Skin Prep QUESTION

sorlando · Feb 27, 2010

I've been a nurse for about 11 years and done wounds for about 5 years and never heard of using skin prep to 'prevent pressure sores'. The only way to prevent pressure sores is to reduce pressure. Skin prep can be used to help protect skin from moisture. I think there is a type of peri wipe that contains some skin prep for this purpose. As for the skin prep on the elbows, it may be providing a thin layer of protection against friction shear.

bell104 · Feb 27, 2010

I've been a wound care nurse only for about the past 6 months or so. When I first started at a long term care facility, I noticed a lot of skin prep being used in my facility. In my experience so far, skin prep can toughen the skin and provide a barrier against friction. I found it most beneficial on residents with boggy heels. Applying skin prep a few times a day did toughen the skin and I think prevented further breakdown to the heels. I also use it on blisters but that's it. As far as peeling bed sheets from the resident's skin, if they need the skin prep for prevention then the heels should also be elevated off the surface of the bed to reduce pressure, which would eliminate the bedsheet issue. I looked for info online regarding using skin prep for this purpose but have never come across any. If you find any let me know but in my experience it is appropriate in some situations.

SuesquatchRN, BSN, RN · Feb 27, 2010

The heels should be elevated until the skin prep dries, at the very least.

flynn126 · Apr 13, 2010

I too, wondered about the extensive use of skin prep in my LTC. My past experience, as a NA and nursing student, was that skin prep was only used to help remove tape and adhesives in dressing changes.

I was able to find a little information on an internet related to the expanded use of skin prep, sorry I don't remember where, possibly a vendor site. Some additional uses bulleted creation of a thin protective barrier, and reduce friction. The skin prep product is also sold in other forms like spray on and swabs.

StNeotser, ASN, RN · Apr 13, 2010

We also use skin prep on heels. We don't do it as much as you seem to be doing though, normally we do it when there has been a now healed pressure ulcer.

Melina · Apr 14, 2010

Liquid barrier films (I've always used 3M Cavilon No Sting) will protect intact or damaged skin from urine, feces, other body fluids, tape trauma, and friction. I use them all the time to prevent maceration around trach stomas. 3M has a ton of info on its use here. (under the "resources" tab.

E. Chester, LPN · Mar 30, 2011

Full-Time Wound care nurse for two years. Here is the way to justify "Skin prep to bilateral heels q.s." (Yes, my nurses hate it.)

F-314 states, " Based on the comprehensive assessment of a resident, the facility must ensure that a resident who enters the facility without pressure sores does not develop pressure sores unless the individual's clinical condition demonstrates that they were unavoidable; and a resident having pressure sores receives necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing."

According to Smith-Klein as seen here,

http://www.americandiabeteswholesale.com/product/smith-nephew-no-sting-skin-prep-wipes_17.htm , Skin preps reduce friction.

When utilizing the all-too-familiar Braden Scalen, most nurses believe their job is complete. In LTC however, this is only the beginning. Dr. Barbara Braden also has protocols that go along with your outcomes on the Braden Scale that MUST be implemented in a partial effort to avoid an F-314 tag. If you fail to initiate these protocols, you WILL get F-314 and probably at "widespread" level.

As we can see, even at the lowest level of risk, "At Risk - 15-18", the protocol clearly states to "manage friction and sheer". As seen above in the visible link, Skin Preps reduce friction.

Skin preps to bilateral heels Q.S. with supporting documentation of the same being done accomplishes all of the above. Two years, five surveys, and ZERO F-314 tags.

You still must manage the other co-morbidities for residents; however, this has proven to demonstrate an effort being made on the part of your facility to AVOID heel wounds, DTIs, etc.

As a side note, we utilize skin prep on DTI (without open areas), blisters (not open), and yes scabbed areas (eschar) in addition to stable eschar, and they all do exceedingly well on preps.

Again, NO F-314 TAGS or any tag with regard to wounds in five surveys.

