What is slough? Defining the proteomic and microbial composition of slough and its implications for wound healing.

Slough is a well-known feature of non-healing wounds. This pilot study aims to determine the proteomic and microbiologic components of slough as well as interrogate the associations between wound slough components and wound healing. Ten subjects with slow-to-heal wounds and visible slough were enrolled. Aetiologies included venous stasis ulcers, post-surgical site infections and pressure ulcers. Patient co-morbidities and wound healing outcome at 3-months post-sample collection was recorded. Debrided slough was analysed microscopically, through untargeted proteomics, and high-throughput bacterial 16S-ribosomal gene sequencing. Microscopic imaging revealed wound slough to be amorphous in structure and highly variable. 16S-profiling found slough microbial communities to associate with wound aetiology and location on the body. Across all subjects, slough largely consisted of proteins involved in skin structure and formation, blood-clot formation and immune processes. To predict variables associated with wound healing, protein, microbial and clinical datasets were integrated into a supervised discriminant analysis. This analysis revealed that healing wounds were enriched for proteins involved in skin barrier development and negative regulation of immune responses. While wounds that deteriorated over time started off with a higher baseline Bates-Jensen Wound Assessment Score and were enriched for anaerobic bacterial taxa and chronic inflammatory proteins. To our knowledge, this is the first study to integrate clinical, microbiome, and proteomic data to systematically characterise wound slough and integrate it into a single assessment to predict wound healing outcome. Collectively, our findings underscore how slough components can help identify wounds at risk of continued impaired healing and serves as an underutilised biomarker.

Enhanced exploration of the mode of action of a five-layer foam dressing: critical properties to support wound healing.

OBJECTIVE: The aim of this in vitro experimental series was to explore the mode of action of a hydrocellular polyurethane foam dressing (HPFD) and how its advanced features support beneficial interactions with the wound bed to address common barriers to wound healing, thus supporting improved clinical outcomes. METHOD: Multiple in vitro microbiological tests were performed, assessing prevention of bacterial ingress, surface removal of bacteria, bacterial sequestration and retention into the dressing in a clinically relevant environment. Odour molecule concentrations were measured using gas chromatography and further assays explored matrix metalloproteinase (MMP)-9 retention in the dressing using enzyme linked immunosorbent assay. RESULTS: The HPFD demonstrated marked reductions in bioburden levels across multiple tests. These included prevention of bacterial ingress for seven days, removal of surface bacteria and absorption into the dressing. Further tests identified that most bacteria were sequestered into the hyperabsorbent layer (90.5% for Pseudomonas aeruginosa and 89.6% for meticillin-resistant Staphylococcus aureus). Moreover, the majority of bacteria (99.99% for both test organisms) were retained within the dressing, even upon compression. Additional tests demonstrated a marked reduction of odour molecules following incubation with HPFD and total retention of protease MMP-9 within the dressing. CONCLUSIONS: Proactive management of the wound environment with an appropriate advanced wound dressing, such as the HPFD examined in these in vitro investigations, can not only help to minimise the barriers to healing, as observed across this test series by direct interaction with the wound bed, but may, as a result, provide an ideal environment for wound progression with minimal disturbance.

Artificial intelligence in wound care: diagnosis, assessment and treatment of hard-to-heal wounds: a narrative review.

OBJECTIVE: The effective assessment of wounds, both acute and hard-to-heal, is an important component in the delivery by wound care practitioners of efficacious wound care for patients. Improved wound diagnosis, optimising wound treatment regimens, and enhanced prevention of wounds aid in providing patients with a better quality of life (QoL). There is significant potential for the use of artificial intelligence (AI) in health-related areas such as wound care. However, AI-based systems remain to be developed to a point where they can be used clinically to deliver high-quality wound care. We have carried out a narrative review of the development and use of AI in the diagnosis, assessment and treatment of hard-to-heal wounds. We retrieved 145 articles from several online databases and other online resources, and 81 of them were included in this narrative review. Our review shows that AI application in wound care offers benefits in the assessment/diagnosis, monitoring and treatment of acute and hard-to-heal wounds. As well as offering patients the potential of improved QoL, AI may also enable better use of healthcare resources.

