in-service guide: skin care® in... · 2013-11-12 · professional medical’s exclusive embrace...

In-Service Guide:Skin Care

P R O F E S S I O N A L M E D I C A L , I N C .

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Supervise or assist resident in washing and rinsing, moving from clean to dirty areas. Wash and rinse the face using soap-free cleanser. Wipe the eyes from the inside to the outside, switching to a clean corner of the mitt before returning to inner eye/cleaning other eye.

Fold washcloth into a mitt or gather corners together.

Wash and rinse ears, neck, arms, axillas and shoulders, hands, fingernails and chest (clean well under the female breasts).

Use the following procedure for shampooing and bathingMaterials needed: Shampoo and body wash, washcloths, basin, pitcher, gloves, nail clippers and deodorant

Regulate temperature and flow of water pri-or to and during shower/bath or shampoo. Position resident to shampoo hair, offering washcloth to protect the eyes. Direct warm water close to scalp and away from face.

Shampooing & Bathing

2 In-Service Guide: Skin Care

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Wash and rinse peri area from front to back. No assistance needed: Instruct resident to wash and rinse “between legs” or “privates.” Give them privacy while task is being completed. Assistance needed: Wash hands, wear gloves and provide perineal care as appropriate. Remove gloves and wash hands after perineal care is completed.

Wash and rinse abdomen, skin folds and umbilicus, legs and feet (including area between toes), back and neck area.

Trim fingernails/toenails if needed/ allowed. Complete tub or shower bath as appropriate. Dry resident completely. Apply deodorant to underarms.

Apply a small amount of shampoo and body wash to scalp, work up lather and massage into scalp using tips of fingers — not fingernails. Rinse hair thoroughly and towel dry hair.

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Turn resident on side. Spray wipe with perineal cleanser and gently wipe the remaining area, including the rectum and buttocks, without returning to the urethral area. Appropriately and gently cleanse from clean to dirty area, leaving entire area clean and dry.

If indwelling catheter is present, hold and support catheter tubing to one side to avoid traction or unnecessary movement during procedure. When cleaning urethral area, gently spray and wipe the catheter tubing from urethra outward for about three inches of tubing. Keep drainage bag below level of bladder.

Apply moisture barrier to buttocks and peri area. Please refer to pages 14 and 15 for additional information on barrier creams and washcloths.

Use the following procedure for providing perineal careMaterials needed: Disposable washcloths/wipes, towels, linens, underpad, perineal cleanser, barrier cream and gloves

Wear gloves and use wipes to remove heavy soiling prior to perineal care. Then remove/discard gloves and wash hands. Place protective underpad under buttocks. Cover resident with linens and raise cover to expose perineum. Wash hands and put on clean gloves for perineal care.

Perineal Care


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*For female residents: Separate labia and gently wash down the center over the urethral area, wiping downward from front to back and stopping at the base of labia. Then wash and dry, as appropriate, the remaining perineal area, wiping from front to back and alternating from side to side and moving outward to the thighs.

Remove soiled linen and place in an appropriate receptacle. Leave resident in position of comfort.

*For male residents: Wipe the urethral area in a circular motion. Continue to wash down the penis and the rest of the perineal area, including the scrotum, using downward strokes and working outward to the thighs. If uncircumcised male, retract foreskin before and replace foreskin after procedure. If an indwelling catheter is present, appropriately and gently wash and dry the tip of the penis, starting at urethra first and working outward in a circular motion. Then wash and dry the entire perineal area, including the penis, scrotum and outward to thighs.

Wet washcloth/wipe and apply perineal cleanser sparingly. Gently wipe perineal area, wiping from “clean” urethral to “dirty” rectal area to avoid contamination.

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Cleanse, Moisturize and ProtectThree steps to perineal skin care

Delicate skin is a delicate subject but the proper care of perineal skin can greatly increase the comfort, dignity and health of your incontinent residents.