Al.RobertsWCS · Apr 7, 2011

This note is to Nurserin. Bravo... you have it right on the nose. Using skin prep for prevention of pressure ulcers is a big joke. Of course if you go to a manufacture's website it's going to say anything to increase the sale of there products. There is nothing else for me to say. Any new comers please read the first post of this topic. I can't say it any better that she did...

Al R. CWCA

E. Chester, LPN · Apr 9, 2011

With all due respect to the WCS, I think we are missing the rationale for the use of skin prep.

It is NOT utilized for the prevention of decubiti, it is utilized to address one of the risk factors for the development of decubiti; friction.

Feel free to check the link to Dr. Braden's link on protocols associated with Braden Scales. If you do not address the risk factor, you will get tagged (F-314 at a level greater than "Isolated") (quote from a state survey team leader this year, 2011).

This is also the rationale for Granulex; it prevents fricton. http://www.webmd.com/drugs/drug-3729-Granulex+Top.aspx?drugid=3729&drugname=Granulex+Top&source=0&pagenumber=4

Al.RobertsWCS · Apr 9, 2011

Ok, First off. If you are doing an intervention to address one of the risk factors for prevention of a Pressure Ulcer (PU), then it is indeed an intervention for prevention of a PU. So I think we understand what the skin prep is trying to be used for, it's just not logical.

I can't find anywhere on the Braden Scale where it says to use skin prep for the prevention on PU's. More over, I can't find it anywhere on the internet either.

Granulux is a product to increase the rate of granulation fill-in or growth. It isn't used as a skin barrier.

The simple fact is that PU's are developed at the Hypodermis, not the Epidermis. You can put anything you want on the Epidermis and it won't prevent a PU. It's all about the Mechanism of Injury; Friction, Shearing or Pressure.

Wound Care is a very difficult and subjective area of medicine, probably the most I think.

If you think about what you are doing and putting on a wound, assessing every dressing change, you to will be successful in allowing wounds to heal. It's no different than giving medication. You shouldn't give a medicine if you don't know what it is, what it does, how it does it and why it does it. Just the same, you shouldn't put a product on a wound if you don't know what it does and what it's for. Read the packet insert, granted, there is a bit of bias on most of them but you will read what the product was manufactured for.

I don't care who orders what, if it needs something different, get your information stright and pass it to whom ever you need to to get the orders changed.

A large amount of physicians today treat wounds at a substandard level for today's Evidence Based Practice. And it's simply because they are not sure what to do about it either.

In sumation I state again; Skin prep for treatment of or prevention of a PU is a Joke.

Al Roberts CWCA

E. Chester, LPN · Apr 9, 2011

WCS or CWCA? You are entitled to your opinion.

Your argument concerning finding a treatment recommendation on the Braden scale is unfounded and illogical; Braden scale does not offer recommendations. Do you see on the Braden scale where it tells you to utilize NPWT (KCI) on a unstageable with less than 50% slough? Braden makes no recommendations for particular treatments.

We will have to agree to disagree on this one.

Granulex as evidenced by the link provided, is most assuredly utilized as a skin barrier against friction in the case of almost every admission to LTC. Maybe at Suwannee they don't do this, but this is the case in my area, but south of you we have to get this order discontinued upon admission.

I completely agree with you on the subjective nature of wound care, especially when most MDs do not know how to heal a wound. Therefore, evidence-based practice is what we have to fall back on. I have offered my rationales for my decision to utilize skin prep as a barrier to friction, not as a prevention for decubiti. The state, my MDs, medical directors, a RN-CWOC, a RN-CWS as well as a corporate wound care consultant all concur and support the use of skin prep as utilized above.

As far as pressure ulcers starting at the hypodermis; you are absolutely correct and my mentor was one of the first to utilize ultrasound to prove the same, as well as the existence of what we now call suspected deep tissue injuries (sDTI).

In the acute care setting, what do you utilize? As a side note and in all seriousness, why do all my admissions come to me with red mushy heels? Serious question.