RESEARCH FORUM: Friction and Shear Considerations in Pressure Ulcer Development
Darlene Hanson RN, MS
Diane K. Langemo PhD, RN, FAAN
Julie Anderson PhD, RN, CCRC
Patricia Thompson RN, MS
Susan Hunter RN, MSN

Advances in Skin & Wound Care: The Journal for Prevention and Healing
January 2010 
Volume 23  Number 1
Pages 21 - 24
  PDF Version Available!

Friction and shear, seemingly innocuous properties of nature, can increase the risks for injury in healthcare for both patients and practitioners. This article addresses friction and shear and their association with pressure ulcers (PrUs), highlighting recent research studies related to each.Friction is blamed for a number of untoward events of the skin. In particular, it is known to be a causative factor in falls, blisters, dermatitis, skin tears, injuries during patient transfers, airbag deployment injuries, and marathon runners' skin irritations, as well as PrUs.1-3 Friction-induced injuries also can be caused by patient skin rubbing on starched bed linens, primarily affecting the elbows, heels, and knees and, less often, the sacral areas. Increasing the likelihood of PrU development, friction/shear injuries can occur during the positioning of patients in the bed, during the placement of a bedpan, during a transfer to another bed surface or wheelchair, and when moving patients up in bed. The mechanism of injury is that the underlying skin layers move with the patient, while the epidermal/dermal layers adhere to the bed or chair surface because of friction, causing shearing of tissues under the skin. Friction may induce the injury, but the resultant damage is shear to the underlying tissue layers, in this case.Although friction against the skin is rarely noticed until it results in an injury, it is present nonetheless. As an example, consider the difference between wearing a tight, chafing garment for jogging versus wearing a smooth, stretchy material. Most individuals would likely select the latter but may not be aware that it is friction they are avoiding. And when a person sleeps on a bed that has high-thread-count linens and notices that he/she has a better night's sleep, it might be a lack of friction that accounts for the improvement. This kind of friction might seem inconsequential to wound care and PrUs, but consider patients in hospitals who rarely choose

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