PROBLEM Our standard skin tear treatment included triple-antibiotic-ointment, thin adhesive strips and daily 4x4 and gauze wrap dressing changes. 60% of skin tears treated became infected, often taking more than 20 days to resolve.

RATIONALE After thorough analysis and experimentation with alternatives, the author determined that the most cost-effective management technique was to use polymeric membrane wound dressings for skin tears with a simple-to-use Skin Tear Protocol. Polymeric membrane wound dressings decrease wound pain, concentrate the body's natural wound-healing fluids in the wound bed, and contain a built-in wound cleanser.

PROTOCOL 1. Cleanse tear with saline. 2. Approximate with thin adhesive strips. 3. Covered with polymeric membrane island dressing. 4. Do not disturb for 3 days unless exudate visible through dressing. This often occurs in the first 24 - 48 hours. Dressing change procedure: Just remove old dressing, place new dressing on wound. No cleansing is performed. 5. New polymeric membrane island dressing is left on for about 4 more days.

RESULTS Using this protocol, skin tears are reliably free from the signs and symptoms of infection (less than 1%). Skin tears are usually completely healed in 5-10 days (3 dressing changes), depending on the size of the initial wound and the resident's health status. Usually only 3 dressing changes are required for the entire course of the skin tear healing process. Residents report pain relief and that the adhesive on polymeric membrane island dressings is reliable and very comfortable.

The Protocol was replicated in 8 other long-term-care facilities, ranging from small rural facilities with limited RN support to large urban facilities, with the same excellent outcomes in each facility.

CONCLUSION The Carlyle Nursing Associates' Skin Tear Protocol reduced infections from 60% to less than 1%, sped healing, reduced overall costs and helped relieve residents' pain associated with skin tears.