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Closing the Evidence-Based Gap in Skin Care

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Closing the Evidence-Based Gap in Skin Care

  As clinicians in skin and wound care, we are constantly challenged to practice from a solid evidence base where “evidence-based practice” (EBP) represents the integration of evidence with clinical expertise.   Skin care is a clinical area where, traditionally, we have had an EBP gap. Skin is vulnerable to damage from moisture, chemical irritants, and mechanical damage from friction and adhesives. Patients expect, and regulations require, that skin breakdown risk is identified and that effective strategies for prevention and management are created. This includes protection from adhesive trauma, periwound maceration, incontinence-associated dermatitis, friction from bony prominences, and a host of other challenges to skin integrity.   For years, clinicians have relied on moisture barrier creams and ointments to protect vulnerable skin from injury. Despite problems with application and removal, and the fact that most are not suitable for use with adhesives, they do offer skin protection to varying degrees and their use is widespread. However, there has been an EBP Gap. Clinicians use these creams largely based on tradition rather than evidence of efficacy—relying instead on formulation principles and anecdotal information.   What can be done about that EBP Gap?   The use of barrier films—liquids applied to the skin that form a thin, transparent protective polymer coating—originated in ostomy care. Early formulations were comprised exclusively of copolymers dissolved in alcohol as a solvent. While they enabled adhesion, they caused patient discomfort if skin was compromised, largely limiting their use. The first alcohol-free terpolymer-based barrier film entered the market in the early 1990s. Clinicians expressed immediate interest in this product because it could be used on damaged skin without discomfort. Its clinical use rapidly expanded beyond ostomy care to include other significant skin protection needs.   3M conducted an extensive literature search in medical databases and discovered more than 60 citations specific to this unique barrier film. The papers were reviewed for applicability and consistency with the product’s indicated uses. After evaluating the data, the authors concluded that indeed, there is extensive clinical evidence for this barrier film.   The conclusion— use of an alcohol-free terpolymer-based barrier film is clinically suited to prevent and/or treat a variety of common and important skin damage problems. What’s more, there is a significant body of evidence demonstrating this product’s clinical efficacy as well as cost-effectiveness. Key studies are summarized here: www.3M.com/Cavilon/Evidence. Debra Thayer, MS, RN, CWOCN Sr. Technical Service Specialist 3M Skin & Wound Care Division