17.8 Appropriate selection and use of barrier creams and films

A soap substitute (e.g. proprietary shower gel)

  • for normal skin care cleansing/hygiene when the skin is vulnerable for example with incontinence. (Soap and water is not recommended for cleansing a patient with urinary or faecal incontinence as it is alkaline and can upset the pH balance of the skin) (Beldon 2007)
  • Products should only be prescribed if there is a therapeutic need. There should be a clear rationale for the prescriber item documented in the notes/careplan, and there should be regular review of the indication for the prescribed item

A liquid barrier cream, Medi Derma-S®

  • To prevent skin damage from moisture exposure and for moisturising patients' skin who are at high risk of developing a moisture lesion or incontinence-associated dermatitis, as identified by a skin assessment (such as those with incontinence, oedema, dry or inflamed skin). This can be applied to dry, intact skin and damaged/ excoriated skin. They provide a barrier between the skin and the irritant. Sachets should only be used in the Secondary Care setting. In the Primary Care setting, in patient's homes and in care homes, tubes should be used.

A liquid barrier film, Medi Derma-S®

  • To prevent skin damage from moisture exposure, and can be applied to damaged/ excoriated and/or intact skin, without stinging and dry quickly to provide a waterproof barrier protective against irritants such as faeces and urine. They contain silicone polymers such as dimethicone and create a dry, water repellent, transparent barrier. The film locks in moisture to hydrate and protect the skin. For use in small areas such as around stomas and wounds. The aerosol is used for greater surface areas and difficult to reach areas.

Medi Derma-Pro® Foam and Spray Cleanser

  • Incontinence cleanser that is pH balanced, skin friendly, no-rinse, moisturising cleanser suitable for use on compromised and at-risk skin from moisture associated skin damage, particularly severe incontinence and excessive moisture.

Medi Derma-Pro® Ointment

  • Skin protectant and moisture barrier ointment designed to provide effective skin protection from the effects of urine, faeces, friction and shear for both at risk and compromised skin. It forms a long lasting protective waterproof barrier that protects and prevents associated trauma to at-risk skin, whilst repairing and restoring the integrity of compromised skin. Can be applied to broken and unbroken skin. For moderate to severe skin damage and can be used with continence pads.

Please note that applying multiple layers of barrier products should be avoided. It will make the area uncomfortable for the patient and cracking of the product can occur which will allow moisture to penetrate.

Resources

  • All Wales Tissue viability Forum and All Wales Continence Forum, 2014, Best Practice Statement on the Prevention and Management of Moisture Lesions
  • Beldon, 2007, The impact of Faecal Incontinence on Wound Care Continence UK 1(2) 8-13
  • NICE 2012, Baseline Assessment tool for NICE Guideline on Pressure Ulcers (CG179)
  • Medicareplus International Limited, 2016, Patient Information Leaflet, Medi Derma-Pro® Foam and Spray Incontinence Cleanser

 

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