Transcript Routine Perineal Care and Incontinence Care

Routine Perineal Care and Incontinence Care
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Perineal 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.
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Routine Perineal Care and Incontinence Care
Perineal Dermatitis
 Perineal 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.1
 Up to half of elderly long-term care residents
are incontinent of stool.1
– Perineal dermatitis develops in a third of
patients with fecal incontinence. 1
Perineal dermatitis causes itching
and pain and can increase the risk for
urinary tract infection, skin infection,
and pressure ulcers.
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Routine Perineal Care and Incontinence Care
Perineal Dermatitis
 In 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.1
 The 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.2
Residents at risk for perineal dermatitis
should have routine perineal skin care
that includes gentle cleansing and the
application of a moisture barrier.
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Routine Perineal Care and Incontinence Care
Perineal Skin Damage
 Even though painful and preventable, perineal
skin damage occurs in as many as 41% of adults
in long term care.3
 Perineal 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.3
 Preventive cleansing and application of a
protectant reduce the incidence of pressure
ulcers by as much as 59%.1
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Routine Perineal Care and Incontinence Care
Perineal 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 closed
– Talk with the resident and
explain what you are doing
– Expose only the area to
be cleansed
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Routine Perineal Care and Incontinence Care
Perineal and Incontinence Care
Optimal perineal/ incontinence care requires:
 The right product
 The right process
 Staff compliance
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Routine Perineal Care and Incontinence Care
Perineal and Incontinence Care Basics
Preserve the resident’s skin:
 Use warm, not hot water
 Avoid force or friction – be gentle
 Fold the washcloth to provide a softer surface for cleansing
Use Standard Infection Control Precautions:
 Always wear gloves for perineal/incontinence care –
add an apron or gown per facility policy
 While wearing gloves, avoid contaminating environmental
surfaces and supplies
 Put on clean gloves to apply perineal cream or ointment
Minimize opportunities to spread contamination:
 Remove excess fecal material with diaper or disposable wipe
 Cleanse from the area of least contamination to the area of
most contamination
 Refold and change cloths to prevent spreading contamination
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Routine Perineal Care and Incontinence Care
Standards of Care in Long-term Care Facilities
(LTCFs)
 Regulations from the Centers for Medicare and Medicaid Services
(CMS) establish standards for LTCFs
 Regulations are divided into 2 parts
1) Written regulatory statements are labeled by F-tags and a
number. F-tag is jargon for the actual regulation as published in
the Federal Register.*
2) 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.
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Routine Perineal Care and Incontinence Care
CMS 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.
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Routine Perineal Care and Incontinence Care
CMS 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
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Routine Perineal Care and Incontinence Care
PROVON® 3 in 1 Wash Cream
 A single product for complete, no-rinse
bathing and perineal care
 Cleans, moisturizes and helps reduce odors
in one step
 Gentle cleansing agent loosens dirt, urine
and stool from the skin and reduces the
amount of force or friction needed during
bathing and incontinence care
 Moisturizes the skin with 10 conditioning
agents
 pH balanced
 Dermatologist tested and dye-free
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Routine Perineal Care and Incontinence Care
PROVON® 3 in 1 Wash Cream
Perineal Cleansing
Prepare cloth(s) by adding 2-3 pumps of product to each warm, damp cloth
Males
Females
 Cleanse the penis - tip to base
 For uncircumcised male, gently
push foreskin back, cleanse tip
of penis, and replace foreskin
 Refold cloth to unused surface,
cleanse groin, then scrotum wipe toward rectum
 Use additional cloths as
necessary
 Place cloths in soiled linen bag
 Cleanse groin and both
outer labia
 Refold cloth to unused
surface
 Separate labia and
cleanse downward,
wiping toward rectum
 Use additional cloths
as necessary
 Place cloths in soiled
linen bag
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Routine Perineal Care and Incontinence Care
PROVON® 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
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Routine Perineal Care and Incontinence Care
PROVON® 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 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
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Routine Perineal Care and Incontinence Care
PROVON® 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 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
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Routine Perineal Care and Incontinence Care
Applying 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.
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Routine Perineal Care and Incontinence Care
References
1. Driver DS. Perineal dermatitis in critical care patients.
Critical Care Nurse 2007;27:42-46.
2. 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.
3. Nix, D. (2010). Prevention and Treatment of Perineal Skin
Breakdown Due to Incontinence. Ostomy Wound
Management 52(4).
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) 31-40.
5. http://www.cms.gov/manuals/Downloads/som107ap_pp
_guidelines_ltcf.pdf p.195 Pressure Sores; p. 232 Urinary
Incontinence
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Routine Perineal Care and Incontinence Care
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Routine Perineal Care and Incontinence Care