Promoting skin health: hands-on tips for care home nurses

    When it comes to incontinence there are three all-important steps to maintaining healthy skin: keep it dry, keep it clean, and keep it protected.

    An elderly care home resident receives assistance from her nurse in the garden

    Since skincare is an essential component of nursing care, nurses can play an important role in determining the causes of incontinence and helping to prevent incontinence-related skin breakdown by initiating an effective care plan. 

    In this article we explore some of the most important factors that can interfere with the skin’s balance when it comes to continence care and personal hygiene.

    Too much or too little moisture can disturb the skin’s balance.

    Wet skin experiences greater friction against material than dry skin. Friction arises when a person is pulled in bed and not lifted, or when their torso is raised, causing a downward slide. It can also occur when a foot or elbow rubs against a resistant surface. When overhydrated, the skin may react more adversely to these sources of friction than it should. 

    Shear occurs when inner and outer layers of skin tissue are pulled horizontally in opposite directions. When the skin is moist, it can remain stuck to a resistant surface, despite the rest of the body moving, and cause a skin tear. 

    Very dry skin, on the other hand, is uncomfortable, and can lead to cracking, scaling and itching. Scratching an itch compounds the problem by further damaging the skin and disrupting the skin barrier function. Some medications and illnesses can also dry out the skin, and of course age tends to make skin more dry, scaly and rough. Some soaps, too, can impact skin pH levels by removing natural skin oils that lubricate and protect.

    An elderly resident and her nurse walk and talk in the care home garden.

    High pH and high temperatures affect microflora and skin health.

    A low skin pH keeps the skin in balance and helps maintain the important skin barrier. Friendly skin bacteria can live in a lower pH (pH 4-6), whereas pathogenic (infectious) bacteria prefer a higher pH (5). Overhydrated skin, high pH and a high temperature all increase the risk of skin damage. To maintain bacterial control and defence, it’s important that the products and care procedures we use don’t disturb the skin’s natural pH.

    Who is at a higher risk of skin damage?

    As ageing skin is often sensitive and more prone to infections, older people generally run a higher risk of skin damage. Also at risk are people with medical conditions that can impair skin health, such as diabetes, malnutrition or cognitive impairment.

    The TENA ProSkin 3-step skin health solution

    The TENA ProSkin™ 3-step skin health solution is a skincare routine and range of products specifically designed to deal with incontinence and aging skin. Would you like to know more?

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    The TENA ProSkin 3-step skin health solution

    How to prevent IAD and pressure injuries

    Prolonged contact with moisture or faecal enzymes raises the risk of developing IAD, which is an independent risk factor for the development of pressure injuries. An effective care plan starts with a daily examination of the condition of your resident’s skin. Here are four of the most important things to keep in mind:

    The number one, shown over a pair of TENA absorbent pants

    Keep the skin dry

    Establish an effective continence care and bowel management program. Toilet as often as needed to prevent urinary and faecal leakages. Remember that absorbent products are not a substitute for normal toilet use. 

    As needed, use breathable, skin-friendly, fast-absorbing incontinence products that quickly wick away liquids from the skin. Be sure to assess products carefully to ensure they match the person’s level of mobility, body size and shape, and degree of incontinence. Always fit the product correctly, as this provides comfort and dignity, and prevents leakages on clothes and linens. Change products when needed, taking special care to remove faeces-soiled products immediately, then clean the skin gently before applying a new absorbent product.

    The number two, shown over a package of TENA ProSkin Wet Wipes

    Keep the skin clean

    To prevent IAD and other skin issues in the genital area, it’s crucial to maintain the skin’s natural pH balance by avoiding moisture and heat buildup. Have a daily routine, and carefully inspect and clean the skin after each product change – especially the folds. Always use the right products and make sure the skin is dry after cleaning. 

    The surface-active agents in a wash cream are gentler to sensitive skin in the perineal area than those found in soap. They also help to preserve the pH balance. TENA no-rinse products (Wash Cream, WWG, WW and Mousse) are used to gently clean, moisturise and protect even the most delicate and fragile skin, helping maintain its important skin barrier function.

    The number three, shown over a tube of TENA ProSkin Barrier Cream

    Keep the skin protected

    Maintain a daily routine to moisturise the whole body with a lotion to keep the skin soft and smooth and prevent itching. 

    Use a barrier cream in situations when the skin needs extra protection. This will provide an extra layer on top of the skin, to protect it from excess moisture and irritants like urine and faeces. When the barrier cream is transparent you can easily assess skin condition after application. If you don’t see improvement after five days of treatment, re-evaluate your care plan and make the needed changes.

    A close view of an elderly woman’s shoulder.

    Reduce mechanical injuries

    People in care are at increased risk of friction, shear or pressure-related skin trauma. This may be the result of being moved, the body’s physical position, prolonged lack of movement, or rubbing and chafing. Try to reduce pressure on areas of your resident’s body that are susceptible, such as bony prominences and exposed areas. Interventions might include using memory foam cushions, alternating pressure air mattresses, or other pressure reduction aids. 

    Make use of mechanical aids for lifting if required. Friction, shear and pressure-related traumas are more likely to occur when over-hydrated skin comes into contact with clothing, incontinence products, or the resistant surface of a bed or chair. 

    Be very gentle when cleaning and treating the perineal area, to avoid friction. Instead of rubbing, pat the area dry, then fit the new pad gently. Make sure the resident’s incontinence product is correctly fitted and is the right size and type, with the right absorption capacity. And be sure to change it when needed.

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