According to the Centers for Medicare & Medicaid Services (CMS), skin problems related to incontinence and moisture can range from irritation to an increased risk of skin breakdown.1 If perineal skin is exposed to urine or stool for prolonged periods of time, incontinence-associated dermatitis (IAD) can begin to develop.2

IAD is characterized by irritation and inflammation. Approximately 20 percent of long-term care residents have IAD, and 73 percent of them are incontinent. Residents with IAD are susceptible to developing secondary cutaneous infections, especially candidiasis, which thrives in warm, moist areas.3 They are also more likely to develop pressure ulcers when other risk factors are present.2

Preventing breakdownOne of the key steps to preventing skin breakdown and its complications is to keep perineal skin clean, moisturized and protected. According to Tag F315 of the State Operations Manual, research has shown that a soap and water cleansing regimen (which can dry the skin) might be less effective in preventing skin breakdown than a routine that includes no-rinse incontinence cleansers and moisture barriers. Moisturizers help to preserve skin’s moisture by either adding moisture or sealing in moisture that is already there.1

To save time and increase efficiency, your facility might consider selecting a product that performs multiple steps, such as a no-rinse cleanser that also contains moisturizers and dimethicone to protect the skin. Barrier creams, such as those that contain dimethicone, are ideal for residents who have significant urinary incontinence as well as those with fecal or double incontinence (both urinary and fecal).

Perineal Care



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Best-in-class products Professional Medical’s exclusive Embrace skin care products are the natural choice for delicate skin. They’re designed to work together as a system to cleanse, moisturize and protect.

Step 1: CleanseThe Embrace family includes three convenient options for skin cleansing.

No-rinse Embrace Moisturizing Cleanser & Skin Protectant with Breathable Barrier freshens skin, helps prevent perineal rash and leaves behind a protective dimethicone layer.

Embrace Skin Caring Total Body Foamer is a gentle, no-rinse alternative to soap and water can be used on as a perineal cleanser, body wash and shampoo.

Embrace Sensitive Skin Caring Washcloths with Breathable Barrier are formulated with a gel-based blend of natural ingredients, including aloe, vitamin E, chamomile and sweet almond oil. Breathable dimethicone helps seal out wetness. The washcloths can be used with our other cleansers as an easy, convenient system for delivering great skin care.

Step 2: Moisturize Embrace Skin Repair Cream is a whole-body moisturizer designed for daily use. It protects and helps relieve dry, chapped or cracked skin. Dimethicone forms an invisible protective barrier.

Embrace Moisturizing Hand & Body Cream moisturizes and softens rough, dry skin. It can be applied to any area in need of moisturization. The formula is enriched with aloe vera, lanolin and vitamins A, D and E.

Step 3: Protect Embrace Skin Protectant with Breathable Barrier features organic aloe vera, chamomile and dimethicone to moisturize, freshen and soothe delicate skin.

Wash, rinse and dry skin of back if indi-cated. Pour small amount of lotion into your hands and rub hands together to warm.

Turn resident on side and uncover resident’s back and (if acceptable to resident) buttocks. Keep remainder of body covered with top sheet or bath blanket.

Rub back for 2 to 3 minutes, including neck, shoulders and (if acceptable to resident) buttocks. Do not rub over bony prominences or reddened areas. Spread lotion over back.

Use the following procedure for lotion applicationMaterials needed: Lotion

Pour a small amount of lotion into your hands and rub together to warm. Apply lotion to the body as needed.

Lotion Application


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Apply firmer pressure on upward strokes, using long, smooth strokes, and keep your hands in contact with resident’s skin.

Put hands at base of spine and move hands up back, around shoulders, down sides of back and (if acceptable to resident) around buttocks.

Rub in a circular motion upward along the spine, moving outward over back, including buttocks and coccyx.

Typical application includes shoulders, arms, hands, legs and feet (avoiding area between toes).

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Wash all surfaces of the fingers and hands (up to the wrist).

Vigorously rub hands together in a circular motion for at least 10 seconds.

Clean under nails if needed.

v Use the following procedure

for handwashingMaterials needed: Hand soap and clean paper towels

Turn on warm water. Wet hands.

Handwashing


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Dry hands on clean paper towel. Turn off faucet with paper towel.

Rinse hands thoroughly from wrist to fingertips, keeping fingertips down.

Discard towel appropriately without contaminating hands.

Apply soap to hands to produce lather.

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With your fingers interlaced, rub your palms together.

Place your right palm over the back of your left hand. Interlace your fingers and rub the surfaces together. Then repeat this with your left palm on the back of your right hand.

Curl your fingers under and rub the backs of your fingers against the palm of the opposing hand.

Use the following procedure for hand sanitizer applicationMaterials needed: Hand sanitizer

Make sure that the product you are using is at least 60 percent alcohol. Apply a palmful of product to your cupped hand.

Hand Sanitizer Application


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Clasp the fingers of your right hand in the palm of your left hand and rub your fingers backward and forward. Then repeat this with your left hand and right palm.

