2Perineal and Incontinence Care Providing perineal and incontinence care are two of the most important responsibilities entrusted to caregivers in long-term care facilities.Thorough care provides comfort and reduces odors and helps residents maintain their dignity and feeling of self-worth.Careful perineal/incontinence care also preserves skin and helps prevent perineal dermatitis.Providing good perineal care can have a positive effect on the well-being and self-esteem of your residents.
3Perineal DermatitisPerineal dermatitis is often associated with incontinence and ranges in severity from redness to areas with open abrasions.Urinary incontinence rates between 30-50% have been reported for long-term care residents.1Up to half of elderly long-term care residents are incontinent of stool.1Perineal dermatitis develops in a third of patients with fecal incontinence. 1Perineal dermatitis causes itching and pain and can increase the risk for urinary tract infection, skin infection, and pressure ulcers.
4Perineal DermatitisIn one study, 56.7% of patients with pressure ulcers also had fecal incontinence, making fecal incontinence one of the most common risk factors for pressure ulcers.1The clinical practice guidelines of the Wound, Ostomy, and Continence Nurses Society (WOCN) recommend keeping the skin clean and dry and applying an incontinence skin protectant after each episode of incontinence.2Residents at risk for perineal dermatitis should have routine perineal skin care that includes gentle cleansing and the application of a moisture barrier.
5Perineal Skin DamageEven though painful and preventable, perineal skin damage occurs in as many as 41% of adults in long term care.3Perineal skin damage may progress rapidly to ulceration and secondary infection including bacterial and yeast infections which increase discomfort and treatment costs, and compromise quality of life.3Preventive cleansing and application of a protectant reduce the incidence of pressure ulcers by as much as 59%.1
6Perineal and Incontinence Care Accepting help with something as personal as perineal or incontinence care can represent a loss of privacy and self-esteem to the resident.Respect the resident’s dignity:Keep the door closedTalk with the resident and explain what you are doingExpose only the area to be cleansed
7Perineal and Incontinence Care Optimal perineal/ incontinence care requires:The right productThe right processStaff compliance
8Perineal and Incontinence Care Basics Preserve the resident’s skin:Use warm, not hot waterAvoid force or friction – be gentleFold the washcloth to provide a softer surface for cleansingUse Standard Infection Control Precautions:Always wear gloves for perineal/incontinence care – add an apron or gown per facility policyWhile wearing gloves, avoid contaminating environmental surfaces and suppliesPut on clean gloves to apply perineal cream or ointmentMinimize opportunities to spread contamination:Remove excess fecal material with diaper or disposable wipeCleanse from the area of least contamination to the area of most contaminationRefold and change cloths to prevent spreading contamination
9Standards of Care in Long-term Care Facilities (LTCFs) Regulations from the Centers for Medicare and Medicaid Services (CMS) establish standards for LTCFsRegulations are divided into 2 partsWritten regulatory statements are labeled by F-tags and a number. F-tag is jargon for the actual regulation as published in the Federal Register.*Interpretative Guidelines are used for enforcing the regulations. These consist of an explanation of the intent of the regulation, definitions of terms, and instructions for determining compliance with the regulation. Interpretative Guidelines are continually revised by CMS and are used during surveys of long-term care facilities.*The Federal Register is the official journal of the Federal Government of the United States and contains proposed rules, new regulations, and public notices of government agencies.
10CMS F-Tag 314: Pressure Sores Residents who enter facility without pressure sores do not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable.A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing.Identify risk factors including exposure of skin to urine and fecal incontinence.
11CMS F-Tag 315: Urinary Incontinence Skin related complications:Frequent washing with soap and water can dry the skin, use of perineal rinse may be indicated.Moisturizers help preserve the moisture in the skin by either sealing in existing moisture or adding moisture to the skin.Moisturizers should be used sparingly – if at all – on macerated (soggy) or excessively moist skin.5
12PROVON® 3 in 1 Wash CreamA single product for complete, no-rinse bathing and perineal careCleans, moisturizes and helps reduce odors in one stepGentle cleansing agent loosens dirt, urine and stool from the skin and reduces the amount of force or friction needed during bathing and incontinence careMoisturizes the skin with 10 conditioning agentspH balancedDermatologist tested and dye-free
13PROVON® 3 in 1 Wash Cream Perineal Cleansing Prepare cloth(s) by adding 2-3 pumps of product to each warm, damp clothMalesCleanse the penis - tip to baseFor uncircumcised male, gently push foreskin back, cleanse tip of penis, and replace foreskinRefold cloth to unused surface, cleanse groin, then scrotum - wipe toward rectumUse additional cloths as necessaryPlace cloths in soiled linen bagFemalesCleanse groin and both outer labiaRefold cloth to unused surfaceSeparate labia and cleanse downward, wiping toward rectumUse additional cloths as necessaryPlace cloths in soiled linen bag.
14PROVON® Perineal Wash Perineal Cleansing Remove excess fecal matter. Apply product to warm damp wash cloth(s). Gently clean entire perineal area, always wiping from front to back. Repeat with additional washcloths as needed.Benefit of not using basin of water for perineal cleansing – proven to be reservoir for bacteria and potential source of transmission of healthcare acquired infections.4
15PROVON® Perineal Skin Protectant Ointment with 99% Petrolatum Water-resistant skin protectant thatacts as a moisture barrierBarriers shield skin from exposure to irritants and moisture.Provides temporary barrier to urine and fecal matter.Helps protect red, irritated skin.Contains petrolatum (skin protectant), skin conditioning agents and fragrance.Non-greasy
16PROVON® Perineal Skin Protectant Ointment with 60% Petrolatum Creamier consistency than Perineal Skin Protectant Ointment with 99% Petrolatum.Water-resistant skin protectant that acts as a moisture barrier.Barriers shield skin from exposure to irritants and moistureProvides temporary barrier to urine and fecal matterHelps protect red, irritated skinContains petrolatum (skin protectant), skin conditioning agents and fragranceNon-greasy
17Applying PROVON® Perineal Skin Protectant Ointment with Petrolatum Apply after skin has been cleansed and patted dry.Apply a continuous, light film to the perineum, buttocks, and especially to the sacrum.Apply with a gentle touch – no aggressive rubbing.
18ReferencesDriver DS. Perineal dermatitis in critical care patients. Critical Care Nurse 2007;27:42-46.Wound, Ostomy, and Continence Nurses Society. Guideline for Prevention and Management of Pressure Ulcers. WOCN Clinical Practice Guideline No. 2. Glenview, IL: Wound, Ostomy & Continence Nurses Society; 2003.Nix, D. (2010). Prevention and Treatment of Perineal Skin Breakdown Due to Incontinence. Ostomy Wound Management 52(4).Johnson, D. et.al. (2009) Patients’ bath basins as potential source of infection: A multicenter sampling study. American Journal of Critical Care 18(1)_guidelines_ltcf.pdf p.195 Pressure Sores; p. 232 Urinary Incontinence
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