One of my female residents has recently developed a fungal infection in her groin area. She is occasionally incontinent of urine, but is fully continent of bowels. She has an order for Nystatin powder, which is being applied BID. The resident is not obese, so skin folds are not an issue here.
There seems to be a big issue regarding whether or not we should apply regular barrier cream or lotion to her groin.
The staff is completely divided; there has even been bickering and name-calling regarding this (come on, REALLY??) between both CNAs AND nurses. Half of the staff believes that barrier cream should NOT be applied at all, even after incontinence episodes, because it would "create the perfect medium for further microbial growth" and that the BID Nystatin treatments are all that is necessary. The other half believes that barrier cream SHOULD be applied, because the rash would get dried out, worsen, and itch (or possibly bleed if the resident scratches). They say that barrier cream should always be applied to any reddened areas, period.
As it is right now, the resident has not been getting any barrier cream or lotion on the affected area. The resident's rash is very dried out and looks quite painful. I know that anti-fungal barrier cream does exist, but it not available in the facility. I have brought it up, but have largely been ignored.
If it were a more clear-cut problem, such as an obese resident with a fungal infection in skin folds, we would know exactly what to do. With this, however, there seems to be so many opinions as to what should or shouldn't be done.
I know this seems like such a simple issue, but you would not believe the problems it has been causing staff, let alone the resident!
