Help!! Wound disagreement

[dawn.starrett]

I am a wound care nurse in a LTC facility. I have several patients that have what I believe to be Shearing wounds to the sacral area inside of the gluteal fold. I have been treating them as such with treatment. Lately my DON has been telling me that any wound inside a fold (including inside the "crack" for better lack of terms at this point) is a yeast/fungal infection. Now I am familiar with what a fungal infection looks like, but she is changing all of my treatment orders to treat these incidents as fungal/yeast. She has even told my wound care doctor who has seen these wounds and agrees that they are shearing that we are treating them as yeast and not as he has recommended. My question is is it true that wounds in any kind of fold are yeast/fungal?

[woundnurse4u]

While it is possible to have superimposed candidiasis to an open wound to the natal cleft/gluteal fold, I would not consider every wound to this anatomical location to be candidiasis. Candidiasis has symptoms that include redness, pruritis, yeasty odor, yeasty crusting or drainage, and satellite lesions. However, you could try a combo product that includes a zinc oxide barrier with an antifungal medication (like Baza anti-fungal cream). Another possible cause is ulceration caused by inner gluteal pressure (gluteals are pulled together and pressure is not offloaded/dispersed). Those patients benefit with pressure redistribution devices to beds and chairs and proper repositioning on a routine basis.