1. Thomas Hess, Cathy BSN, RN, CWOCN

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The fundamental building blocks addressing the prevention of skin breakdown are generally overshadowed by the deluge of intervention strategies touted for patients with chronic wounds. It is paramount that providers take these proactive steps in clinical practice to develop sound skin care prevention and intervention pathways.


Use the following skin care product categories to help you develop a skin care formulary for your facility. When creating the skin care formulary, remember to include products under these categories. And be sure to understand the reimbursement guidelines for all products ordered. You may find that many skin care products are considered routine supply items and are included in the general cost of an inpatient stay, whether the stay is for acute or long-term care. It is the clinician's responsibility to verify whether a product has been assigned a Healthcare Procedure Coding System Code (HCPCS). The ultimate responsibility for correct HCPCS coding lies with the provider or supplier who is submitting a claim to a third-party payer. Lastly, accurate descriptions of your patient's skin care findings complement and complete your documentation process!


* Antifungals and antimicrobials (topical): products that inhibit the growth of organisms that cause superficial skin infections, such as yeast.



Description: The pH of the skin is in the acidic range but varies in different areas of the body. The pH is important because it regulates some of the functions of the stratum corneum, including its permeability function; the integrity and cohesion of skin cells, or what holds the cells together; and the defense against bacteria and fungi. Based on the skin's pH, the skin flora (microorganisms that live on or infect the skin) grows differently. Antifungal and antimicrobial products inhibit the growth of organisms that cause superficial skin infections, such as yeast. These products are formulated as creams, ointments, lotions, or powders and may be found in select moisture barriers.


* Liquid skin protectants (also called skin sealants): products that protect the skin by forming a transparent protective barrier.



Description: Liquid skin protectants, or skin sealants, are formulated with a polymer and solvent. When the product is applied to the skin, the solvent evaporates, and the polymer dries to form a transparent, protective barrier. Select liquid skin protectants may irritate denuded or compromised skin. Liquid skin protectants can be formulated with or without alcohol and products are manufactured in wipes, swabs, sprays, and foam applicators.


* Moisture barriers (also called skin protectants): ointments, creams, or pastes that protect the skin from urinary and fecal incontinence by shielding the skin from irritants or moisture (eg, dimethicone, petrolatum, and zinc oxide).



Description: Moisture barriers, sometimes called skin protectants, are ointments, creams, or pastes that shield the skin from exposure to irritants or moisture from sources, such as incontinence, perspiration, and enzymatic and wound drainage. Three common ingredients found in moisture barriers include dimethicone, petrolatum, and zinc oxide, or a combination thereof. Some products are formulated with additional properties, such as antibacterial, antiyeast, or antifungal ingredients. A moisture barrier may be formulated with a skin cleanser or as a standalone paste, cream, powder, or ointment. Once the moisture barrier is applied to the skin, it may appear clear, translucent, or opaque depending on the formulation.


* Skin cleansers: pH-balanced products used to provide moisture and to effectively remove urine, feces, or both without patient discomfort.



Description: Skin cleansing removes unwanted microorganisms while maintaining the skin's barrier function. The characteristics of skin cleansers vary according to the needs of those using the product. For example, skin cleansers are available as a rinse or no-rinse formulation; an all-in-one product that cleanses, moisturizes, and protects; or a variation of these options. In addition, some products are manufactured for cleansing the entire body or only the perineal area. Therefore, when choosing a skin cleanser, it is important to understand the ingredients and total formulation and to match the product to the patient's clinical goals.


* Therapeutic moisturizing products: lotions and creams used to replace lost lipids in skin.



Description: One of the skin's main functions is to hold in moisture. The epidermis produces lipids, oily substances that limit the passage of water into or out of the skin. If the skin is deficient in lipids, moisture can escape. The loss of moisture causes dry, flaky, itchy skin. Therapeutic moisturizers replace skin lipids and maintain skin hydration. These products can be found as creams, lotions, or ointments, with or without an antimicrobial ingredient. Common ingredients found in therapeutic moisturizers include emollients and humectants. Some products are applied daily, whereas other products are indicated to be applied more frequently.


Source: Hess CT. Clinical Guide to Skin and Wound Care. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2008.