The comfort and functional performance of personal protective equipment for police officers: a systematic scoping review.

This scoping review aimed to identify and summarise evidence on the comfort and functional performance of police officer personal protective equipment (PPE). The Arksey and O'Malley (2005) five-stage framework for scoping reviews was followed. PubMed, CINAHL, Scopus, and Web of Science were searched, and 35 articles were included in the review. The findings show that increased police PPE mass increases heart rate, metabolic energy expenditure, and perceived exertion in response to exercise. Unisex armour designs cause increased discomfort for females with larger bra sizes. PPE reduces joint-specific range of motion, with the design and location impairing movement more than mass. Jumping and sprinting performance is decreased with heavy PPE but unaffected by lighter protection, while agility is compromised with most forms of protection. Future research is needed on the fit and function of PPE for specialist police units, such as mounted police, along with further investigations on how fit can affect functional performance.

This paper identifies and reviews existing evidence on the comfort and functional performance of police officer personal protective equipment (PPE). This is significant because it summarises and categorises key concepts that underpin research in this area, whilst highlighting gaps in the current knowledge and areas for future research.

Polyhexamethylene biguanide and its antimicrobial role in wound healing: a narrative review.

A wound offers an ideal environment for the growth and proliferation of a variety of microorganisms which, in some cases, may lead to localised or even systemic infections that can be catastrophic for the patient; the development of biofilms exacerbates these infections. Over the past few decades, there has been a progressive development of antimicrobial resistance (AMR) in microorganisms across the board in healthcare sectors. Such resistant microorganisms have arisen primarily due to the misuse and overuse of antimicrobial treatments, and the subsequent ability of microorganisms to rapidly change and mutate as a defence mechanism against treatment (e.g., antibiotics). These resistant microorganisms are now at such a level that they are of grave concern to the World Health Organization (WHO), and are one of the leading causes of illness and mortality in the 21st century. Treatment of such infections becomes imperative but presents a significant challenge for the clinician in that treatment must be effective but not add to the development of new microbes with AMR. The strategy of antimicrobial stewardship (AMS) has stemmed from the need to counteract these resistant microorganisms and requires that current antimicrobial treatments be used wisely to prevent amplification of AMR. It also requires new, improved or alternative methods of treatment that will not worsen the situation. Thus, any antimicrobial treatment should be effective while not causing further development of resistance. Some antiseptics fall into this category and, in particular, polyhexamethylene hydrochloride biguanide (PHMB) has certain characteristics that make it an ideal solution to this problem of AMR, specifically within wound care applications. PHMB is a broad-spectrum antimicrobial that kills bacteria, fungi, parasites and certain viruses with a high therapeutic index, and is widely used in clinics, homes and industry. It has been used for many years and has not been shown to cause development of resistance; it is safe (non-cytotoxic), not causing damage to newly growing wound tissue. Importantly there is substantial evidence for its effective use in wound care applications, providing a sound basis for evidence-based practice. This review presents the evidence for the use of PHMB treatments in wound care and its alignment with AMS for the prevention and treatment of wound infection.

Experimental and clinical evidence for DACC-coated dressings: an update.

