Good skin care and incontinence

Hello. My name is Jan Rice and I’m a wound nurse consultant. having looked after people with wound and skin problems for over 35 years. Skin is the largest organ of the body. Undamaged skin helps to protect the body against bacteria and is part of the general immune system, keeping you healthy. If skin is damaged in any way then bacteria and organisms may enter and cause you to feel unwell. This short video is designed to help you understand the importance of skin care, particularly when there is a bladder or bowel leakage problem. I will also touch on the ways to manage the skin to ensure that it is working to fight infection and keep the person you are caring for as healthy as possible. Skin is made up of 3 layers. The epidermis which is the top layer providing protection from the external factors. The dermis, which is the second layer containing blood vessel, lymph capillaries, sensory nerve endings, sweat glands and hair follicles. The collagen in this layer provides the skin with its strength and elasticity. The subcutaneous layer, which is the deepest layer made up of connective tissue and fat. Skin changes are related to a number of factors and these may include environment, including sun exposure, genetic makeup, nutrition, age and incontinence, which I will focus on for the purpose of this video. The urea and ammonia in urine can affect the pH balance of the skin, causing it to become too alkaline. Water in the urine softens the skin so the skin is easily burnt. Diarrhoea is equally as damaging as the enzymes have not been absorbed and these also burn the skin. Perspiration can also add to the risk of irritation and painful skin breakdown. The skin areas at greatest risk are around the anus, the back passage, the genitals and between the buttocks and the inner thighs. Damp, warm skin is unfortunately a good place for bacteria and fungal infections and urinary tract infections. Episodes of bladder leakage or faecal incontinence, that is soiling, can cause inflammation of the skin surface, resulting in: redness, pain and itchiness and sometimes swelling or dryness, blisters, flaking. The damaged skin is vulnerable to infection. Ageing skin needs careful daily attention. Generally it’s much more open to skin problems and is even more fragile than a baby’s skin. This is because of the higher likelihood of medication use, illness, lower fluid intake, and poorer nutrition on older age groups. The thinner epidermal layer, that is the top layer, of the ageing skin is more prone to damage by friction, that is rubbing, and pressure. Also ageing skin is less likely to heal because the cells of older skin multiple slower, particularly if the diet is poor. Young people can change over their skin cells every 28 days but for older people this can take 40 days or more. As we age or have some reason for sensitive, fragile skin the vulnerability to damage occurs easily. Skin must be supple and elastic. Good care involves cleansing gently with a pH balanced cleanser, preferably not soap but rather a soap alternative. Liquid soap cleansers are less damaging to the skin than a bar of soap and the pH of the skin means it is compatible with the acid mantle of the skin which is part of the protect barrier. When soap is overused, the acid mantle of skin is removed and exposes the skin to damage. Once the skin has been cleansed, it should be gently dried. A course towel and rubbing firmly to dry is not recommended but rather gently patting the skin dry is kinder to the fragile and ageing skin. The most important step of moisturising comes next. Use a pH balanced, perfume free good quality moisturiser. There are many moisturisers available and in general the more you pay, the better the product. Cheaper moisturisers may contain agents that ideally we do not use on fragile or elderly skin. If the skin is very dry then using a moisturising cream or ointment is preferable to a liquid. Many companies have removed agents known to cause allergies and irritation to the skin, so a thorough reading of the label is recommended to ensure that what is put on the skin does not contain sodium lauryl sulphate, parabens or balsam of Peru. The pharmacist may be able to offer some advice on products for sensitive skin. Moisturisers should be applied twice daily and the skin should feel hydrated, soft and supple at all times. As previously mentioned, skin needs to be moisturised and preferably twice daily but in some cases more regularly. If heating is turned up or the air is particularly cold and dry then the skin will be dry and become itchy, so hydration is imperative. Do not have very hot or hot showers as the more heat the itchier the skin will feel post cleansing. If the skin is itchy, cooling it down will help to reduce this discomfort. Products containing oatmeal are known to be a natural anti-itch agent. Excoriation is a red, painful, moist skin condition often seen when urine has been in contact with skin for too long or when other agents or chemicals ‘burn’ the skin. I use the word ‘burn’ because the irritant damages the skin in a way similar to a burn. This condition can be extremely painful and cause great discomfort. A zinc cream or ointment will act as a soothing agent and also as a barrier against any further irritant, for example urine. Ensuring bacteria have been managed before applying a barrier agent is part of the regime, so cleansing with an antiseptic solution in the shower and rinsing off after lathering into a foam may aid in the reduction of unwanted bacteria on the skin’s surface. Pressure injuries are caused by too much pressure over a bony prominence. You may once have known them as bed sores although they do not always occur in bed. In fact many occur from sitting in chairs. The weakened skin is more susceptible to pressure and so when unwell it is imperative that the person does not rest on one part of their body for too long. Keep adjusting their position. If the person is incontinent then ensuring the pad is changed frequently when required rather than sitting in a very wet pad, is important. But pad changes and movement must be combined with good skin care – cleansing, patting dry and applying moisturisers and barrier agents as required. It is recommended to eat a nourishing, balanced, varied diet, consume plenty of fluids, have good night’s sleep, apply moisturiser to dry skin twice a day, apply barrier agents to skin at risk of damage, change continence aids as required, keep active and mobile and do not sit for too long in one place or lay on one side for too long. If the skin condition is self treated and there is no improvement in the skin condition within 5 to 7 days, it is recommended that professional help is sought. The local doctor, nurse or pharmacist may be able to help. If help is sought from these professionals and there is no improvement in two weeks, then ask for a referral to a dermatologist. For more information phone the National Continence Helpline on 1800 33 00 66. It’s a free, confidential phone service staffed by continence nurse advisors providing information and advice on continence management, funding schemes, continence services, continence products and resources to anyone in Australia. The helpline operates Monday to Friday, 8am to 8pm Australian Eastern Standard Time. Thank you for watching this video.

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