Caregiver holding a resident's hand
Credit: Cecilie_Arcurs/E+/Getty Images Plus

The global pandemic inspired and incited nurses, aides, therapists and others to provide care on the fly. Disrupted supply chains and rigid emergency government rules forced many out of their comfort zones. But skin and incontinence still had to be tended to and cared for — and it was — the best way everyone knew how, as our experts explain.

1. The pandemic added new twists to old practices.

Caregivers who helped residents to be more mobile wound up maximizing routine skin care while promoting pressure reduction, said Briggs Healthcare LTC and senior living consultant Mary Madison, RN, RAC-CT, CDP.

To Tony Forsberg, RN, BSBA, WCC, CSPHA, Essity HMS North America’s national clinical director, the pandemic experience has been anything but routine.

“We learned that limiting cleansing and protection options helped simplify choices,” he said. “For those bathed in a bed or chair, caregivers learned it is faster, more hygienic and pleasant to use a disposable bathing glove than a bath basin, he said. Another key lesson: Use a 3-in-1 product to cleanse, moisturize and soothe.

Caregivers also learned all too well how to ward off the ravages of moisture from intertriginous dermatitis, which damages skin with heat, moisture and friction, and from increased sweating (diaphoresis) that often accompanies COVID-induced fever, said Michelle Christiansen, vice president of clinical sales for the Medline Personal Care Division.

2. Brushing up on basic incontinence care and prevention paid dividends.

Staffing shortages required temporary help, which at times led to inconsistent care and cutbacks on supply costs. One way to remain vigilant is with a regular schedule for care and toileting. Remind staff to check both every time they enter a room, Madison said.

As a back-up, Forsberg suggests switching to higher absorbency, multi-void, fully breathable products, which help when staff levels drop.

“If you reduce the average number of changes by just one in 24 hours in a community with 100 incontinent residents, you will have saved your staff 25 hours of incontinence related care per 24 hours,” he explained.

3. Revising on the fly has become the new normal.

The pandemic taught most frontline caregivers to improvise, whether it involved supplies or procedures.

Here are a few ideas:

• Replace reusable underpads and washcloths with pre-moistened disposable underpads to help limit the spread of harmful bacteria, and simplify bed set-up to save precious nursing time, said Sam Savaglio, U.S. regional marketing manager of incontinence at Cardinal Health.

• Provide flexible training during “all hands on deck” periods, said Deborah Nickelson,  RN, WCC, nurse advisor for the national clinical team at Essity.

• Save burdened staff by switching to extended wear incontinent products and placing bedside commodes in rooms so residents with mobility issues can toilet more easily, said Michele Mongillo, RN, BSN, MSN, RAC-CT, senior clinical director at  First Quality.

4. There are new ways of approaching old problems.For starters, streamline and use available tools.

Amin Setoodeh, RN, senior vice president of skin health and clinical services for Medline, suggested simplifying the care process with techniques such as patient off-loading and boosting devices that reduce the force required by the staff to log-roll patients.

Consider the high-tech value of telemedicine,too.

“The integration of telemedicine has been a key part of improving patient outcomes and providing consistent care, as the Journal of Wound Care pointed out,” said Gentell wound and product specialist Wendy Wernick, BS, RN, WOCN. “These are practices these facilities will be able to carry forward into the future, long after the pandemic is officially declared over.”

Savaglio reiterated the importance of being proactive and focusing on improving nurse morale with simplified formularies, education, right size-right fit products and reusable premium underpads to save time and improve outcomes.

Nickelson stressed how simplifying skin cleansing can improve compliance and reduce waste during acute staff shortages.

“We must simplify skin health management by building a comprehensive program that addresses skin care regimens, malnutrition, off-loading, and microclimate and wound care treatment,” Setoodeh added.