Wound Care Made Incredibly Easy

84

External threats to skin integrity

Effects of external moisture on unprotected skin

Process

How it affects skin health The acid mantle function of the skin is impaired. The permeability allows even more fluid and caustic materials (such as destructive enzymes) to penetrate the skin.

What may happen if barrier is not restored Bacteria and fungi can proliferate to the point of causing infection because they thrive in an alkaline environment. Inflammation (dermatitis) occurs due to the penetration of irritants.

The pH becomes alkaline.

The barrier becomes more permeable because lipids are impaired and the tight junctions between cells are loosened.

Overly moist skin has an increased friction coefficient.

Skin sticks to linens and clothes.

Skin tears, blisters, and abrasions may occur, especially over heels and fleshy prominences like the buttocks. If skin sticks in place and gravity pulls the skeleton downward kinking blood vessels, shearing injury can occur, causing ischemia and pressure injuries over bony prominences.

Get wise to wounds

In long-term care, MASD is reported to the Centers for Medicare & Medicaid Services (CMS) in the Minimum Data Set (MDS). Data available up to 2017 show that the percentage of residents with MASD in quarter 1 of 2013 was 5.8, 2016 was 6.9, and 2017 was 6.63. Between 2013 and 2016, it is likely that reporting of MASD had improved with education efforts (Ayello, 2017). Hopefully, when newer data become available, the percentages will improve. However, during the COVID-19 pandemic, there was likely an increase in all skin issues due to declining health of long-term care residents and shortage of staff plus fatigue and difficulty working with personal protective equipment.

Nothing new under the sun, except terminology

International Classification of Disease (ICD) codes from the World Health Organization are used by most countries in the world to de fine causes of mortality and morbidity and for data collection. In the United States, the ICD codes are also how organizations bill insur ance companies for reimbursement for health care and supplies. The United States is currently using ICD-10. ICD-11 was released in January 2022, but due to the complexity of changing electronic data collection systems, it will probably not be implemented until at least 2025. In the meantime, in October of 2021, the CMS and the Cen ters for Disease Control and Prevention (CDC) approved a clinical

Copyright © 2023 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.