OBJECTIVE: To update the evidence in relation to the use of dialkylcarbamoyl chloride (DACC)-coated wound dressings in the prevention, treatment and management of wounds. METHOD: PubMed and PubMed Central databases were searched to identify articles published since 2020 describing the experimental and clinical evidence for DACC-coated dressings, and their antimicrobial effect, as well as their impact on the prevention and treatment of infected wounds. The identified articles were then narratively reviewed. RESULTS: The search yielded 113 articles (plus references from ad hoc sources), of which nine met the inclusion criteria. Of the nine included studies, five related to clinical aspects and four were laboratory studies. CONCLUSION: A number of new studies have provided further evidence for the mode of action of the antimicrobial effect of DACC-coated dressings and its wide spectrum effect (including World Health Organization-prioritised microorganisms). Additional clinical studies have provided evidence of new applications, such as in treating wounds in paediatric patients, and extended the evidence relating to their use in treating surgical site infections. Evidence also shows that DACC-coated wound dressings can aid in the binding of biofilms, and how this technology can align and support antimicrobial stewardship in the prevention of antimicrobial resistance.

Considerations for an ideal post-surgical wound dressing aligned with antimicrobial stewardship objectives: a scoping review.

OBJECTIVE: Most surgical wounds heal by primary or secondary intention. Surgical wounds can present specific and unique challenges including wound dehiscence and surgical site infection (SSI), either of which can increase risk of morbidity and mortality. The use of antimicrobials to treat infection in these wounds is prevalent, but there is now an imperative to align treatment with reducing antimicrobial resistance and antimicrobial stewardship (AMS). The aim of this review was to explore the published evidence identifying general considerations/criteria for an ideal post-surgical wound dressing in terms of overcoming potential wound healing challenges (including infection) while supporting AMS objectives. METHOD: A scoping review examining evidence published from 1954-2021, conducted by two authors acting independently. Results were synthesised narratively and have been reported in line with PRISMA Extension for Scoping Reviews. RESULTS: A total of 819 articles were initially identified and subsequently filtered to 178 for inclusion in the assessment. The search highlighted six key outcomes of interest associated with post-surgical wound dressings: wound infection; wound healing; physical attributes related to comfort, conformability and flexibility; fluid handling (e.g., blood and exudate); pain; and skin damage. CONCLUSION: There are several challenges that can be overcome when treating a post-surgical wound with a dressing, not least the prevention and treatment of SSIs. However, it is imperative that the use of antimicrobial wound dressings is aligned with AMS programmes and alternatives to active antimicrobials investigated.

Effectiveness of a polyhexamethylene biguanide-containing wound cleansing solution using experimental biofilm models.

OBJECTIVE: Antiseptics are widely used in wound management to prevent or treat wound infections, and have been shown to have antibiofilm efficacy. The objective of this study was to assess the effectiveness of a polyhexamethylene biguanide (PHMB)-containing wound cleansing and irrigation solution on model biofilm of pathogens known to cause wound infections compared with a number of other antimicrobial wound cleansing and irrigation solutions. METHOD: Staphylococcus aureus and Pseudomonas aeruginosa single-species biofilms were cultured using microtitre plate and Centers for Disease Control and Prevention (CDC) biofilm reactor methods. Following a 24-hour incubation period, the biofilms were rinsed to remove planktonic microorganisms and then challenged with wound cleansing and irrigation solutions. Following incubation of the biofilms with a variety of concentrations of the test solutions (50%, 75% or 100%) for 20, 30, 40, 50 or 60 minutes, remaining viable organisms from the treated biofilms were quantified. RESULTS: The six antimicrobial wound cleansing and irrigation solutions used were all effective in eradicating Staphylococcus aureus biofilm bacteria in both test models. However, the results were more variable for the more tolerant Pseudomonas aeruginosa biofilm. Only one of the six solutions (sea salt and oxychlorite/NaOCl-containing solution) was able to eradicate Pseudomonas aeruginosa biofilm using the microtitre plate assay. Of the six solutions, three (a solution containing PHMB and poloxamer 188 surfactant, a solution containing hypochlorous acid (HOCl) and a solution containing NaOCl/HOCl) showed increasing levels of eradication of Pseudomonas aeruginosa biofilm microorganisms with increasing concentration and exposure time. Using the CDC biofilm reactor model, all six cleansing and irrigation solutions, except for the solution containing HOCl, were able to eradicate Pseudomonas aeruginosa biofilms such that no viable microorganisms were recovered. CONCLUSION: This study demonstrated that a PHMB-containing wound cleansing and irrigation solution was as effective as other antimicrobial wound irrigation solutions for antibiofilm efficacy. Together with the low toxicity, good safety profile and absence of any reported acquisition of bacterial resistance to PHMB, the antibiofilm effectiveness data support the alignment of this cleansing and irrigation solution with antimicrobial stewardship (AMS) strategies.