Wrap your right hand around your left thumb and rub the thumb in a rotating manner. Repeat this with your left hand on your right thumb.

Don’t rush! This process should take at least 20-30 seconds. Once your hands are completely dry, you’re ready to care for your residents!

Rub your palms together.

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Advanced Skin Care

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Embrace™ and Compliance® Skin ProtectantsMoisturize and protect skin

Compliance and Embrace skin protectants form a protective barrier to help prevent and treat perineal rash and seal out wetness.

Embrace™ Skin Protectant with Breathable Barrier Features: n Soothes and moisturizes skinn Enhanced with dimethicone, chamomile and organic aloe veran Helps prevent and treat perineal rashn Forms a protective barrier to help seal out wetnessn Fresh, clean, gender-neutral scent

Compliance® Antimicrobial Skin Protectant Features: n Moisturizes and soothes red, irritated skin with organic aloe vera n Forms a protective barrier with zinc oxiden Dermatologist tested n Antimicrobial

Item # Size Unit of SaleEmbrace Skin Protectant with Breathable Barrier

600-BC4N1 6 ounces 12/cs

Compliance Antimicrobial Skin Protectant

600-BC3N1 6 ounces 12/cs

Embrace™ Moisturizing Cleanser & Skin Protectant with Breathable BarrierCleanse, moisturize and protect skin

Dermatologist-tested Embrace Moisturizing Cleanser & Skin Protectant with Breathable Barrier freshens skin and helps prevent perineal rash.

Features: n Gentle, no-rinse alternative to soap and watern Creates a protective, breathable barrier against wetnessn Enriched with dimethiconen Cleanses, moisturizes and protects in a single stepn pH balanced for delicate skin

Item # Size Unit of SaleEmbrace Moisturizing Cleanser & Skin Protectant with Breathable Barrier

600-MC4N1 6 ounces 12/cs

Additional product info is available online


Embrace™ Skin Repair CreamDaily defense against dry skin

Embrace Skin Repair Cream is a whole-body moisturizer designed for daily use. It protects and helps relieve dry, chapped or cracked skin.

Features: n Nurtures and conditions skin n Designed to provide maximum hydration while still being light enough for everyday usen Forms an invisible protective barrier with dimethicone n Nourishes and rejuvenates skin with organic aloe vera and vitamins A and D

Item # Size Unit of SaleEmbrace Skin Repair Cream

600-SC4N1 8.5 ounces ea

600-SC4N1-32 32 ounces, pump top 12/cs

Compliance® and Embrace™ Skin Caring Washcloths For a clean, soft feeling

Compliance and Embrace Skin Caring Washcloths contain a blend of natural ingredients to cleanse, moisturize, freshen and soothe skin. Additionally, our premium Embrace washcloths leave behind a breathable dimethicone barrier to help seal out wetness.

Features: n Rinse-free formula

n pH balanced and hypoallergenic

n Latex- and alcohol-free

Item # Size Unit of SaleEmbrace Skin Caring Washcloths

600-WC5N1 8” x 12.6” 72/pk | 12 pk/cs

Compliance Skin Caring Washcloths

600-WC4N1 8” x 12.6” 80/pk | 12 pk/cs


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Advanced Skin Care & Additional Products

Embrace™ Skin Caring Total Body Foam CleanserMoisturize and protect skin

Embrace Skin Caring Total Body Foam Cleanser has a gentle, no-rinse multipurpose for-mula that can be used as a perineal cleanser, body wash and shampoo. It creates a rich foam, features a gender-neutral fresh scent and is enriched with aloe.

Features: n Antimicrobialn Leaves the skin clean and conditionedn Rich foam rapidly removes urine and feces to help ensure effective skin cleansingn Specially formulated for delicate skin

Item # Size Unit of SaleEmbrace Skin Caring Total Body Foam Cleanser

600-SCP8-F 8 ounces 12/cs

Embrace™ Moisturizing Hand & Body CreamCleanse, moisturize and protect skin

Our exclusive Embrace Moisturizing Hand & Body Cream is professionally formulated for the caregiver. It moisturizes deeply and softens rough, dry skin.

