46
WOUND CARE TODAY
2015,Vol 2, No 1
FOCUS ON MOISTURE LESIONS
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Creams are applied to intact skin,
while spray foam applicators and
wipes can be applied to either intact or
broken skin. It is important to ensure
that these are applied to dry, clean
skin — if the skin is contaminated
with urine or faeces, these products
will only serve to seal them against the
skin where they will continue inflict
damage. These products should always
be applied in accordance with the
manufacturer’s instructions.
Talcum powder or creams should
not to be used underneath these
products. Whichever products are
chosen, it is important to establish
if they are compatible with any
incontinence pads being worn.
Incontinence pads can become
clogged with various products that
prevent them from adequately
absorbing and containing urine (for
example, some creams designed
for use with infants can cause
absorbency problems). However,
because many barrier products
include dimethicone (a silicone oil),
they do not have this effect.
Infection
If the skin is broken then the
possibility of infection should be
considered, particularly as the sacral/
buttock area is susceptible to
fungal infections.
Nurses should consider the
use of an anti-fungal cream for
local infections.
Candida albicans
is a common fungus that thrives
in environments such as moisture
lesions. Diagnosis of
Candida albicans
is usually made by observation rather
than skin‘scrapings’, and wound
swabs will not normally identify it.
Infection with
Candida albicans
is more likely when the patient
has other skin problems or
comorbidities. If
Candida albicans
is
identified, the nurse should wash
the skin regularly and dry it carefully
afterwards (overweight people or
their carers should be careful to dry
any skin folds). Antifungal cream
should be applied, remembering
always to wash the hands carefully
after touching an infected area and
after applying any cream.
Similarly, the alkaline nature of
normal soap raises the pH balance of
the skin when in contact with urine
and faeces, and this in turn facilitates
the growth of bacteria.
There are skin cleansers available
that can be used as an alternative to
soap, including:
i
3-in-1 preparations
i
Foams
i
Sprays
i
Wipes.
These cleansers can have a
soothing effect on the skin. It is
important that the patient and family/
carers are aware that these products
are designed for the adult skin and do
not contain alcohol. The use of baby
wipes is not recommended on adult
skin as many contain alcohol, which
has a drying effect.
After washing, the skin should be
patted and not rubbed dry as this not
only causes friction and skin damage,
but can also be very painful.
Barrier creams/films
Early identification of at-risk patients
and the use of an appropriate barrier
cream/film is important (see below).
Pain
Management of the pain associated
with moisture lesions is a top priority,
and the patient’s pain level should
be assessed using a visual analogue
scale, before appropriate analgesia
is prescribed.
The use of barrier products can
reduce the erythema by protecting
the skin and this in turn may help to
reduce the pain. The aim of a barrier
film or cream is to protect, repair,
restore or prevent skin damage
by mimicking the skin’s natural
barrier function. Barrier protection is
available as creams and films as well
as sprays, foam applicators and wipes.
CONCLUSION
It is important to classify moisture
lesions correctly. Treating them as
pressure ulcers not only results in
failure to heal, it also causes a great
deal of discomfort and distress.
The prevention of these lesions
should be the key aim, with good
holistic assessment including skin
and continence status. Nurses should
consider carefully the appropriate use
of barrier creams and incontinence
aids to ensure that they are patient-
specific. Assessments should be
revisited on a regular basis, especially
if the patient’s health changes or
drugs/treatment such as antibiotics
are administered that may affect the
patient’s continence status.
WCT
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Evans J, Stephen-Haynes J (2007)
J Wound
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Fader M, Cottenden AM, Getliffe K
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Cochrane Database Syst Rev
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Gray M, Bliss DZ, Doughty DB et al
(2007)
J Wound Ostomy Continence Nurs
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Goode PS, Burgio KL, Halli AD et al
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Maklebust J, Sieggreen M (1995)
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Nix DH (2002)
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NATVNS (2008) Available at:
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nhs.uk/MediaLibrary/
Downloads/Workstreams/
NoNeedlessSkinBreakdown/
ExcoriationTool.pdf (accessed 16 April,
2015)
Rush A (2009)
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Top tip:
Use appropriate urinary
incontinence products and/or
a faecal management system if
there is profuse diarrhoea.