International validation of a venous leg ulcer risk assessment tool.

OBJECTIVE: To internationally validate a tool for predicting the risk of delayed healing of venous leg ulcers (VLUs). METHOD: A 10-item tool including sociodemographic factors, venous history, ulcer and lower limb characteristics, compression and mobility items to determine the risk of delayed healing of VLUs has previously been developed and validated in Australia. This study prospectively validated this tool using receiver operating characteristic (ROC) methods; using the area under the curve (AUC) to quantify the discriminatory capability of the tool to analyse the international populations of the UK, Austria and New Zealand. RESULTS: The validation of the tool in the UK, Austria and New Zealand has indicated that the model has moderate discrimination and goodness-of-fit with an AUC of 0.74 (95% CI: 0.66-0.82) for the total risk assessment score. CONCLUSION: The international validation of a risk assessment tool for delayed healing of VLUs will allow clinicians globally to be able to determine realistic outcomes from an early assessment and to be able to guide early tailored interventions to address the specific modifiable risk factors and thus promote timely healing.

Mental illness stigmatisation among Malaysian adults: a systematic review.

BACKGROUND: Stigmatisation is considered a 'second illness' for people with a mental illness and is highly prevalent in Malaysia. Stigmatisation negatively impacts wellbeing, recovery and productivity. Addressing stigmatisation is integral towards people attaining a higher quality of life. AIM: To explore mental illness stigmatisation in Malaysian adults. METHOD: A systematic literature review was conducted using thematic analysis to synthesise and categorise evidence. Five key themes emerged, providing insight into mental health stigmatisation. FINDINGS: Cultural beliefs, limited knowledge of mental health and lack of education on mental health were factors influencing stigmatisation. Stigmatisation significantly affected the wellbeing and functioning of people with a mental illness. Interventions such as contact-based education effectively reduce stigmatising attitudes manifested by healthcare providers. CONCLUSION: Establishing mental health literacy, encouraging patient contact, promoting mental health awareness and strengthening mental health policies could reduce mental illness stigmatisation and its impact in Malaysia. Future research is warranted to investigate the impact on physical wellbeing and anti-stigmatising strategies targeting the general public.

Antimicrobial stewardship in wound care implementation and measuring outcomes: results of an e-survey.

OBJECTIVE: Antimicrobial resistance (AMR) occurs (as a result of misuse, such as over-prescribing) when certain pathogens fail to respond to treatment with antimicrobials. Consequently, patients can become severely ill and possibly die. A strategy referred to as antimicrobial stewardship (AMS) has been introduced which reduces the impact of this antimicrobial misuse. To explore health professionals' (working in wound care, treating both acute and hard-to-heal wounds) position in terms of the following: awareness of AMS; if they are aware of AMS, if they implement procedures to support its practice; and if they implement AMS, do they measure its impact by and compare pre- and post-implementation? METHOD: An e-survey designed to explore health professionals' awareness of AMS and its implications for wound care. RESULTS: There were 987 respondents to the survey. The majority were specialist wound care nurses, mainly based in the UK or the US and Canada. A high proportion of those surveyed were completely/partially aware (35.1/57.9%, respectively) of AMS, and almost all implemented strategies to reduce antimicrobial prescribing. Of those surveyed, 36% took steps to measure the impact of AMS, and as a result 35.2% reported positive impacts (for example, cost reductions, a reduction in the systemic use of antimicrobials, a reduction in the topical use of antimicrobials and a reduced level of antimicrobial-resistant microorganisms). Challenging aspects of AMS implementation were reported by 33.2% of respondents (for example, poorer clinical outcomes in terms of healing and increased costs). The data highlighted that 40.49% felt that AMS would be 'easy' or 'very easy' to implement while 21.73% felt that AMS would be 'difficult' or 'very difficult' to implement. CONCLUSION: Education strategies need to be devised to raise awareness and support health professionals, including wound care practitioners, to understand and implement effective AMS programmes. Development of clear metrics is required to evaluate the effect of AMS programmes in clinical practice.

