by Susan Cleveland, BSN, RN, WCC, CDP, NADONA Board Secretary
Part 2 in a two-part series looking at the basics of preventing and managing moisture-associated skin damage in the long-term care setting. For Part 1,...
By Aletha Tippett MD
The other day I received a phone call from a dear physician friend of mine who works tirelessly in the field of pressure support and pressure ulcer prevention. He had been talking to some older nurses who told him that "in their day" they kept their patients lubed up and never had a skin problem. He knows that I advocate vigorous skin lubrication and sought guidance.
I reminded my friend that dry skin is like graffiti. If you see dry skin, there are problems lurking. Always, when I have seen dry skin, within the week there would be a new pressure ulcer. The legs and feet are particularly prone and need to be lubricated every day. I always tell my patients "if I can't hold on to you, then neither can the surface to create a wound."
If skin is dry, there is more friction, with more incidence of skin erosion and skin ulceration. Tissues subjected to friction are more susceptible to pressure ulcer damage. Friction against the skin contributes to the development of shear stresses. Shear stress and pressure combine to produce the damage and ischemia of the skin and deeper tissues that results in pressure ulcers. Dry skin also has less elasticity and is more prone to tearing from pulling injuries such as in turning and repositioning. Patients at risk from increased friction include elderly, those with uncontrollable movements such as spasticity, and those who use braces or appliances that rub against the skin.
Skin lubrication helps prevent skin injury and pressure ulcers, but it needs to be combined with the proper pressure support to definitively prevent pressure ulcers. Also, skin lubrication must be done consistently, not just one time or occasionally. It needs to be done every day. In my recent phone conversation, my physician friend also wanted to know what I use for skin care on my patients. I told him my first choice was Bag Balm® and have used that for years with great success. However, there are some facilities that will not use Bag Balm, so in that case I order A&D® ointment. It works almost as well.
The old-timers remember applying skin lubrication daily and that's what we should all be doing. If you are lubricating the skin you can simultaneously be inspecting the skin, and you will also be repositioning your patient, so it's really a three-in-one preventative. Skin lubrication is usually left off in a list of things to do to prevent pressure ulcers, but please add it to your "must do" list.
Two resources that might be helpful:
Hess, Cathy. Did you know? The Difference between Friction and Shear. Advances in Skin & Wound Care: June 2004, Vol 17, Issue 5, p. 222
International review, a consensus document. Pressure Ulcer Prevention: pressure, shear, friction and microclimate in context. Lisa MacGregor, Editor. Wounds International, Enterprise House, London, UK. 2010
About The Author
Aletha Tippett MD is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, family physician, and international speaker on wound care.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.