness of these education initiatives," said Ms Ang Shin Yuh, senior nurse manager at SGH.