Sub-epidermal moisture assessment as a prompt for clinical action in treatment of pressure ulcers in at-risk hospital patients.

OBJECTIVE: This study assesses anonymous patient-level data on the use of sub-epidermal moisture (SEM) assessment technology as a tool in the prevention of pressure ulceration in at-risk hospital patients. METHOD: The relationship between technology-generated prompts for clinical action (patient turning, application of pressure redistributing equipment, heel protection or cream) and consequent clinical action was evaluated using data cross-tabulations (using data aggregated over multiple anatomical sites); in a multilevel model with patients clustered within wards, clustered in turn within hospitals, and controlling for additional patient- and institution-level factors; and using receiver operating characteristic (ROC) analyses of anatomy-specific data. The ability of the SEM assessment technology to detect deep and early-stage pressure ulcers/injuries on specific anatomical areas of a patient's body on admission, earlier than visual and tactile skin tissue assessments (STA), was assessed. RESULTS: A total of 15,574 patient assessments ('cases') were reported on 1995 patients. Most incidences of nurse action were in response to a prompt from SEM assessments (4944/5494; 90.0%). An SEM delta (Δ)≥0.6 resulted in nurse action in 4944/13,071 cases (37.8%). The multilevel model revealed strong evidence that SEM Δ prompts were significantly associated with nurse action (p<0.001; adjusted odds ratio: 1.99). CONCLUSION: In this study, SEM assessment technology effectively prompted nurse action moreso than skin reddening diagnosed via trained clinician judgement and STAs. While baseline responses of nurses' actions remained low, with or without SEM Δ prompts, findings verified the 'clinical utility' of SEM assessment technology as an objective prompt for early clinical action over and above existing mechanisms.

Sub-epidermal moisture assessment as an adjunct to visual assessment in the reduction of pressure ulcer incidence.

OBJECTIVE: To assess the effectiveness of sub-epidermal moisture (SEM) assessment technology as an adjunct to visual assessment to reduce pressure ulcer (PU) incidence alongside standard PU care pathways. METHOD: Data were obtained from wards located within 28 institutions in the UK, Canada, Belgium, Spain and Ireland. At each ward, the proportion of patients scanned who were observed to have one or more PUs of Category 2 or above during a pre-Pressure Ulcer Reduction Programme (PURP) implementation period starting between November 2017 and July 2018 was recorded. The proportion of patients scanned who were observed to have one or more PUs of Category 2 or above during a post-PURP implementation period starting between November 2018 and July 2019 was also recorded. A meta-analysis was conducted on the data using wards as the unit of analysis, to facilitate overall estimate of the PURP. A sensitivity study was also conducted to assess the sensitivity of results to data from specific institutions. RESULTS: A synthesised estimate of the overall relative risk (RR) was calculated to be 0.38 (95% confidence interval 0.26 to 0.56). Hence the risk of PU in the post-PURP cohort was about one-third that of the corresponding risk in the pre-PURP cohort. The sensitivity analysis revealed no evidence that any individual ward exerted excessive influence on the findings. CONCLUSION: The analysis has revealed strong evidence that implementation of the PURP was associated with reduction in incidence of Category 2 or above PUs across a wide range of clinical settings.

