Protection
Maintaining skin integrity
There are three steps that help keep skin from becoming damaged1 1. Cleanse properly 2. Protect skin from becoming too moist 3. Keep skin from becoming too dry
In a patient who is incontinent, excess moisture comes from several sources, including urine, liquid stool, and sweat (when using a pad or brief). The risk of skin damage depends on how much and how often incontinence occurs and whether the use of a pad or brief keeps waste material next to the surrounding skin. Moisture that remains on the skin will sink in and soften the skin. The skin then loses its natural ability to act as a barrier, and can no longer protect itself against irritation from urine or feces.2
Topical agents may be used to protect the skin from the damaging effects of too much moisture.4 In a study at a clinical research facility, petrolatum was shown to be effective in protecting the skin from softening.4
It is important to remember that the skin must always be protected. If irritating moisture is allowed to come in contact with the skin, it can result in dermatitis. The symptoms of dermatitis include perineal redness, swelling, or blistering. The exact cause of perineal dermatitis is unclear. However, skin that is too moist allows irritating substances and bacteria to enter the skin. Also, skin that is too moist can easily become damaged.2
Also, areas subject to friction are more likely to experience skin breakdown. Potential damage can be minimized when a plan of care is put into place to identify and protect these areas. Some at-risk areas include: heels, buttocks, base of the spine, elbows, and the two rough knobs on the upper part of the thigh bone.1 Special dressings, called hydrocolloid dressings (a substance that forms a gel when mixed with water), may be put into place on the skin to help lessen the effects of friction.5
References [+]
- Revis DR, Caffee HH. Pressure ulcers, nonsurgical treatment and principles. February 14, 2006. eMedicine Web site. http://www.emedicine.com. Accessed October 15, 2007.
- Gray M, Ratliff C, Donovan A. Perineal skin care for the incontinent patient. Adv Skin Wound Care. 2002 Jul/Aug;15[4]:170-178.
- Clinical Practice Guideline Number 3: Pressure Ulcers in Adults: Prediction and Prevention. Rockville, Md: US Dept of Health and Human Services, Agency for Health Care Policy and Research; 1992. AHCPR publication 92-0047.
- Hoggarth A, Waring M, Alexander J, Greenwood A, Callaghan T. A controlled, three-part trial to investigate the barrier function and skin hydration properties of six skin protectants. Ostomy Wound Manage. 2005 Dec;51(12):30-42.
- Bryant RA, Clark RAF. Skin pathology and types of damage. In: Bryant RA, Nix DP. Acute & Chronic Wounds: Current Management Concepts. 3rd ed. St Louis, Mo: Mosby, Inc; 2007:100-109.