Comprehensive Skin Care Management in Long-Term Care Facilities
Regular skin assessments and individualized, evidence-based skincare routines are the cornerstone of effective skin care management in long-term care facilities, significantly reducing the incidence of pressure ulcers, skin tears, and intertrigo while improving overall skin health. 1, 2
Assessment and Risk Identification
- Use validated risk assessment tools (Braden, Norton, or Waterlow scales) to identify residents at risk for skin breakdown, though clinical judgment is equally effective 1
- Perform daily visual and tactile skin inspections, particularly focusing on:
- Pressure points (sacrum, heels, elbows, shoulders)
- Areas prone to moisture (skin folds, perineum)
- Extremities (especially lower limbs for dryness)
- Document baseline skin condition and monitor changes regularly
Core Skin Care Protocol
Cleansing
- Use pH-balanced, no-rinse cleansers rather than soap and water, which can be drying and irritating 1, 3
- For general bathing:
Moisturization
- Apply moisturizers twice daily, particularly after bathing when skin is still slightly damp 3
- Use emollients containing:
- For dry skin: Products with high lipid content (50% white soft paraffin with 50% liquid paraffin) 3
- For normal skin: Lighter lotions with humectants
- Focus moisturization on extremities, which tend to be drier than trunk areas 3
Incontinence Management
- Clean skin promptly after incontinence episodes using no-rinse cleansers 1
- Apply moisture barrier products containing zinc oxide or dimethicone for residents with incontinence 1, 4
- Use disposable bodyworns rather than non-disposable products, as they better prevent skin deterioration 4, 5
Prevention of Specific Skin Conditions
Pressure Ulcer Prevention
- Implement regular repositioning every 2-4 hours using 30-degree tilted positions 1
- Use advanced static mattresses or overlays rather than standard hospital mattresses 1
- For high-risk residents, consider air-fluidized beds which reduce pressure ulcer size 1
- Ensure protein intake of 1.2-1.5 g/kg/day to enhance tissue integrity 1
Skin Tear Prevention
- Use proper transfer techniques to avoid friction injuries
- Ensure adequate hydration of skin through moisturization
- Pad bed rails, wheelchair arms, and other potential sources of injury
- Avoid adhesive products on fragile skin
Management of Existing Wounds
- For pressure ulcers:
Implementation Strategies
- Establish a multidisciplinary skin care team with designated "skin champions" 1
- Provide ongoing staff education about skin assessment and care protocols
- Conduct regular audits of skin care practices and outcomes
- Document all assessments and interventions to guide treatment decisions
Common Pitfalls to Avoid
- Avoid therapeutic "diabetic" diets that may lead to decreased food intake and unintentional weight loss 6
- Avoid "no concentrated sweets" or "no sugar" diet orders, which are ineffective for glycemic management 6
- Avoid alternating-air mattresses as they show no clear benefit over static mattresses and are more expensive 1
- Avoid excessive bathing which can lead to skin dryness and breakdown
- Avoid using adhesive tapes on fragile skin
Special Considerations
- For diabetic residents, monitor skin closely as they are at higher risk for delayed wound healing 6
- For residents with physical disabilities, implement more frequent skin checks due to higher risk of pressure ulcers 6
- For residents with cognitive impairment who may resist care, consider:
- Timing skin care during periods of greater cooperation
- Using distraction techniques during care
- Explaining procedures even if comprehension seems limited
Recent evidence from a 2024 cluster-randomized trial demonstrates that implementing structured, evidence-based skin care protocols significantly reduces the incidence of skin tears (19.2% vs 27.2%), pressure ulcers (13.6% vs 16.9%), and intertrigo (27.0% vs 37.8%) compared to standard care 2.