The importance of periwound skin in wound healing: an overview of the evidence.

DECLARATION OF INTEREST: The authors have no conflicts of interest.

Antimicrobial stewardship: a JWC Masterclass.

This paper presents an overview of a Journal of Wound Care (JWC) webinar 'Antimicrobial Stewardship Masterclass' which took place on 17 June 2021, bringing together international experts in the field of wound care. The webinar was undertaken to provide an educational platform elucidating the basis of an effective antimicrobial strategy in wound care, and to demonstrate how it impacts on wound care clinicians and their day-to-day practice, using examples of 'real-life' patient outcomes.

Establishing a consensus on wound infection definitions.

OBJECTIVES: The aim of this study was to establish an international, interorganisational consensus on wound infection terminology. METHODS: This project consisted of definition scoping and a Delphi process to produce a consensus glossary for 18 wound infection terms. Recent guidelines/consensus documents were reviewed to identify 2-4 definitions for each term. An online consensus process was undertaken using the RAND Appropriateness Method, a consensus method for panels to reach agreement. International wound organisations nominated experts to participate, from whom 21 participants were selected to represent different organisations, geographic regions and disciplines. In the first consensus round, each term was presented alongside 2-3 definitions and participants nominated their preferred definition, with the majority vote used to select a baseline definition. The consensus process then proceeded, with participants using a 9-point Likert scale to score their level of agreement or disagreement with the definition for each term. Participants also provided a justification outlining the reason behind their rating. At the end of each round, an index was calculated to provide a quantitative evaluation indicating whether agreement or disagreement had been reached. RESULTS: Reasoning statements were summarised and the definitions were adjusted to incorporate concepts identified by participants. The adjusted definition was presented in the next consensus round, together with the reasoning statements. Terms for which a final definition was not achieved in three consensus rounds were finalised with preferential voting using 2-3 definitions that had reached consensus. PROJECT PROGRESS AND SIGNIFICANCE: The project generated a glossary of wound infection terms, endorsed through participation of 15 international organisations, for dissemination of guidelines and clinical decision-making/teaching tools.

IWII Wound Infection in Clinical Practice consensus document: 2022 update.

ABSTRACT: Wound infection is a major challenge for clinicians globally, with accurate and timely identification of wound infection being critical to achieving clinical and cost-effective management, and promotion of healing. This paper presents an overview of the development of the International Wound Infection Institute (IWII)'s 2022 Wound Infection in Clinical Practice consensus document. The updated document summarises current evidence and provides multidisciplinary healthcare providers with effective guidance and support on terminology, paradigms related to biofilm, identification of wound infection, wound cleansing, debridement and antimicrobial stewardship. Integral to the update is revision of wound infection management strategies which are incorporated within the IWII's Wound Infection Continuum (IWII-WIC) and management plan. The aim of the 2022 IWII consensus document update was to provide an accessible and useful clinical resource in at least six languages, incorporating the latest evidence and current best practice for wound infection and prevention. Dissemination techniques for the consensus are discussed and highlighted.

The Impact of Care Bundles on the Incidence of Surgical Site Infections: A Systematic Review.

OBJECTIVE: This systematic review assesses the effects of care bundles on the incidence of surgical site infections (SSIs). DATA SOURCES: The search was conducted between February and May 2021, using PubMed, CINAHL, SCOPUS, Cochrane, and EMBASE databases. STUDY SELECTION: Studies were included if they used systematic review methodology, were in English, used a quantitative design, and explored the use of care bundles for SSI prevention. A total of 35 studies met the inclusion criteria, and 26 provided data conducive to meta-analysis. DATA EXTRACTION: Data were extracted using a predesigned extraction tool, and analysis was undertaken using RevMan (Cochrane, London, UK). Quality appraisal was undertaken using evidence-based librarianship. DATA SYNTHESIS: The mean sample size was 7,982 (median, 840) participants. There was a statistically significant difference in SSI incidence in favor of using a care bundle (SSI incidence 4%, 703/17,549 in the care bundle group vs 7%, 1,157/17,162 in the usual care group). The odds ratio was 0.55 (95% confidence interval, 0.41-0.73; P < .00001), suggesting that there is a 45% reduction in the odds of SSI development for the care bundle group. The mean validity score for all studies was 84% (SD, 0.04%). CONCLUSIONS: The results indicate that implementing care bundles reduced SSI incidence. However, because there was clinically important variation in the composition of and compliance with care bundles, additional research with standardized care bundles is needed to confirm this finding.

