'On the wagon'

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'On the wagon'
'On the wagon'
Skin care products have gained increasing importance in long-term care as providers search for ways to keep incontinent residents comfortable and prevent decubitus ulcers from forming.

Manufacturers are trying to be as accommodating as possible to meet the demand, launching a plethora of new products designed for optimum efficacy and protection.

In looking at the trends appearing in skin care products, the consensus of providers and vendors alike seems to be: alcohol, “no,” but grapefruit, “yes.” While there is not a complete prohibition on alcohol in skin care products, long-term care clinicians are showing a preference for lotions, creams and gels that exclude it.

“Products with alcohol tend to dry the resident's skin, which in many cases is already frail. Therefore, the use of alcohol solutions is typically frowned upon,” says J. Hudson Garrett Jr., Ph.D., senior director of clinical affairs for PDI Healthcare. “Yet, there are certainly certain barrier creams and ointments that have value, especially in the prevention of decubitus ulcerations.”

Wound care nurse Diane Heasley, RN, confirms that among clinicians, “alcohol is a big no-no,” as are petroleum bases because they don't allow the skin to breathe. Instead, fast-absorbing, aesthetically pleasing ingredients with water and humectant bases are preferable because they synergize the skin's natural balance, says Heasley, who is president of Caring Directions.

“There are wonderful skin cream washes that also incorporate dimethicone to trap moisture, maintain an acid pH and provide ease of fecal and urine removal,” she says. “Certain scents — baby powder and grapefruit, for example — have led the way in pleasing the olfactory senses because they both are clean scents.”

Heasley believes that the number of skin care products available has tripled since she started in the field 18 years ago. She figures that the number of products out there is now around 15,000. While a greater variety gives the clinician more options in skin care, it also can make decision-making more difficult, she says.

“Everyone has ‘the best and the greatest,'” she explains. “At the end of the day, it really comes down to two questions: ‘How dry is the skin? And can I tolerate any greasy feel?'”

Garrett agrees that the growth in choices presents a dilemma for product users.

“This increased number of products can lead to confusion among healthcare providers, particularly those at facilities without a dedicated wound care specialist on staff,” he says. “It is critical to fully evaluate every product label and efficacy claim and to evaluate every product before a full house implementation.”

Although there are more companies offering products for skin care than in the past, the selection remains largely unchanged, said Cheryl Smith, manager of washroom products for SCA's Tork division.

“More so than anything, we are seeing a broader range of systems and delivery methods,” she says. “In fact, we've found that while various options and the overall breadth of product available has increased, the same basic refill offerings are used in many facilities. Products that are tried and proven still make up a majority of the volume.”

Going green
Environmental consciousness has been strong in healthcare for several years, evidenced by the growing influence of groups such as Practice Greenhealth. The “green” movement has many in the healthcare supply chain looking at products, practices and packaging for ways to reduce the industry's impact on the environment.

As a manufacturer, SCA Tork is responding to a strong demand for green skin care products from its customers, Smith says.

“More often than not, customers are buying a product that has been third-party certified, doesn't use additives harmful to the environment and reduces the use of fragrances or dyes in an effort to reduce the overall environmental impact,” she says. “We've found that customers are much more open and aware of green options and may buy based on ‘green' qualities.”

Group guides purchases
Practice Greenhealth is a consortium of healthcare providers, manufacturers and affiliated service firms. Last fall, the group purchasing organizations coalesced on the release of the Standardized Environmental Questions for Medical Products, a guide to help healthcare providers identify, request and purchase environmentally preferable medical products. It includes questions about chemicals of concern, recyclability and other environmental issues.

Susan Vickers, vice president of community health for Catholic Healthcare West, says the guide serves as a useful tool for providers who want to find environmentally safe products.

“The search for alternative products is often difficult because of limited supply and little knowledge about product makeup,” she says. “If manufacturers now know they will be asked about product sustainability, we feel they will become better informed and more responsive to requests for safer, more sustainable products.”

While alcohol has fallen out of favor in many skin care products, other ingredients have gained popularity. To create lotions, creams and gels that soothe, moisturize, nourish and protect sensitive skin, manufacturers are incorporating more therapeutic and aesthetic properties into their products.

For instance, McKesson Medical-Surgical has introduced its THERA brand of advanced skin therapy, which includes a proprietary blend of vitamins and minerals. They also have safflower seed oil, which is a lubricant; ginger root extract, which may decrease inflammation in the skin; and lavender ylang, which provides a floral fragrance. The product line also includes antimicrobial foaming and moisturizing body cleanser, dimethicone and calazinc body shield, moisturizing body cream and antifungal body powder.

Board-certified wound ostomy continence nurse Mary Petersen, RN, provides clinical oversight of the skin care line for McKesson and says the products meet her high standard of performance. Petersen has worked as a wound, ostomy, continence nurse around the greater Minneapolis area for more than 20 years.

“I have provided care at the bedside to patients with fragile and compromised skin in the home, hospice and acute care settings,” she says. “All of the THERA products are scientifically formulated to aid in soothing and nourishing the skin while providing clinicians with an optimal skin care system for their patients.”

Tony Forsberg, product director for SCA's TENA division, says scent plays a major role in skin care products and pointed to a recent study that involved the company.

“When asked if scent was important, most participants noted that it wasn't, as long as the product worked and did not include an offensive odor,” he says. “However, when presented with a choice of products, we found that a great number of participants chose products with a scent that they rated as more pleasing to them.”

Other therapeutic ingredients such as antibiotics can be critical to skin healing, but should be used with great care, Garrett says.

“Antibiotics have an important role to play in tissue healing — comorbidities such as diabetes or peripheral vascular disease can cause tissue perfusion, which can lead to a decreased ability to heal,” he says. “But the use of systemic antibiotic therapy is not typically recommended unless absolutely necessary because of the high risk for antimicrobial resistance and development of clostridium difficile in residents.”

Smith concurs that antibiotics and antimicrobials can be important factors for providers concerned about cross-contamination and the spread of bacteria. She also maintains that hand washing is the best defense against the spread of infection and recommends that hand-washing products, such as sanitizers, be readily available throughout the facility.

All providers want to make sure they keep harmful germs and diseases away from residents, she notes.

“What we have found, through our research, is infection control and buyers care more about the efficacy of the product rather than the specific active ingredients,” she says. “Instead of a list of ingredients, they require the necessary data to support kill claims and demonstrate that using the product will effectively protect against various bacteria and viruses.”
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