What is the best barrier cream for preventing and managing pressure ulcers (bed sores)?

Best Barrier Cream for Pressure Ulcers (Bed Sores)

Skin creams containing fatty acids are the most effective barrier creams for preventing and managing pressure ulcers, as they have been shown to decrease the risk of pressure ulcers compared to standard care. 1

Understanding Barrier Creams for Pressure Ulcers

Barrier creams serve as a protective layer between the skin and potential irritants, helping to:

• Maintain skin integrity
• Prevent moisture damage
• Reduce friction and shear forces
• Create a protective barrier against bodily fluids

Evidence-Based Recommendations

First-Line Barrier Cream Options:

1. Fatty acid-containing creams:

   • Low-quality evidence shows these creams may reduce pressure ulcer incidence compared to control compounds (RR 0.42,95% CI 0.22 to 0.80) 1
   • They help maintain skin pH closer to normal range
   • Provide better moisture control than standard care

2. Dimethicone-based barrier creams:

   • Forms a moisture barrier that helps protect skin 2
   • Particularly useful for areas exposed to moisture
   • Helps prevent maceration of peristomal skin 3

What to Avoid:

• Doughnut cushions: These are not recommended as they can actually increase pressure ulcer risk by concentrating pressure on surrounding tissue 4
• DMSO cream: May increase the risk of pressure ulcer incidence compared with placebo (RR 1.99,95% CI 1.10 to 3.57) 5

Application Protocol

1. Cleanse the area:

   • Use a skin cleanser rather than soap (soap can be drying and alter skin pH) 1
   • Gently pat the area dry

2. Apply barrier cream:

   • Use a thin, even layer
   • Apply to intact skin around the wound edges
   • Reapply after each cleansing or as directed

3. Monitor for adverse reactions:

   • Watch for signs of rash or irritation
   • Low-quality evidence shows minimal adverse events (occasional wet sores or rashes) 1

Comprehensive Prevention Strategy

Barrier creams should be part of a multicomponent approach that includes:

• Support surfaces: Use advanced static mattresses or overlays rather than standard hospital mattresses 1
• Repositioning: Implement a schedule every 2-4 hours 4
• Risk assessment: Use validated tools like Braden, Norton, or Waterlow scales 1, 4
• Skin monitoring: Regular assessment for early signs of pressure damage 4

Special Considerations

• Incontinence: For patients with urinary or fecal incontinence, barrier creams are particularly important to prevent incontinence-associated dermatitis, which can lead to pressure ulcers 6

• Tracheostomy sites: Barrier creams containing dimethicone have been shown to maintain better skin pH, moisture, and temperature in peristomal skin 3

Common Pitfalls to Avoid

• Over-application: Thick layers of barrier cream can trap moisture and cause maceration
• Infrequent assessment: Skin under barrier cream still needs regular inspection
• Relying solely on creams: Remember that pressure redistribution remains the cornerstone of prevention
• Confusing IAD with pressure ulcers: Incontinence-associated dermatitis requires different management than true pressure injuries 6

By implementing these evidence-based recommendations for barrier cream selection and application, along with comprehensive pressure ulcer prevention strategies, you can significantly reduce the risk and severity of pressure ulcers in at-risk patients.