Best Practice for the prevention and management of moisture lesions
Deborah Glover, RGN, BSc (Joint Hons), Dip. C, P & M
Pressure damage or moisture lesion?
Differentiating between sacral pressure damage and moisture lesions is not always straightforward. Fortunately, help is at hand.
As mentioned in Sally William’s article, the All Wales Tissue Viability Forum and All Wales Continence Forum, have joined forces to produce an excellent document, the All Wales Best Practice Statement on the Prevention and Management of Moisture Lesions [1]. The aim of this document is to provide guidance on the detection, prevention, assessment, and management of moisture lesions caused by incontinence and perspiration.
What is a moisture lesion?
In this document, a moisture lesion is defined as:
‘…being caused by urine and/or faeces and perspiration which is in continuous contact with intact skin of the perineum, buttocks, groins, inner thighs, natal cleft, skin folds and where skin is in contact with skin’.
The first indication of damage is likely to be erythema on intact skin, usually painful. Excoriation can lead to superficial broken skin which is red and dry, or macerated skin, which is red and white, wet, soggy and shiny (Figure 1). If the damage occurs in the natal cleft, a linear vertical split is seen. Otherwise, damage is uneven. A ‘kissing ulcer’ is damage to either side of a skin fold.
Management
MANAGE THE INCONTINENCE!
One cannot begin to treat the skin damage if the source of damage, i.e. moisture from urine and/or faeces is present. Other considerations include:
- skin monitoring
- good skin care – soap should be avoided as it can increase the pH balance of the skin. Skin cleansers are an alternative, maintaining the Skin’s pH and usually containing a surfactant for protection. Barrier creams and skin protectors can be used
- ensuring a good nutritional status
- maintaining an optimal microclimate
- repositioning of immobile patients
- pressure relief
The authors conclude the document by stating that as part of the holistic assessment, the skin and continence status should be assessed regularly, as early recognition and use of appropriate interventions can prevent moisture lesions occurring.
Skin should be cleansed after each episode of incontinence using pH-friendly skin cleaners rather than soap and water, which can strip the skin. A barrier product should be used.