Moisture-associated skin damage (MASD) is a common problem for wound clinicians. It connotes a spectrum of skin damage caused by inflammation and erosion (or denudation) of the epidermis resulting from prolonged exposure to various sources of moisture and potential irritants. These can include...
By Kathi Thimsen RN, MSN, WOCN
Cleansers for skin and wound care have always been a topic of much discussion. How and why do we use skin cleansers? What are the differences between skin cleansers and soap? Can you use a skin cleanser in a wound? Why not? What should you use for wound cleansing?
Skin cleansers became vogue in the late 1970s and early 1980s. During that time, patient care for perineal hygiene was basically limited to soap, water, a bedpan, and a washcloth. Patients also had considerable skin integrity alterations related to harsh cleaning with soap and the washcloth. Scrubbing the skin was the procedure.
Then came cleansing products that introduced surfactants - those “scrubbing bubbles” that lift the soil from the surface being cleaned. Surfactants are agents that reduce the surface tension between the soil and the skin. As the tension is minimized, the ease of wiping the soil away increases. No harsh scrubbing is required. The result of this approach is a significant decrease in skin breakdown. Alterations in the skin do still occur if the soiling agent (stool, urine, or emesis) is not removed thoroughly and in a timely fashion.
Skin cleansers are primarily composed of water and ingredients like surfactant/wetting agents. Antimicrobial agents may be incorporated to provide antimicrobial action, or as a preservative component.
Effectively using a skin cleanser with a surfactant is very simple. Spray the area to be cleansed with the skin cleanser. Allow it to “go to work” by covering the soiled skin surface for 30-60 seconds. Use a warm, moist, cleansing cloth to gently wipe and pat the area. Repeat this step until the soil is removed. Use a warm, moist cloth to remove any excess cleanser and pat dry. As a final step, apply a skin protectant or barrier to the area at risk (appropriate skin protectants/barriers will be discussed in an upcoming article).
Skin cleansers are NOT wound cleansers. Wound cleansers are formulated to provide a surfactant in a hydrating and mucous membrane friendly application. Skin cleansers and wound cleansers have different formulations and ingredient components. One is for use on intact or breached skin, while the other is for open wounds and cavities.
Typically, saline or purified water is the major component of a wound cleanser formulation. A surfactant may also be included in the solution to reduce surface tension holding debris (dried exudate, loose and devitalized mucous membrane) to the wound bed. Some cleansers also contain an antimicrobial agent. Like skin cleansers, this agent can be used for both antimicrobial purposes, or as a preservative component.
To use a wound cleanser, apply to the wound bed and allow the solution to “wet” the tissue for 5-10 seconds. Rinse debris with saline. Rinsing with additional wound cleanser is an option if you are using a no-rinse cleanser.
Care Tip: Using a saline or no-rinse wound cleanser to moisten or hydrate the wound is another consideration.
Regardless of the type of cleanser you are using, review the ingredient section of the product to examine for dyes, fragrance, or other irritants. Using products that contain these ingredients increases the potential for skin irritation, patient sensitivity, and reaction.
Know what's in the product you recommend and include it in any care protocol.
About The Author
Kathi Thimsen RN, MSN, WOCN is a leader in the field of wound and ostomy care, publishing articles, presenting at conferences nationally and internationally, and serving on numerous committees and education boards including the International Association of Forensic Nurses Ethic Committee.
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.