Skin breakdown is a common problem amongst individuals, particularly seniors, receiving regular care. Immobility, incontinence, and other health conditions can lead to excessive skin breakdown, and increased risk for poor skin health. The following is a look at some of the causes of skin breakdown, and what caregivers can do to help prevent it:
1. Pressure: Pressure sores are particularly common in those that are bed ridden, in wheel chairs, or immobile in some way. They are the result of a compression of soft tissues between a bony prominence and an external surface (bed, chair). Sometimes, when an individual remains in the same position too long, the external pressure exceeds the capillary's ability to manage it, and the blood supply reduces or is cut off, so blood does not get to the muscles and skin tissue as needed, and breakdown of the tissue occurs. If the individual has any additional medical conditions, such as incontinence, this can happen far more rapidly as the skin may already be compromised due to urine, stool, or excessive moisture.
Caregivers can help to prevent pressure sores and skin breakdown due to pressure from occurring by changing the individual's position at least every two hours, but cleaning, moisturizing, and protecting the skin, and by helping reduce pressure with pillows, cushions, and the like.
2. Moisture: Over-hydrates skin often results in maceration. When skin experiences maceration, it has a lowered resistance to skin breakdown. Things like pressure, and friction, can and will be a lot harder on the skin, and breakdown occurs more rapidly.
Caregivers can help to avoid breakdown caused by excessive moisture by choosing the right incontinence products and changing them frequently. In addition, a skin protectant, moisture barrier should be used to help protect the skin.
3. Shear: Shear occurs when a patient slides in a bed or chair, and the skin stays stationary, but the underlying tissue shifts. This can lead to the capillaries stretching and tearing, and reduced blood flow. When the skin does not get the blood flow it needs, it breaks down more quickly.
Caregivers can help to prevent shear by helping individuals move, not by sliding, but by lifting and setting back down. They can also help the skin to be stronger through cleaning, moisturizing, and protecting it with ointments, regularly.
4. Friction: Frictional damage is a common cause of skin breakdown for incontinent and immobile. It is when the skin is pulled across a coarse surface. This can be an absorbent product, a washcloth or rag, a bed linen, etc. When an individual needs frequent changing and washing, for example, the skin's outer layer can be rubbed away, exposing the moist under layers, and allowing bacteria to enter and breakdown the skin.
Caregivers can help to prevent frictional damage by using a no-rinse cleanser between changes. By finding the right size and fit for incontinence products, and by reducing the amount of friction the skin experiences with more careful moving and care. Patting an area dry, for example, is a better option that rubbing it dry.
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