In-Service Guide:

Skin Care

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P RO FESSIO N A L

M ED ICA L ,

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Shampooing & Bathing 1

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

Regulate temperature and flow of water prior 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.

3

4

Fold washcloth into a mitt or gather corners together.

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In-Service Guide: Skin Care

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.

5

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

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2

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.

6

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

8

7

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.

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

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Perineal Care 1

Use the following procedure for providing perineal care Materials 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.

3

4

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.

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In-Service Guide: Skin Care

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.

5

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

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2

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

6

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

*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.

*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.

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Perineal Care

Cleanse, Moisturize and Protect Three 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

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In-Service Guide: Skin Care

Preventing breakdown One 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).

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Best-in-class products

Step 2: Moisturize

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.

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.

Step 1: Cleanse 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.

The 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.

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

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.

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Lotion Application 1

Use the following procedure for lotion application Materials needed: Lotion

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

3

4

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.

8

In-Service Guide: Skin Care

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

5

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.

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2

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

6

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

8

7

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

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

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Handwashing 1

v

Use the following procedure for handwashing Materials needed: Hand soap and clean paper towels

Turn on warm water. Wet hands.

3

4

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

10

In-Service Guide: Skin Care

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

5

Clean under nails if needed.

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2

Apply soap to hands to produce lather.

6

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

8

7

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

Discard towel appropriately without contaminating hands.

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Hand Sanitizer Application 1

Use the following procedure for hand sanitizer application Materials 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.

3

4

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.

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In-Service Guide: Skin Care

With your fingers interlaced, rub your palms together.

5

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

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2

Rub your palms together.

6

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.

8

7

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.

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!

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Advanced Skin Care

Embrace™ and Compliance® Skin Protectants Moisturize 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 skin n Enhanced with dimethicone, chamomile and organic aloe vera n Helps prevent and treat perineal rash n Forms a protective barrier to help seal out wetness n 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 oxide n Dermatologist tested n Antimicrobial

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Item # Size Embrace Skin Protectant with Breathable Barrier 600-BC4N1

6 ounces

Unit of Sale 12/cs

Compliance Antimicrobial Skin Protectant 600-BC3N1

6 ounces

12/cs

Embrace™ Moisturizing Cleanser & Skin Protectant with Breathable Barrier Cleanse, 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 water n Creates a protective, breathable barrier against wetness n Enriched with dimethicone n Cleanses, moisturizes and protects in a single step n pH balanced for delicate skin Item # Size Unit of Sale Embrace Moisturizing Cleanser & Skin Protectant with Breathable Barrier 600-MC4N1

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In-Service Guide: Skin Care

6 ounces

12/cs

Embrace™ Skin Repair Cream Daily 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 use n Forms an invisible protective barrier with dimethicone n Nourishes and rejuvenates skin with organic aloe vera and vitamins A and D Item # Embrace Skin Repair Cream

Size

600-SC4N1 600-SC4N1-32

Unit of Sale

8.5 ounces

ea

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.

Additional product info is available online

Features: n Rinse-free formula n pH balanced and hypoallergenic n Latex- and alcohol-free Item # Embrace Skin Caring Washcloths 600-WC5N1

Size

Unit of Sale

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 Cleanser Moisturize and protect skin Embrace Skin Caring Total Body Foam Cleanser has a gentle, no-rinse multipurpose formula 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 Antimicrobial n Leaves the skin clean and conditioned n Rich foam rapidly removes urine and feces to help ensure effective skin cleansing n Specially formulated for delicate skin Item # Size Embrace Skin Caring Total Body Foam Cleanser 600-SCP8-F

8 ounces

Unit of Sale 12/cs

Embrace™ Moisturizing Hand & Body Cream

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Cleanse, moisturize and protect skin

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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 caregivers n Convenient pump top n Enriched with aloe vera, lanolin and vitamins A, D and E n Fragrance and dye free n Can be applied liberally to hands and any other areas in need of moisture, such as elbows and feet Item # Size Embrace Moisturizing Hand & Body Cream 600-HC4N1

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In-Service Guide: Skin Care

16 ounces

Unit of Sale 12/cs

Shampoo & Body Wash Item # DermaVera

Size

Unit of Sale

600-SCC8

8 ounces

48/cs

600-SCC1

1 gallon

4gl/cs

Item # PeriGiene

Size

Unit of Sale

600-SCP8

8 ounces

48/cs

600-SCP1

1 gallon

4gl/cs

Size

Unit of Sale

Peri Care

Lotion Item # DermaDaily 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

Size

Unit of Sale

Antimicrobial Soaps Item # DermaKleen 600-SCL12

7.5 ounces

24/cs

1 gallon

4gl/cs

Size

Unit of Sale

4 ounces

24/cs

16 ounces

12/cs

Size

Unit of Sale

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

600-SCL1

Additional product info is available online

Hand Sanitizers Item # GelRite 600-SCS4 600-SCS17

Gloves Item # Embrace Nitrile Exam Gloves

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

N/A

ea

Glove Box Holder 500-DGLV-WR

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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.

• E m C brace w leanse Moistu ri ith B r & S ki zing reat hab n Prote • E le B c m arri tant T brace er otal S Bod kin Ca y Fo r ame ing r • E mbr w a ith B ce Skin reat hab Protect a le B arri nt • C er S omplia n k in Prot ce Ant imic ecta rob nt i al • E mbr S ace w kin Car Sensiti ith B ing W ve reat hab ashclo th • C le B arri s o m er W plia nce ash S clot hs kin Ca ring • E mbr R a epa ce Ski n ir C ream • E m H brace and M & B oisturi z ody Cre ing am

Key Skin Care Ingredients & F-Tag Regulations

Ingredient

Benefits

Aloe vera

Heals and softens the skin

Beeswax

Increases skin’s essential moisture

X X

Chamomile

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

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

Lanolin

Protects, softens and soothes skin

Olive oil

Helps prevent dry skin and is a mild antibacterial agent

Purified water

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

Shea butter

Contains natural fatty acids that help nourish and moisturize skin

X

Sunflower seed oil

Rich in vitamins, helps moisturize and condition the skin

X

Sweet almond oil

An excellent emollient and moisturizer

Vitamin E

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

X

X

X X

X

X

X

X

X

X

X

X

X X

X

X

X

X

X

X

X X

X

X

X

X

X

X X

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. Intent The 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 Guidelines Determine 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.

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In-Service Guide: Skin Care

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1917 Garnet Ct. New Lenox, IL 60451 800.648.5190

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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. 708-Skin_Care_Inservice_Guide [08/13]