Use of ankle-brachial pressure index to assess patient suitability for lower limb compression.

BACKGROUND: Compression therapy is a safe, effective treatment for lower leg conditions such as lymphatic insufficiency and venous hypertension. The most common method of arterial assessment is the calculation of a patient's ankle-brachial pressure index (ABPI). The need for ABPI is highlighted in many best practice statement and local policies. ABPI compares the arterial flow of the arms and the legs, providing a ratio used to determine the presence and severity of peripheral artery disease and assess whether a patient is suitable for compression therapy. AIM: This study critically reviews and analyses findings from contemporary literature with the aim of evaluating the effectiveness of the ABPI screening tool. METHOD: A structured literature review using a narrative approach was carried out. RESULTS: Four studies were identified for inclusion, which involved medical, nursing and allied health professional staff in primary and secondary care, with a total of 51 patients. Analysis generated eight themes: appropriateness of the ABPI tool; clinician education; referral process; access to appropriate equipment; lack of time to conduct the assessment; competence; associated costs; and role definition. CONCLUSION: It is important to undertake a holistic assessment of the patient, incorporating ABPI assessment where not contraindicated. Further research to explore patient experience and safety when assessing a patient's suitability for lower limb compression therapy is required.

Development and psychometric property testing of a skin tear knowledge assessment instrument (OASES) in 37 countries.

AIM: To develop and psychometrically evaluate a skin tear knowledge assessment instrument (OASES). DESIGN: Prospective psychometric instrument validation study. METHOD: The skin tear knowledge assessment instrument was developed based on a literature review and expert input (N = 19). Face and content validity were assessed in a two-round Delphi procedure by 10 international experts affiliated with the International Skin Tear Advisory Panel (ISTAP). The instrument was psychometrically tested in a convenience sample of 387 nurses in 37 countries (April-May 2020). Validity of the multiple-choice test items (item difficulty, discriminating index, quality of the response alternatives), construct validity, and test-retest reliability (stability) were analysed and evaluated in light of international reference standards. RESULTS: A 20-item instrument, covering six knowledge domains most relevant to skin tears, was designed. Content validity was established (CVI = 0.90-1.00). Item difficulty varied between 0.24 and 0.94 and the quality of the response alternatives between 0.01-0.52. The discriminating index was acceptable (0.19-0.77). Participants with a theoretically expected higher knowledge level had a significantly higher total score than participants with theoretically expected lower knowledge (p < .001). The 1-week test-retest intraclass correlation coefficient (ICC) was 0.83 (95% CI = 0.78-0.86) for the full instrument and varied between 0.72 (95% CI = 0.64-0.79) and 0.85 (95% CI = 0.81-0.89) for the domains. Cohen's Kappa coefficients of the individual items ranged between 0.21 and 0.74. CONCLUSION: The skin tear knowledge assessment instrument is supported by acceptable psychometric properties and can be applied in nursing education, research, and practice to assess knowledge of healthcare professionals about skin tears. IMPACT: Prevention and treatment of skin tears are a challenge for healthcare professionals. The provision of adequate care is based on profound and up-to-date knowledge. None of the existing instruments to assess skin tear knowledge is psychometrically tested, nor up-to-date. OASES can be used worldwide to identify education, practice, and research needs and priorities related to skin tears in clinical practice.