Wound Care Made Incredibly Easy

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External threats to skin integrity

area (under the breasts), under the pannus (fatty abdominal apron), groins, gluteal cleft (between the buttocks), and interdigital areas (especially between toes). It is important to examine other skin fold areas in people that have contractures or other deep folds. Risk factors for ITD include excessive sweating, deep skin folds, atrophy of skin and decreased sebum (due to aging, medications, or disease), atopy (genetic susceptibility to irritants), diabetes, and immune deficiency.

Get wise to wounds

Over the course of 2 years, Arnold-Long and Johnson (2019) studied inpatients in a U.S. acute care and acute rehabilitation hospital who had been referred for any reason to a wound and ostomy care nurse. The mean prevalence of ITD among these patients was 40%, and the mean incidence of hospital-acquired ITD was 33%. Incidence was higher in those classified as obese, and the most common location was the gluteal cleft.

Treating ITD

Because of the association between deeper skin folds and ITD, one long-term approach to improving the risk is to assist with weight loss when feasible. Most literature on the topic recommends avoiding oil-based ointments (“no grease in the crease”) because oil further re duces evaporation. Consider zinc oxide preparations instead because these barriers absorb small amounts of sweat or weeping. When skin fold moisture is likely to be a long-term problem, another strategy is to use a textile woven to wick fluid laterally. Three products available contain silver, which is useful to combat fungal and bacterial skin in fections. The products are InterDry Ag from Coloplast, DermaTex Ag from Hartmann, and McKesson Silver Moisture Wicking Fabric. Fol low directions and leave at least 2 in of the fabric hanging outside the fold to allow evaporation. When using a wicking textile with silver, it is not necessary to add another antifungal medication as the silver is considered the treatment when used as directed. Medline offers a wicking cloth that slowly releases hydrogen peroxide and is called DriGo-HP Intensive Skin Therapy Barrier Sheet. Two products help maintain dry skin folds but without antimi crobials, so they can be used long term. Medline offers a Skinfold Dry Sheet that has an absorbent core to wick moisture off the skin. It cannot be cut but can be folded to fit into a crease and holds up to 8 oz. It is also sold under the name UltraSorbs. A similar product from Tranquility is called ThinLiner Moisture Management. These are pre ferred alternatives to towels and pillowcases often used in skin folds because cloth absorbs moisture and holds it against the skin, and many towels and washcloths are rough.

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