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2. Describe how the skin protects the body from threats to skin integrity. ... Eliminate harsh skin care products. Minimize contact with soap and solvents. ... – PowerPoint PPT presentation

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1
Created by
SKIN INTEGRITY
REDUCING THE THREATS !
  • Ruth Bryant RN, MS, CWOCN
  • Director, webWOC Nursing Education Program
  • Partner, Bryant Rolstad Consultants, LLC
  • Minneapolis, MN

2
Skin Integrity Reducing the Threats
Objectives
  • 1. Correlate normal skin anatomy with maintaining
    skin integrity.
  • 2. Describe how the skin protects the body from
    threats to skin integrity.
  • 3. Describe the threats posed by aging, soap,
    bathing, dry skin and skin tears.
  • 4. Identify nursing interventions that reduce the
    threat to skin integrity.

3
Why the Focus on Skin Integrity?
  • Intact top layer of skin is a barrier from
    environmental threats.
  • When skin integrity is altered, the risk of
    problematic complications such as pressure
    ulcers and skin infections is increased.
  • With aging, the skin is less efficient as a
    barrier and less resilient to environmental
    threats.
  • An increasing number of patients will be admitted
    to our institutions who have a heightened risk
    for altered skin integrity by virtue of their age.

4
Anatomy of the Skin
5
Skin Integrity Key Structures of the Skin
  • Stratum Corneum
  • Dermis
  • Basement Membrane Zone (BMZ)

6
Stratum Corneum
  • Intact stratum corneum is the first line of
    defense for the body.
  • The stratum corneum is constantly being replaced
    and requires an orderly, regulated process of
    keratinocyte proliferation and differentiation.

7
Dermis
  • The second layer of the skin.
  • Contains sebaceous glands.
  • Predominant proteins are elastin and collagen.
  • Contains a ground substancecomposed of
    proteoglycans (PGs) and glycosaminoglycans
    (GAGs)

8
Basement Membrane Zone (BMZ)
  • Located where the epidermis and dermis meet.
  • Epidermal surface consists of fingerlike
    downward projections known as Rete pegs.
  • Dermal surface consists of upward projections
    known as Dermal papillae.
  • Dermal papillae contains numerous capillary
    loops.

9
Functions of the Skin
  • Sensation
  • Metabolism
  • Thermoregulation
  • Communication
  • Protection

10
The Protective Function of the Skin
  • An intact stratum corneum protects the skin from
    Fluid and Electrolyte loss.
  • Capillary loops and dermal proteins assist in
    retention of moisture in skin.

11
The Protective Function of the Skin
  • The collagen and elastin present in the dermis
    protect the skin from Mechanical Injury .

12
The Protective Function of the Skin
  • Skin pigmentation and the presence of melanin
    protects the skin from Ultraviolet Radiation.

13
The Protective Function of the Skin
  • Several characteristics of the skin provide
    protection from Pathogens
  • Intact stratum corneum
  • Presence of Sebum
  • Acid pH (4.5-6.5)
  • Normal skin flora (resident flora)
  • Skin Immune System

14
Threats to Skin Integrity
  • Natural Threats
  • Aging
  • Dry Skin
  • Man-induced Threats
  • Skin Tears
  • Soaps
  • Conventional Bathing Techniques

15
AGING Natural Threat to Skin Integrity
  • Age alters the skins ability to retain moisture
  • Decrease in dermal proteins.
  • Decrease in number of capillary loops in
    basement membrane zone.
  • Prolonged epidermal turnover.

16
AGING Natural Threat to Skin Integrity
  • Age changes that alter skins ability to resist
    pathogens
  • Change in the composition of sebum
  • Decreased number of Langerhans cells
  • Decrease in number of mast cells

17
AGING Natural Threat to Skin Integrity
  • Age changes that alter skins ability to resist
    mechanical stresses
  • Flattening of Rete ridge and Dermal papillae
  • Decreased amount of dermal proteins (elastin and
    collagen)
  • Decrease in subcutaneous fat

18
DRY SKIN Natural Threat to Skin Integrity
  • Affects 75 of people over 64 years of age.
  • Results from prolonged epidermal turnover.
  • The aging corneocytes in the stratum corneum
    are less adherent so the barrier function of the
    skin is compromised.
  • Less adherent corneocytes create a larger surface
    area which allows more fluid loss through the
    skin.

