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 Kathi Thimsen RN, MSN, WOCN
Skin protectants and moisture barrier products serve two purposes in patient care: first is to protect the skin from harmful stimuli (incontinence, wound drainage, saliva, gastric juices, etc.); second is to create a barrier between the skin and the environment. It is amazing that one product and basically one classification of ingredient can get the job done!
A barrier ingredient creates a moisture retentive action, decreasing the loss of water from the body (through the skin) or trans-epidermal water loss (TEWL). The ability of a product and the ingredient components to reduce moisture loss and provide protection is accomplished with a variety of natural or synthetic agents.
Typically, a barrier or protectant product will be developed and manufactured in compliance with a drug (over the counter) monograph that is published in the Federal Register and the US Pharmacopeia. The monograph directs product formulators to use a specific ingredient included in the monograph (in this case, skin protectants) and in the concentrations that have been previously studied to be safe and effective within a specific range.
Commonly used barrier or protectant ingredients in skin care products include, but are not limited to: petrolatum and zinc oxide. The ingredient(s) may also be used in combination to further enhance the protectant/barrier performance.
Petrolatum and mineral oil are naturally derived petrochemicals. Yes, these are derived directly from petroleum. This is why clinicians should understand product ingredients and quality. Petrolatum has more than a dozen levels of quality and purity. One end of the spectrum is motor oil. The polar product is a watery, thin, odorless and transparent liquid. The latter ingredient is thin, colorless, odorless, very refined and likely free of impurities associated with petroleum.
A medicament used for perineal excoriation (not intended for human use, rather for cow or other animal utters, etc.) uses a low grade of petrolatum. Look at the product: does it have a scent? Does it feel smooth, or does it have a grainy texture? Can you see through it or is it opaque? If the product has an odor, is grainy, or is opaque, then it may contain impurities, irritants and possibly toxins. If used on intact and non-traumatized skin, it may be without incident. Are your patients healthy, non-compromised and hydrated, and have intact skin? If your patients are like those of most wound care providers’, they are fragile, compromised, under-nourished, under-hydrated, and have very friable and thin skin. All of the patient issues enhance the potential for skin irritation and sensitivity along with potential for ingredient absorption and systemic penetration.
Our next topic will continue to discuss skin and wound care ingredients with a look to ingredients from nature and sources of animal or plant.
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 [publication name], Kestrel Health Information, Inc., its affiliates, or subsidiary companies.