This analysis assesses the classic literature that led to the inclusion of friction as a causative factor in the development of pressure ulcers in light of more recent research on the effects of shear. Injuries to the superficial layers of the skin caused by friction are not pressure ulcers and should not be classified or treated as such.

2017 Jun;71:97-114. doi: 10.1016/j.ijnurstu.2017.03.012.

Friction usually, but not always, accompanies shear. The reason for the misdiagnosis may be a misinterpretation of classic pressure ulcer literature that reported friction increased the susceptibility of the skin to pressure damage. How can friction and shear be reduced?

When there is loss of the top skin layer, there is also a breach in the barrier against infection.

Many times you may identify signs of shearing stresses within a wound that presents an irregular shape and undermining.

Friction injuries are often misdiagnosed as pressure ulcers. This inflammation can lead to deeper injury or could be the initial damage needed to start pressure ulcer formation. J Wound Ostomy Continence Nurs.

2018 Oct;69(10):839-847. doi: 10.1007/s00105-018-4230-6.Alderden J, Cummins MR, Pepper GA, Whitney JD, Zhang Y, Butcher R, Thomas D.J Wound Ostomy Continence Nurs.
This is due to friction. Wolters Kluwer COVID-19 is an emerging, rapidly evolving situation.

The analysis in this article suggests that friction can contribute to pressure ulcers by creating shear strain in deeper tissues, but friction does not appear to contribute to pressure ulcers 2015 Jan-Feb;42(1):47-61. doi: 10.1097/WON.0000000000000087.Int J Nurs Stud.

The analysis in this article suggests that friction can contribute to pressure ulcers by creating shear strain in deeper tissues, but friction does not appear to contribute to pressure ulcers in the superficial layers of the skin. 2006;25(1):23-39. doi: 10.1080/15569520500536600.Kottner J, Kröger K, Gerber V, Schröder G, Dissemond J.Hautarzt.

For the past couple weeks, there has been an ulcer wound on Barbara's lower back that has progressively gotten bigger, deeper, and more painful. 2011 Dec;48(12):1487-94. doi: 10.1016/j.ijnurstu.2011.07.004. You can feel this ‘drag’ effect if you run your hand over something.Shear causes stretching and tearing of blood vessels which reduces blood flow, increases blood pooling and can lead to cell damage.Shearing stops or reduces blood flow more easily than pressure alone (for example, it is easier to cut off flow in a water hose by bending than by pinching it).Although shear and friction causes tissue damage slightly differently to pressure, the damage produced is the same as with pressure.Importantly, it is difficult to create pressure without shear, and shear without pressure, so the two usually go hand-in-hand.For information on how pressure leads to pressure injury, see our article As well as being a key element of making shear force, friction between the skin and the stationary surfaces such as bed clothes can result in the loss of the top layer of the skin (the stratum corneum).Think about repeatedly rubbing your skin against a surface – after a time, the skin would start to become red and sore.

There are several strategies to reduce shear and friction forces: While the major factor in the development of pressure injury is pressure itself shear and friction forces also play a part.When you move over a surface and remain in contact with it, the skin gets pulled along that surface.

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