CSIRO has developed a garment that will prevent skin tears in the elderly while providing the highest levels of comfort and patient tolerance.
Outline of research
Skin tear prevention is a rapidly emerging area of priority for the aged care industry worldwide.
Approximately 15 per cent of people in high-care nursing homes have a 'skin tear' at any one time, according to a study by Mr Geoff Sussman, Director of Wound Education and Research Group at the Victorian College of Pharmacy.
Data from nursing homes involved in the project indicated that the average high-care resident can expect to have one or two skin tears per year, with particularly vulnerable patients experiencing up to 10 or 15 tears per year.
Skin tears are caused by age-related changes that reduce blood flow to the skin and cause a flattening of skin layers. The layers become less well anchored together, fat deposits dwindle and the skin becomes dry and inelastic and highly susceptible to shear injuries. Simple knocks or even being helped from a wheel chair can cause the skin to tear.
What CSIRO did
In response to the Sussman report, Mr Robin Cranston at CSIRO assembled a research team to develop a garment that will prevent skin tears in the elderly while providing the highest levels of comfort and patient tolerance.
After considerable research, garments have been produced that performed very well in wear trials conducted at nursing homes. These garments are about to undergo clinical trials.
Garment design criteria
The fabric had to be engineered to comply with a list of features that a next-to-skin product needs to have to satisfy both clinicians and patients. Some of these criteria included that the garment must be:
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quickly and easily fitted by nursing staff under time pressure
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safely fitted and put in place without risking tears from zippers, Velcro, protective hard edges or from carer’s fingernails
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aesthetically pleasing
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comfortable and well-tolerated against the skin - the garment should not cause clamminess, irritation, itchiness or discomfort in any climate conditions
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affordable
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robust and able to survive the rigors of a nursing home laundry at high temperature
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providing a high level of protection against skin tears (bumps, shears, scratching, friction)
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lightweight
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wearable over several days before laundering.
The prototype design
The research team developed a specialized knit structure with two crucial mechanical properties:
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the textile can stretch by 100 per cent without applying any significant pressure, which in itself would be problematic, this makes the garments easy to put over ankles and wrists
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the fabric contracts to provide the necessary fitting to protect the skin against the friction that causes tears.
Key design elements were:
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use of superfine merino wool next to the skin for moisture and odour absorption, softness and bulk
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an engineered knit structure that forms loops that collapse in on themselves - the loops are held closed with a small amount of elastomer (five per cent Lycra in 95 per cent wool garment), giving the fabric extraordinary stretch and recovery properties
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the low power of the stretch means that while the garment is form fitting, the wearer feels very little pressure from the garment and is comfortable without reduction of blood circulation to the skin
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padding is attached to the outside of the leg protectors for additional protection around the shin region which is the most vulnerable area for severe tears
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the prototype textile is Chlorine/Hercosett treated to minimize shrinkage to provide a robust machine-washable garment that maintains its integrity.
With the support of Australian Wool Innovation (AWI) and an international manufacturer of wound management products, the research team approached nursing home staff for insightful critiques through a wearer trial.
The wearer trial
CSIRO conducted a three-month wearer trial with three selected nursing homes in Geelong, Victoria, in order to finalise 'ready to market' designs. The trial was conducted by nursing home staff to ensure garments were used under real-life conditions
The results demonstrated that the garments clearly met the desired criteria. Direct feedback from the nursing homes showed the garments were:
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comfortable
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well tolerated over long periods
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easy and safe to use
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did not generate odour
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laundered satisfactorily
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did not mark the skin
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effective in preventing tears
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providing additional warmth for frail elderly who suffered from poor circulation.
The garments were worn exclusively by residents with a history of skin tears. However no irritation, itchiness or discomfort occurred. No odour was produced, even though garments were worn for almost 24 hours per day on an ongoing basis, only being removed when the resident was bathed. No skin tears occurred during the trial.
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