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!
This seems to me to be a matter that could easily be settled by bringing up the issue with the patient's physician. He may offer satisfying rationale for the prescription he wrote, or may change the order based upon staff concerns that are based on patient assessment.
I would think that its ok to apply a nice liberal amount of Nystatin powder and then apply barrier cream on top to help keep out excessive moisture. If you can get an order for Nystatin cream that would be great but if you can't then I would do powder and then the barrier cream on top. I would think that the barrier cream would also help keep the powder on the skin if done correctly which would allow for greater absorption.
Specializes in private-duty, hospital, LTC, clinic.
Thinking about it again...from my experience. Apply a thin layer of Nystatin creme, allow that to dry briefly, 30-40 seconds at least, fan it with your hand, then without disturbing the Nystatin...apply barrier creme on top. YES, that is what works best :)
As Morte has indicated, I believe the answer lies in the origin of the infection. However, if you cannot rule out moisture as the cause or contributing factor then by all means apply the barrier over the antifungal agent.
I vote for clotrimazole alone. Worked like gangbusters on my baby's incredibly nasty diaper rash (open sores and all) and hey, you wanna talk incontinence?
Be careful mixing 2 products together. It could be an issue....you're not a pharmacist and shouldn't be compounding ointments.
Per both our wound care nurse, who is certified, and the Aloe Vesta rep, you can mix their barrier cream products together. :) Not an Aloe Vesta rep, but I do really like their products. I just wish there was a way to keep it from coming off the pt's bottom and onto the bed pad when you roll the pt back onto their backside!
Would you use the nystatin powder into the barrier cream in skin fold areas? I'm looking for something to apply when the patient has very thin opening in skin fold area and has surrounding areas that are
Specializes in LTC,Hospice/palliative care,acute care.
Our policy prohibits mixing creams and powders. We do have an anti fungal barrier cream but for the life of me I can't remember the name of it or even the manufacturer.
Sounds like the frequency of the nystatin should be increased and the barrier cream should be applied after the nystatin. If it isn't cleared up or showing improvement then it could be something else and should be reevaluated.
Greer's Goo is the answer. It is a compounded cream containing zinc oxide, nystatin, and hydrocortisone. Used several times each day, the rash will be gone quickly.
Several people have responded with a suggestion to mix nystatin powder INTO the barrier cream. This is considered compounding and hence illegal for a nurse. Only the pharmacist should be mixing medications, etc.
calmwillow
4 Posts
This seems to me to be a matter that could easily be settled by bringing up the issue with the patient's physician. He may offer satisfying rationale for the prescription he wrote, or may change the order based upon staff concerns that are based on patient assessment.