More Than One Good Reason to Use Skin Prep

As seen in the Consultant Connection July 2016 Issue
by Susan M Cleveland BSN, RN, WCC, CDP

Skin, largest organ of the body, is designed to protect against outside forces of evil. The world’s daily caustic barrage of fluids and other traumatic events can take their toll on the healthiest skin. Consider tissues weakened by age and co-morbidities now attempting to withstand these assaults. The care provided must include consideration for maintaining the skin’s integrity. This includes applying barriers that allow for dressing adherence and the natural process of skin sloughing.
During recent wound rounds, five out of nine residents were experiencing dressing adherence problems. All of these elderly individuals had dry skin, dehydration, poor circulation, lack of mobility, and other issues. We are treating pressure injuries (new National Pressure Ulcer Advisory Panel term), stoma sites and moisture associated injuries on the group. My first question is: Are you using any skin prep? Although skin prep is recommended as part of the dressing application protocol, it was skipped, in this example, 55% of the time. 
Two of the residents had excessive moisture related to incontinence and required frequent dressing replacement. The other three had several denuded areas from either shearing or the dressing pulling off ‘good’ tissue. In all five cases an application of skin prep could very likely have prevented the adherence problem. 
Thorough wound and peri-wound cleansing and skin prep application as part of wound care protocol are essential to maintaining skin integrity and a lasting dressing adherence. Skin prep is often utilized in prevention with application to mushy heels, superficial tissue injuries, without hesitation. Many other uses for skin prep include protection from moisture associated skin damage (MASD), skin tears, and ostomy device adherence.  There is more than one reason to use skin prep and they are all for the good of the resident in measured outcomes.
There are many non-sting prep products on the market. Marathon Cyanoacrylate Skin Protectant and 3M Cavilon are examples. Visit ICP’s website,, to review studies on Medline’s Marathon product.