How to do it ... Skin/wound care

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When it comes to the best ways to practice good skin and wound care, experts repeatedly return to a common theme, independent of one another: Practice the basics. Keep a simple routine that thrives on preventive maintenance. Do this, and the complicated or costly materials and treatments shouldn't be needed. When skin care becomes wound care, it unfortunately starts to mean "big business," and that's bad news for the resident and provider alike. Heed recommendations here to help your chances of maintaining strong, healthy skin – and keep costs down.



1. One of the first preventive steps is making sure residents are cleaned using a proper bathing process. "What defines 'proper' is the big question. I believe it means always using fresh water and soap and completely removing that from the skin's surface so there isn't any residue left that can help break down the skin," says Gregory E. Pearson, vice president – international sales for Bodyline Products International, Glendale Heights, IL. "If proper bathing is performed, it increases the repositioning that will also help prevent wounds. Sometimes we should just go back to the beginning and make the process more simple to get good results."

2. Keeping skin clean and dry is of critical importance, agrees Patricia Oatman, marketing manager for the 3M Medical Division's skin health division.
"Bathe the patient with a pH-balanced cleanser or mild soap and water," she advises. "Apply a moisturizer to skin after bathing to keep the epidermis soft and supple." Dry skin carefully, including the spaces between the toes. When incontinence is an issue, be sure to gently clean the perineum each day, and after each incontinent episode.

3. If and when a wound does occur, be sure to identify it properly – before any treatment. Visualization alone is not enough when a deep tissue injury has occurred, explains Dr. James Spahn, MC FACS, and CEO and founder of EHOB Inc.
"There is no support surface that protects the heel," Spahn adds. "A heel device must be considered if an individual is at-risk for pressure ulcers."

4. Another foot-related piece of advice: Always feel inside shoes before putting them on. Remove any loose objects that could damage skin. Stockings or socks should be clean and fit smoothly, without bulky seams.

5. Special care should be given, of course, to non-ambulatory or disabled residents. "Each sitting-dependent patient should have a wheelchair with an excellent seat cushion that is adjusted to their body and their mobility needs," Rappl said. "Just as shoes are not one-size-fits-all, so wheelchairs and seat cushions are not." Seat cushions should prevent bottoming out and promote good posture, too.

6 .Adhesive tapes and the use of dressings often are unavoidable, and can heighten the risk of skin damage. 3M's Oatman offers these bits of advice, among others, for dealing with such situations: Use breathable (porous) tapes when possible. Clip hair before tape or a barrier film is used. Use only alcohol-free barrier films to reduce the potential danger from adhesives. After applying tape without tension, smooth it gently from the center out, she adds. And also remember: Remove tape and dressings in the direction of the hair growth.

7. Returning again to the "simple" theme: Minimize layers of bedding, and keep bedding free of wrinkles, 3M's Oatman advises. A resident lying on wrinkled bedding is a magnified version of someone walking around with wrinkled socks under their feet.

8. Although the devices have become more intricate and costly, support surfaces still should be treated with a basic approach.
"Many facilities have support surface formularies complicated by too many choices," says Laurie M. Rappl, PT, CWS, clinical support manager for SpanAmerica, Greenville, SC. "Having a quality, general-purpose, static pressure redistribution mattress that addresses patients at risk for skin breakdown, a powered surface that addresses those patients working on healing a wound, and low-air-loss for those patients with excessive body sweat should cover 99% of your needs."


Mistakes to avoid
- Putting off the initial assessment for new residents.

- Failing to follow-up quickly with multiple rechecks after the initial assessment – whether there were early warning signs or not.

- Treating all residents with the same kind of support surface(s).

- Mislabeling a skin breakdown, thereby fouling even well-intended treatment.
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