Periwound Barriers and Protectants
Recommendations
| Identify and Treat the Cause | ||
|---|---|---|
| 1 | Take a careful history and assess skin integrity in patients with risk factors for skin breakdown, including age, skin damage, incontinence, and wounds. | Level of Evidence Not Assessed |
| Address Patient-centered Concerns | ||
|---|---|---|
| 2 | Provide information and advice on prevention and treatment options. | Level of Evidence Not Assessed |
| Provide Local Care | ||
|---|---|---|
| 3 | Develop and implement an individualized strategy to maintain skin integrity, manage risk factors, and treat wounds in patients with risk factors for skin breakdown. Ensure correct use of appropriate skin barriers and protectants. | Level of Evidence Not Assessed |
| 4 | Reassess patients with an appropriate frequency, document progress, and refine strategy as necessary. | Level of Evidence Not Assessed |
| 5 | Implement appropriate management of stoma drainage and draining fistulas with assistance from specialized clinicians. | Level of Evidence Not Assessed |
| 6 | Protect skin in incontinent individuals from contact with urine or fecal material by using appropriate barriers, protectants and containment devices. | Level of Evidence Not Assessed |
| 7 | Prevent delayed wound healing, infection, and wound enlargement by maintaining wound moisture and bacterial balance and protecting periwound skin. | Level of Evidence Not Assessed |
| Provide Organizational Support | ||
|---|---|---|
| 8 | Facilitate healthcare professionals to gain relevant knowledge and skills to offer appropriate advice and information | Level of Evidence Not Assessed |
Background
Skin barriers and protectants are an important component of routine skin care for patients with incontinence, chronic wounds, ostomies, and fistulas. Repetitive exposure of healthy skin to moisture, irritants and trauma from adhesive tape and appliances weakens the normal skin barrier, threatening skin integrity. Barriers and protectants can assist in both maintaining skin integrity and in treating periwound skin breakdown.A skin barrier is defined as a permanent interface between two surfaces that protects the integrity of the skin, whereas a protectant is defined as an indirect temporary technique or application to maintain the integrity of skin at high risk of breakdown.
Skin barriers include the following products:
• Ostomy skin barrier systems: These systems create a secure protective barrier between the skin under the wafer barrier and the urine or fecal material discharged into the pouch. Wafer barriers are available in flat or convex styles, and they may be rigid or flexible. Some wafers have an adhesive backing and/or a tape perimeter. Barrier paste may be used to ‘caulk’ gaps and surface irregularities between the barrier and the skin. Barrier liquid, wipes, and powder protect the skin under the wafer and increase barrier adhesion.
• Ointments and creams: Disadvantages of these products include user variation in application techniques and amounts, potential allergen content, and the need for frequent reapplication.
o Zinc oxide preparations, although effective, easily available and inexpensive, have several disadvantages, including the chance of bacterial contamination; the stiff texture, which may interfere with topical treatments, clog containment devices and generate enough friction to damage skin when repeatedly removed and reapplied; and the inability of caregivers to see the skin.
o Petrolatum-based ointments perform in a similar way to zinc oxide preparations, except that they may melt and wash off easily.
o Silicone-based creams are more expensive than ointments and more resistant to wash off. They also generate less friction, and their transparency allows good skin visualization.
• Film-forming barriers (barrier films or skin sealants): These products differ considerably in composition and performance, but contain a protective polymer dissolved in a fast-drying carrier. Barrier films form a transparent, flexible, durable, moisture-repellant protective film that does not interfere with adhesive dressings or containment devices. They appear to have a low sensitization rate and are resistant to wash off.
• Adhesive dressings: Films and thin hydrocolloids serve both as dressings and skin barriers, when applied using a window-framing technique. These dressings do not require frequent changes and allow easy skin visualization. However, the dressing edge may lift and trap exudate or allow bacterial proliferation. Allergies are also possible.
Various types of skin protectants are available.
• Fluid managers: These comprise absorbent dressings and briefs and containment devices, such as ostomy pouch systems. Fluid managers remove effluent, including wound exudate, urine and fecal material, from the skin surface. Briefs, calcium alginates and hydrofibres bind fluid within their structure. Absorbent foams, which do not lock in fluids, may be associated with skin damage. The large variety of containment devices available allows product selection to be tailored to patient needs.
• Skin cleansers: These surfactant-based products remove debris from intact skin better than water or saline. However, they alter skin pH and dehydrate skin, and many cause sensitization. To avoid damaging the skin, these products should be used only when necessary and rarely on wounds.
• Moisturizers: Moisturizers are applied to intact skin to preserve skin barrier function and are best applied when the skin is damp, to trap moisture in the skin. Routine moisturizer use is essential to maintain skin integrity in patients with fragile aged skin. Hydrating agents, such as lactic acid or urea, bind moisture in the stratum corneum. Emollient creams contain lubricants, such as lanolin, which have high moisture retention properties. Many moisturizers contain allergens and chemical irritants, including stablizers, preservatives, emulsifiers, perfumes, and lanolins.
References
| Essential Publications |
|---|
| 1 | Topical skin care |
Quality Indicator
|
Type: Systematic review |
| Hodgkinson B, Nay R, Wilson J (2007) A systematic review of topical skin care in aged care facilities. Journal of Clinical Nursing 16, 129-136. | |||
| This systematic review of systematic reviews, RCTs, and non-randomized controlled studies was conducted to determine the effectiveness of topical skin care interventions for residents of aged care facilities by examining the incidence of adverse skin conditions such as rash, skin irritation, haematoma or tears, and by patient satisfaction. Since the interventions and outcomes measured in the studies varied, the results were not combined but one or more individual studies were reported. | |||