Would you apply regular barrier cream to a resident with a fungal infection?

[CoffeemateCNA]

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!

Would you apply barrier cream or let it be?

[nsgmjr]

where i work we use sensicare and nystatin by mixing the two together and then applying. Seems to work

[tonebudsid]

Well, if the resident is ambulatory and does not spend a lot of time on her buttocks, then you could leave out barrier cream. If she is OCCASIONALLY incontinent, then regular incontinence care should be good enough to prevent excoriation to the buttocks....so if the fungal infection is specifically in the peri-area, then apply nystatin. Once the fungal infection is gone, then barrier cream should be applied after an incontinent episode. Well, I hope you guys find a way to agree on it. Good Luck!! :)

[mandyc]

I have not had great luck with just barrier cream...Nystatin seems to work the best.

[catshowlady]

Aloe Vesta makes an anti-fungal barrier cream. It is the thinner barrier cream, the one used on intact skin. If I have open skin and the surrounding areas are affected, I mix the thicker barrier cream with the thinner anti-fungal cream.

You could also do as a PP suggested and mix the nystatin powder into the barrier cream. I have done this also, with both nystatin cream and nystatin powder.

:paw:

[wooh, BSN, RN]

Our facility's policy is to apply the antifungal powder, then apply the appropriate barrier cream over that. Seems to work.

[BillyMae]

Use Nystatin creme.

[Penelope_Pitstop, BSN, RN]

Can you see if there is a way to change the order to Nystatin cream rather than Nystatin powder? (And change it to BID and PRN)?

[KyPinkRN]

At my hospital we simply applied the anti-fungal powder and then barrier cream on top of it. The order was usually written BID and PRN (as in whenever the patient was incontinent). We were quite liberal with the anti-fungal powder and usually this would clear things up before the patient was discharged.

[morte, LPN, LVN]

I would be curious why she has developed a fungal infection......has it been dx/looked at by a doc? or is this a chemical burn from urine? Has she developed undx diabetes?...and as far as looking dried out, isnt that what you want? Many, not all, fungii like moisture.....

[CoffeemateCNA]

Thanks for the great responses, everyone.

Just to clarify, I was referring to applying barrier cream in addition to (not instead of) the Nystatin. Right now the Nystatin is being applied when the resident rises in the AM and when she gets in bed in the PM. I was wondering if the barrier cream could be applied in with and in between Nystatin applications during the day, because the Nystatin seems to be "gone" from her skin within a few hours.

I will check and see if the order is only BID or if it is also PRN. I really hope it is already PRN, because the BID application seems to be insufficient.

I really like the idea of mixing the powder with barrier cream or lotion. I will suggest this.

I'm not exactly sure why she has a fungal infxn in the first place. No Hx or s/s of DM. This appeared last week while I was working on a different assignment. I have a strong suspicion her aides were providing less-than-exemplary/non-existent peri care.

I'm sure this resident is as confused as can be. When she requests barrier cream for it, one group pounces on her, telling her it will make it worse. When she refuses barrier cream because of it, the other group pounces on her, telling her it will make it worse. Now she's afraid to do anything for it. It's enough to make your head spin.

[Zaphod, BSN, RN]

Both. Bareer cream is just that-bareer to moisture. The reason she has fungal rash is because of the moisture. Apply Nystatin first then bareer the area so when she is incontinent the skin is protected.