Features: n Ideal for use by both residents and caregiversn Convenient pump topn Enriched with aloe vera, lanolin and vitamins A, D and En Fragrance and dye freen Can be applied liberally to hands and any other areas in need of moisture, such as elbows and feet

Item # Size Unit of SaleEmbrace Moisturizing Hand & Body Cream

600-HC4N1 16 ounces 12/cs

Additional product info is available online


Shampoo & Body WashItem # Size Unit of SaleDermaVera

600-SCC8 8 ounces 48/cs

600-SCC1 1 gallon 4gl/cs

Peri CareItem # Size Unit of SalePeriGiene

600-SCP8 8 ounces 48/cs

600-SCP1 1 gallon 4gl/cs

LotionItem # Size Unit of SaleDermaDaily

600-SCM4 4 ounces 96/cs

600-SCM8 7.5 ounces 48/cs

600-SCM1 1 gallon 4gl/cs

600-SCM9 Empty Bottle | 8 ounces ea

Antimicrobial SoapsItem # Size Unit of SaleDermaKleen

600-SCL12 7.5 ounces 24/cs

600-SCL1 1 gallon 4gl/cs

Hand SanitizersItem # Size Unit of SaleGelRite

600-SCS4 4 ounces 24/cs

600-SCS17 16 ounces 12/cs

GlovesItem # Size Unit of SaleEmbrace Nitrile Exam Gloves

600-NW11 Small 100/bx | 10 bx/cs

600-NW12 Medium 100/bx | 10 bx/cs

600-NW13 Large 100/bx | 10 bx/cs

600-NW14 Extra Large 100/bx | 10 bx/cs

Embrace Stretch Synthetic Exam Gloves

600-SS11 Small 100/bx | 10 bx/cs

600-SS12 Medium 100/bx | 10 bx/cs

600-SS13 Large 100/bx | 10 bx/cs

600-SS14 Extra Large 100/bx | 10 bx/cs

Glove Box Holder

500-DGLV-WR N/A ea



The following chart is a guide to the premium ingredients found in our proprietary Embrace and Compliance skin care products. Each ingredient provides unique benefits to fragile skin.

F309: Quality of Care

Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.

IntentThe facility must ensure that the resident obtains optimal improvement or does not deteriorate within the limits of a resident’s right to refuse treatment, and within the limits of recognized pathology and the normal aging process.

Interpretive GuidelinesDetermine if the facility is providing the necessary care and services based on the findings of the comprehensive assessment and plan of care. If services and care are being provided, determine if the facility is evaluating the resident’s outcome and changing the interventions if needed. This should be done in accordance with the resident’s customary daily routine.

Ingredient Benefits

Aloe vera Heals and softens the skin X X X X X X XBeeswax Increases skin’s essential moisture X X

Chamomile Softens and soothes skin and has antioxidant and anti-inflammatory properties X X X

Cranberry A light, non-greasy moisturizer that is rich in antioxidants X

Dimethicone Forms a protective layer on the skin that helps retain natural moisture X X X X

Lanolin Protects, softens and soothes skin X XOlive oil Helps prevent dry skin and is a mild antibacterial agent X X

Purified water Free of any impurties that could interfere with a product’s stability and performance X X X X

Shea butter Contains natural fatty acids that help nourish and moisturize skin X X

Sunflower seed oil Rich in vitamins, helps moisturize and condition the skin XSweet almond oil An excellent emollient and moisturizer X X X

Vitamin E High levels of antioxidants, reduces transepidermal water loss, strengthens skin’s barrier function X X X X

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References

1 Centers for Medicare & Medicaid Services. State Operations Manual. Appendix PP - Guidance to Surveyors for

Long Term Care Facilities. Rev. 70, 01-07-2011. Available at: http://www.cms.gov/Regulations-and-Guidance/

Guidance/Manuals/downloads/som107ap_pp_ guidelines_ltcf.pdf. Accessed September 4, 2013.

2 Gray M. Incontinence-related skin damage: essential knowledge. Ostomy Wound Manage.

2007 Dec;53(12):28-32.

3 Gray M. Incontinence associated dermatitis. Available at: http://www.sageproducts.com/documents/pdf/ education/studies_articles/iad/sage10212.pdf.

Accessed September 4, 2013.

© Professional Medical, Inc. We reserve the right to correct any errors that may

occur within this brochure.

These pages are intended as a general in-service guide only. Please refer to your facility, state and federal guidelines before developing policies. Professional Medical, Inc., its affiliates or its related companies are not liable for any adverse outcomes

arising from the use of this guide.

Professional Medical, Inc., ProMed, Compliance, Embrace and We Make Improving Care Easier! are trademarks of

Professional Medical, Inc.

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in-service guide: skin care® in... · 2013-11-12 · professional medical’s exclusive embrace...

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