Skin Health in Critical Care

 

Keeping your skin healthy in critical care

In elderly patients, the risk of skin damage is likely to be high or increase in any healthcare setting, and with an increasingly ageing population, keeping patients’ skin healthy is a major challenge for all health professionals (Mark Collier, 2016)1.

The effects of ageing on the skin include decreased collagen and elastin replacement, resulting in the skin becoming slack or loose. There is also thinning of the epidermis (surface layer of the skin), which, along with a flattening of the dermal-epidermal ridge, causes skin to be more fragile. In addition, a decrease in the number and function of sweat glands and the occurrence of sebaceous gland hyperplasia result in reduced sebum production. This contributes to lowered levels of skin moisture. An increase in transepidermal water loss, which causes ageing skin to be dry, may exacerbate this (Kaminar and Gilchrist, 1995).

Therefore, it is important to note that all of these effects of ageing on the skin make it more susceptible to injury. Nearly 80 per cent of critical care patients are over 50 years old2, which, combined with other challenges like prolonged immobility, pressure, friction and moisture, increases the risk of skin breakdown. For this reason, a simple and effective skin health-centric strategy is essential.

 

Medline offers a simple, 3-step solution

STEP 1 – Cleanse the skin

Cleanse the skin thoroughly to remove all irritants, including bodily fluids. When exposed to urine and/or faeces, the skin’s pH changes, and this causes an increase in permeability and a reduction in the natural barrier function. Cleansing the skin also ensures the natural function of the skin is maintained (Wounds UK Best Practice statement, 2012).

Following cleansing, ensure the skin is completely dry.


STEP 2 – Keep excess moisture away from the skin

Where there is the risk of exposure of the patient’s skin to excessive moisture and fluids, place an appropriately sized Ultrasorbs Drypad under their body.  This will absorb and wick away the moisture, helping to keep the skin dry.


STEP 3 – Protect and moisturise the skin

Apply a moisturising barrier cream and/or film to moisturise and protect vulnerable skin, creating a physical barrier and minimising exposure to irritants and excessive moisture, such as bodily fluids.

Good nutrition and hydration

Ensuring patients maintain a healthy weight and good fluid intake helps protect the integrity of their skin. They should have a balanced diet and an intake of 6 – 8 glasses of water per day. Poor nutrition and hydration below the recommended level greatly influence all wound healing by hindering tissue and skin repair.

 


References
1. Collier Mark (2016). Protecting Vulnerable skin from moisture associated skin damage, British Journal of Nursing, 25, No 20: Tissue Viability Supplement1. Collier Mark (2016). Protecting Vulnerable skin from moisture associated skin damage, British Journal of Nursing, 25, No 20: Tissue Viability Supplement
2. NHS Hospital Episode Statistics (HES) data, 2017-18