Breaking Down Skin Breakdown
Skin breakdown occurs when skin integrity is compromised, leading to damage of the skin or underlying tissue. This can result from one or more major risk factors: prolonged pressure on the skin, friction, shear and excessive moisture.
Damage to the skin can lead to complicated wounds, including skin tears and pressure injuries, which are painful and costly. Ensuring the health and well-being of your patients and residents takes a holistic approach that considers various risk factors and combines appropriate skin care products and practices.
Effective prevention addresses all risk factors with the right tools and strategies. As National Pressure Injury Advisory Panel authors note, “The outcome for an at-risk individual can often be altered by carefully selecting and consistently implementing risk-based prevention strategies.”1
5 key strategies for skin breakdown prevention
1. Perform comprehensive skin assessments
Regular skin assessments are crucial for early detection of potential skin breakdown. Healthcare providers should conduct thorough skin checks upon admission and every shift to continue to monitor high risk areas, such as bony prominences (sacrum, heels, elbows) and areas under medical devices. Documenting these assessments helps track changes and adjust care plans accordingly.
2. Maintain an effective skin care routine
When it comes to reducing the likelihood of skin breakdown, it’s important to keep skin healthy with a comprehensive skin care routine using clinically proven ingredients.
3. Relieve pressure with proper repositioning and offloading
Pressure injuries occur when prolonged pressure impedes blood flow to the skin, leading to tissue damage. To help avoid this, regularly turn and reposition patients to alleviate pressure on vulnerable areas. This is especially important for bedridden or immobile patients. The length of time it might take for a pressure injury to develop varies, but it can be as little as four hours.2
4. Ensure nutritional needs are met to aid wound healing
Malnourished patients are four times more likely to develop a pressure injury than people with adequate nutrition.3 When patients are malnourished—either under or over—it could be due to a number of factors, including depression. While a registered dietitian may be called in for consultation on dietary requirements, be aware of changes in a patient’s attitude toward eating, so you can consider specially formulated supplements to help provide missing nutrition. High-protein oral nutritional supplements can reduce the incidence of pressure ulcers by 25% in patients at risk.4
5. Educate your team and patients on skin breakdown
Help frontline staff feel confident in providing care to prevent skin breakdown, and educate patients on the importance of adhering to treatment plans. This includes understanding the risk factors and recognizing early signs of pressure injuries and knowing the best practices to follow. One way to empower your staff is to create a Skin Champion team. A Skin Champion team also helps you standardize best practices, which help meet the needs of the patient and your facility goals.
A holistic approach that considers all aspects of a patient’s care is essential for maintaining skin integrity and preventing skin breakdown. It starts with conducting a comprehensive skin assessment, and includes effective skin care, the right turning and repositioning strategies, proper support surfaces, adequate nutrition, and education for both staff and patients.
Take these steps to help protect fragile and at-risk skin:
1. Cleanse skin with gentle cleanser.
As part of an overall skin care routine, a pH-balanced no-rinse foam cleanser has been shown to reduce risk of skin breakdown. Cleanse skin promptly after episodes of incontinence.
2. Moisturize skin with nutrient-rich moisturizer.
Look for ingredients such as dimethicone and natural emollients, including safflower oleosomes that help restore skin’s natural moisture balance and barrier properties. Avoid irritating chemicals such as parabens. Ideally, moisturize twice a day with 1 ounce per application.
3. Protect skin and prevent moisture loss, while keeping valuable moisture in with a silicone barrier cream.
Routinely monitor areas of the skin where there’s moisture and warmth that can be at risk for moisture-associated skin damage.
4. Soothe skin exposed to excessive moisture.
A skin protectant containing petrolatum and zinc can help dry, light exudate. For painful, irritated skin, zinc cream with added menthol offers temporary relief.