While there are many challenges in long-term care, wound care presents one of the biggest. Fortunately, there is a growing body of technologies and products to improve the management of wounds. At Founders Pavilion, Corning, NY, we've found great success with a small group of products that contain dimethicone. While these products are used for various types of wounds, dimethicone seems to be the key ingredient.

Formulations

There are five formulations that we use:

1. Zinc oxide and dimethicone promotes healing of stage 2 pressure ulcers or stasis ulcers. The zinc oxide in these products is so fine that it makes its way easily into the wound bed. The dimethicone provides moisture, which keeps the skin lubricated to decrease friction and helps make it easier for cleansing.

2. Petrolatum and dimethicone is used as a protectant and to help prevent skin breakdown.

3. A treatment of miconazole nitrates, zinc oxide and dimethicone is used to treat fungal infections. It also provides a protective barrier and is found to work well on skin folds.

4. A treatment containing colloidal silver, zinc oxide and dimethicone provide antibiotic and or antimicrobial effects. The silver helps deodorize and promotes healing. This product is used on large, painful and odorous wounds.

5. A bacitracin, zinc oxide and dimethicone spray helps prevent infections and provides a protective barrier for skin tears, cuts or abrasions. It doesn't need to be rubbed in and leaves no build-up on the skin, which decreases the risk for infection. It reduces pain and, in some cases, the need for dressings.

Case Study

A resident with 27 wounds and an order to see a plastic surgeon was admitted to Founders Pavilion. After review with her attending physician, we began treating her wounds with zinc oxide and dimethicone.

Soon after initiating this treatment, she was able to more actively participate in her rehabilitation due to the decrease in bulky dressings. Her wounds all showed signs of healing within seven days. Seven of the smaller wounds, which had been chronic prior to her admission, were healed within a week. Upon discharge two and a half months later, all her wounds were healed, including a stage 3 pressure ulcer.

She was not the only resident to benefit from these treatments. Since this product has been used in our prevention program, the overall prevalence of wounds related to pressure, incontinence, shearing and irritation due to increased moisture has decreased.

Teamwork

As we all know, wound care does not get resolved by products only. Each facility should have a skin care team. Our team consists of a treatment nurse, resident care coordinator, director of nursing, LPNs, CNAs, housekeeping, social work and physical therapy departments. Our treatment nurse provides treatments and monitors wounds daily. The team meets every month or more if needed.

The entire staff and the residents themselves need to be involved in a skin care program. It takes the entire team working together, focused on a common goal to make prevention and healing successful.

Beth Beecher is director of nursing, Founders Pavilion Inc., Corning, NY.