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Skin Care
Proper skin barrier use and correct ostomy pouch application can help prevent swelling, redness, or rash.
A Review of Perineal Skin Care Protocols and Skin Barrier Product Use
Perineal skin damage secondary to incontinence is painful, prevalent, and preventable. Skin care professionals consider regular application of skin protectants for patients with incontinence the standard of care for preventing perineal skin injury secondary to incontinence. Although protocols to improve care exist, the extent to which they are implemented and followed has not been documented. A study was conducted to ascertain the extent to which perineal skin care protocols are consistent with Wound, Ostomy and Continence Nurses Society Clinical Practice Guidelines and to estimate the level of compliance related to the use of protective perineal skin barriers. A convenience sample of 76 perineal skin care protocols was obtained from acute care (n = 55), long-term care (n = 9), and nondisclosed types of extended care facilities (n = 12). All protocol interventions were compared to the Wound, Ostomy and Continence Nurses guidelines. Healthcare Products Information Services data were used to obtain the total amount of skin protectants sold to US healthcare facilities in 2002. Skin protectant use was compared to previously published urinary and fecal (urofecal) incontinence prevalence data. All 76 protocols lacked one or more of the interventions considered important in perineal skin care. Although 75% of the protocols included the use of skin protectants, Healthcare Products Information Services data and urofecal prevalence data suggest underutilization of skin protectants; an estimated 10 cents per day versus an anticipated average cost of 23.5 cents per application is being spent. Further study is warranted and necessary to ensure the application of evidence-based protocols of care in practice. KEYWORDS: perineal, skin, wounds, incontinence, dermatitis
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An Evaluation of Two Incontinence Skin Care Protocols in a Long-Term Care Setting
Caring for the skin of patients with incontinence is an essential activity in long-term care. A prospective descriptive study to compare the effect of two skin care protocols on skin condition, pain, and caregiver time was conducted. Thirty-two (32) skilled nursing facility residents with incontinence participated in the 3-week study. Patients were randomly assigned to a standard care regimen (soap and water cleansing after each incontinence episode, followed by application of a moisturizing lotion) or study care protocol (no-rinse skin cleanser after each episode and application of a barrier cream with durable properties after the first incontinence episode of each shift). Number and type of incontinence episodes, skin condition, pain, and caregiver time spent were assessed. Skin integrity was maintained in the majority of control (69%) and study group (72%) patients and improvement occurred in 8% of control and 17% of the study group (NS). Study protocol procedures took less time to complete than control procedures (a savings of 79 minutes/patient/day). A positive correlation between pain intensity and level of skin impairment was observed (r = 0.88). The results of this study suggest that at this facility, use of soap, water, and a moisturizer may be less effective and more time-consuming than using a no-rinse cleanser and a durable barrier product.
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Impaired Skin Integrity in the Elderly
Eczemas (decreased moisture retention /hydration of skin). Skin Care Product Formulary for Management of Dry Skin Clinicians use topical skin care products to prevent, treat, and maintain skin integrity. Skin cleansing and cleansers.
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Determining the Efficacy of a Pressure Ulcer Prevention Program by Collecting Prevalence and Incidence Data: A Unit-Based Effort
Pressure ulcer prevention falls within the domain of nursing practice. When the results of a quality improvement survey indicated both an increase in the number of pressure ulcers and a higher prevalence than the national average, the nursing staff of a 500-bed Midwest hospital developed a pressure ulcer prevention program guided by the AHCPR guidelines. The literature supports collecting prevalence and incidence data as indicators of prevention program effectiveness, and the best indicator of the effectiveness of prevention strategies to reduce nosocomial pressure ulcers is incidence. Since the tracking mechanism was instituted, awareness of the results and impact of prevention measures increased; most nursing units experienced a 10% to 20% decrease in the incidence of pressure ulcers. Designing an efficient, timely, and practical method of retrieving pressure ulcer prevalence and incidence data provided a quality assurance method of monitoring the success of the program.
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Preventing Skin Tears in a Nursing and Rehabilitation Center: An Interdisciplinary Effort
Skin tears are painful, traumatic wounds that result from the separation of the epidermis from the dermis. To assess the clinical effectiveness of a preventive skin care protocol, 13-month retrospective pre-intervention data collection followed by 15-month post-intervention skin tear incidence data collection was conducted among all patients in a 209-bed urban nursing and rehabilitation center. The preventive skin care strategies implemented ? staff education, skin sleeves and padded side rails for high-risk patients, gentle skin cleansers, and lotion ? were selected by facility staff members and the multidisciplinary skin team. Nosocomial skin tear data were obtained by reviewing incident reports. Following implementation of the prevention protocols, the number of skin tears changed from a mean of 18.7 to a mean of 8.73 per month (P <0.001). The average monthly reduction in nosocomial skin tears was projected to reduce the dressing and labor costs of managing these wounds an average of $1,698 per month ($18,168.60 annually). The results of this study confirm previously reported research suggesting that the effects of implementing a comprehensive skin care protocol can persist, reducing the incidence of nosocomial skin tears and their associated risks and costs. Prospective cost-effectiveness studies to confirm these findings are needed.
