Managing Moisture lesions or Moisture associated dermatitis (MAD).
Excessive moisture from urinary or faecal incontinence can lead to skin breakdown quite quickly, as the waste products in urine and faeces damage the skin. This leads to Moisture Lesions. These are extremely painful wounds as quite often they expose the surface nerve endings and patients can describe them as feeling like a burn.
Unmanaged they can become infected, cause weight loss and greatly affect the residents quality of life. As a result it is likely these injuries will go on to become a register harm which will be reported such as pressure ulcers so it is vital we have knowledge on how to prevent.
This subject comes up a lot in my training sessions. It's one of those subjects that again has no clear algorithm for long term care settings to follow with some national guidelines listed below.
The mis-mis-categorising of moisture lesions and category 2 pressure ulcers is high, with most Tissue Viability Nurse specialists only able to visit nursing homes for reported category 3, 4 or suspected deep tissue injuries.
This is a common problem across care settings, where categorising skin changes can be difficult. It is of great benefit if you have a carer or nurse with an interest in tissue viability to become a champion of link. Giving this individual time to research or learn can greatly benefit all the staff and residents in-house. below are some basic principles to prevent these injuries and some resources and downloads to help identify them.
Care should be taken to;
• Assist patients to the toilet regularly, if mobile.
• Remind and prompt patients to use the toilet if appropriate, or offer the commode/bedpan.
• Change pads frequently to prevent wet pads sitting against the skin for long periods.
• Ensure patients who wear pads are wearing the correct size and grade for their individual needs.
• Wash and pat dry after every episode of incontinence to remove waste products from skin.
The NICE guidelines state “If your skin is too wet, or if it is dry and inflamed, you may be offered a “barrier cream”. This cream protects the skin and helps prevent pressure ulcers developing”. (NICE, Pressure ulcers: prevention and management. Clinical guideline [cg179] Published date: April 2014) https://www.nice.org.uk/guidance/cg179/ifp/chapter/prevention#barrier-creams
Barrier creams have been used for many years to help prevent pressure ulcers and protect from Moisture Lesions. In the past, Sudocream and later Conotrane were used to this effect, but their efficacy was debated. The use of Sudocream was especially scrutinised due to it “caking” on the skin.
Thee creams can also dry out healthy skin, and reduce the absorbency of pads. These should not be used as they can cause further skin damage, please explain to your patients why these creams are not indicated for use in moisture damage and offer alternatives. They include;
Aqueous cream is not designed as a moisturiser, it is an ineffective emollient due to a high water content, and can cause irritation if left on the skin, especially in skin conditions such as eczema
The European Advisory Panel on Pressure Ulcer Prevention recommend a barrier cream for prevention and a pH-neutral cleaning solution with surfactant (eg Proshield Foam Spray) for ulcers with debris, infection or colonisation (Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. EPUAP, 2014
These are useful in areas of excessive moisture, to prevent the moisture soaking into the skin, such as with urinary or faecal incontinence, or in heavily exuding wounds. These should be applied as directed by the prescriberer, to periwound areas and areas affected by exudate.
• Cavilon or Cutimed Sorbact spray/lollipop for broken skin, and Cavilon or Cutimed Sorbact cream for intact skin.
• Proshield barrier cream, also available in a spray to cleanse the skin with.
• Medihoney antibacterial barrier cream.
Below are some great resources to help guide you and your organisation:
The Welsh Wound Network Prevention and Management off moisture lesions: http://www.welshwoundnetwork.org/files/5514/0326/4395/All_Wales-Moisture_Lesions_final_final.pdf
The Scottish Excoriation tool
The excellent ‘React to Red’ guidelines can be replicated or changed to your workplace depending on what products you use.
Remember to join the FB champion pages where we all share this info and you may pick up some ideas, or be able to share with the group tools you are already using which you find useful:
or contact me if you would like more information.