19
SKIN TEARS Man-Induced Threat to Skin Integrity
  • Risk factors for developing skin tears
  • Advanced age
  • Sensory loss
  • Impaired nutrition
  • Impaired cognition
  • Dependency on staff for ADLs
  • Need for mechanical devices

20
SOAPS Man-Induced Threat to Skin Integrity
  • Alkaline soaps decrease layers of stratum
    corneum.
  • Soaps emulsify lipids.
  • Soaps remove resident and transient flora.
  • Alkaline soaps increase skin natural pH.
  • Soaps may interfere with water holding capacity
    of the skin.

21
Conventional Bathing Techniques Man-Induced
Threat to Skin Integrity
  • How is bathing a threat to skin integrity?
  • Basins often remain damp between baths and are
    therefore a a vehicle for bacterial proliferation
    and transmission.
  • The negative effects of hand washing on the
    integrity of the hands in nurses has been
    extensively documented.
  • Basin bathing is analogous to hand washing.

22
Conventional Bathing Techniques Man-Induced
Threat to Skin Integrity
  • What are the negative effects of hand washing?
  • Changes in resident skin flora.
  • Heavy skin shedding so protective layer of
    stratum corneum is compromised.
  • Broken skin increases the risk of transmission of
    microorganisms.

23
Conventional Bathing Techniques Man-Induced
Threat to Skin Integrity
Frequency
Function
Form
Basin Bathing
24
Conventional Bathing Man-Induced Threat to Skin
Integrity
Alkaline Soaps
Force and Friction
Washcloths
Hot Water
25
How is Alkaline Soap a Threat?
  • Thins the stratum corneum.
  • Emulsifies lipids.
  • Removes resident flora.
  • Alkalinizes skin pH.
  • Reduces water holding capacity of skin.

26
How is the Washcloth a Threat?
  • Washcloth material becomes harsh and rough
    because of frequent laundering in bleach.
  • Washcloth can transmit microorganisms to other
    body parts during bathing process and
    contaminate basin and surrounding environment.

27
How is Hot Water a Threat?
  • Hot water has a drying effect on the skin.
  • The potable water source can be contaminated.
  • Bath water can cross-contaminate personnel and
    environment.

28
How is Force or Friction a Threat?
  • Considerable force and friction is typically used
    to lather up the cloth and skin.
  • This amount of force or friction on the skin can
    be abrasive to the stratum corneum.

29
Reducing the Threat to Skin Integrity
  • How can we provide care to the patient, bathe
    them and still do no harm to their skin?

30
Reducing the Threat of Soap
  • Recommendations
  • Use soaps with neutral pH.
  • Avoid detergent based antiseptics.
  • Eliminate harsh skin care products.
  • Minimize contact with soap and solvents.
  • Consider using waterless cleansers.
  • Use solutions that contain moisturizers.
  • Use moisturizers during and after cleansing.
  • Treat dry skin with moisturizers.

31
Reducing the Threat of Washcloths
  • Recommendations
  • Use thick soft cloths.
  • Additional Benefits
  • Washcloths are a surprisingly costly item in
    institutions because they must be replaced
    frequently.

32
Reducing the Threat of Hot Water
  • Recommendations
  • Avoid hot water use slightly warm water and
    replenish as needed.
  • Use premoistened cloths that can be warmed.
  • Explore utilization of new delivery mechanisms
    for skin cleansing.
  • Additional Benefits
  • Warm bath is very soothing and relaxing.
  • Reduce down time for staff while waiting for tap
    water to warm up.
  • A cool bath is uncomfortable and may have a
    negative effect on thermoregulation.

33
Reducing the Threat of Force Friction
  • Recommendations
  • Pat dry rather than rubbing and scrubbing.
  • Avoid rough skin scrubbers.
  • Minimize force/friction when bathing.

34
Reducing the Threat to Skin Integrity
  • Additional Recommendations
  • Cleanse skin at time of soiling and at routine
    intervals.
  • Individualize frequency of bathing according to
    patient need and preference.
  • (AHRQ, 1992)

35
Reducing the Threat to Skin Integrity Conclusion
  • Dr. Elaine Larson in 1999 stated that
    traditional hand washing practices warrant
    re-examination.
  • With consideration of our ultimate responsibility
    to the patient to optimize the protective barrier
    function of the skin, it is reasonable to
    propose Conventional bathing techniques
    warrant re-examination.
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