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Incontinence-Associated Skin Damage in Nursing Home Residents: A Secondary Analysis of a Prospective, Multicenter Study
More than half of the nursing home population is incontinent of urine or feces, presenting challenges to perineal skin health. To determine the occurrence and severity of skin damage in nursing home residents with incontinence, a secondary analysis of data collected from a multisite, open-label, quasi-experimental study of cost and efficacy of four regimens for preventing incontinence-associated dermatitis in nursing home residents was performed. Sixteen randomly selected nursing homes from across the US were included in the study. Participating nursing home residents were incontinent of urine and/or feces and free of skin damage. Of the 1,918 persons screened, 51% (n = 981) qualified for prospective surveillance. Perineal skin was assessed over a 6-week period; frequency, type, and severity of skin damage were observed. Skin damage developed after a median of 13 (range 6 to 42) days in 45 out of 981 residents (4.6%), of which 3.4% was determined to be incontinence-associated dermatitis. Some residents (14 out of 45, 31%) had incontinence-associated dermatitis or other skin damage in more than one area. This study is one of the first to report the characteristics of incontinence-associated dermatitis in a large sample of nursing home residents. The sample size and random selection of nursing homes impart generalizability to the findings. Incontinence-associated dermatitis is a risk in nursing home residents, especially those with fecal incontinence. These findings suggest that the rate and severity of incontinence-associated dermatitis are low with close monitoring and use of a defined skin care regimen that includes a pH-balanced cleanser and moisture barrier. KEYWORDS: skin damage, dermatitis, incontinence, pressure ulcer, skin treatment, moisture barrier, nursing home
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A Three-Year Multiphase Pressure Ulcer Prevalence/Incidence Study in a Regional Referral Hospital
Pressure ulcers can have a devastating impact on health and care provision, ranging from patient discomfort and increased healthcare costs to a potential reflection on the quality of care. To evaluate the outcomes of prevention education and skin integrity interventions on the incidence of pressure ulcers, a multiphase project was initiated in an urban 154-bed regional referral community hospital in Ontario, Canada that provides care to an urban and rural population. The prevalence study included 84 adult subjects at baseline, 77 after one year (Phase 1), and 100 after 3 years (Phase 2). The Braden Scale for Predicting Pressure Sore Risk and a data collection form were used to record prevalence, incidence, stage, and location of pressure ulcers, and related documented interventions. Incidence data were obtained from patient charts and defined as ulcers that developed >24 hours following admission. Phase 1 interventions involved staff education and replacement of existing skin care products. Phase 2 interventions included adoption of pressure ulcer prevention protocols, advanced wound care products, improved support surface usage, modification of documentation methods, and staff education. Of the 84 patients assessed at baseline, 15 (17.9 %) developed 22 pressure ulcers compared to four of 77 (5.2%) during Phase 1 and two out of 100 (2.0%) during Phase 2. The difference between baseline and both subsequent time points was statistically significant (P < 0.05). These results suggest that education and the implementation of appropriate skin care products and procedures and pressure ulcer prevention protocols may reduce the incidence of hospital-acquired pressure ulcers. Keywords: pressure ulcers, nosocomial, prevention, skin care, acute care
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Skin Care: From Skin Health to Ulcer Prevention
Skin Care: From Skin Health to Ulcer Prevention Skin Matters: Skin Care: From Skin Health to Ulcer Prevention - Robert S. Kirsner, MD, PhD Skin performs a variety of functions. In short, understanding skin care is critical.2 Wound care professionals are in a unique position. Understanding the skin and skin health has a practical importance as well.
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Clinical and Cost Effectiveness of a Cleanser Protectant Lotion for Treatment of Perineal Skin Breakdown in Low-Risk Patients with Incontinence
Perineal dermatitis due to urinary and/or fecal incontinence is a common problem. A multicenter, open label, phase II product evaluation was conducted to determine the effectiveness of a new cleanser protectant lotion in reducing perineal erythema and pain in patients at low-risk for perineal dermatitis and to compare the cost of this product to standard protocols of care. Nineteen elderly patients (14 male, 5 female, mean age 73.1 years) participated in the study. Average baseline scores for erythema and pain were 2.3 (+/- 0.5) and 1.5 (+/- 1.0), respectively (scale 0 to 4). After 7 days, both scores were significantly lower (mean scores 0.6 +/- 0.8 and 0.3 +/- 0.8, respectively; P < 0.01). Based on an average of 2.6 perineal episodes per day, the one-step product evaluated would cost $136 per patient/year less than standard protocols of care while reducing caregiver time (average 23 seconds per episode of care). Optimal perineal care may reduce the incidence of complications; studies to ascertain the safety and effectiveness of commonly used products and procedures are needed.
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Managing Ichthyosis: A Case Study
Ichthyoses ? rare, genetic, incurable dermatologic diseases characterized by dry, thickened, scaling skin ? affect more than 1 million Americans and can cause devastating disfigurement with numerous physical, social, and emotional consequences. Topical treatments typically focus on symptom management. A 44-year-old man presented with severe X-linked type ichthyosis. When his condition did not improve with the use of a variety of topical and systemic treatments, a once-a-day, over-the-counter skin care regimen consisting of a surfactant-free cleanser followed by the application of moisturizer containing amino acids, vitamins, antioxidants, and methylsulfonylmethane was prescribed. After 4 weeks of using this management regimen on a test area on his left arm, the skin was clear and discomfort and itching had subsided. Subsequent application of the skin care products on other affected areas also did not cause any adverse reactions and his skin continued to improve. Symptom resolution and patient satisfaction indicate the product line may be a viable consideration for use in patients with similarly compromised skin.
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