The skin is the largest body organ. It is essential to managing the body's water and temperature through sweating and evaporation. The skin is also the first line of defense against infection. The health of the skin becomes a concern when a person is not able to move around or change their position without help. Fluid retention, poor nutrition, and general ill health make the skin more vulnerable to break down.
Please follow the links below to learn more about skin problems that may come up in critical care, and what is done to prevent and treat them.
- Surgical incisions are made in the sterile environment of the operating room. Every precaution is taken to prevent infection, but all surgery carries the possibility of the wound becoming contaminated with bacteria.
- People who are already critically ill are at a higher risk because their bodies are already working hard to heal from their illness or injury. Staff will monitor the incision for infection, keep it clean and bandage it as needed.
- Central lines are placed through the skin into major blood vessels. They are essential to deliver larger amounts of fluid, total nutrition for people who cannot eat, and many medications. However, they also pose a risk for infection because they break through the skin right into a major blood vessel.
- Central lines are inserted in a sterile way after all the bacteria on the skin have been removed with antiseptic. They are monitored and cleaned regularly to prevent infection. Special dressings are applied to decrease exposure to bacteria that can cause infection at the site.
- Also known as bed sores, pressure ulcers happen when a person's skin does not get enough oxygen and nutrients from the blood. Pressure ulcers can develop when a person lays in one position for too long. Critical illness can disrupt blood flow to the skin as well as other organs. People in the Medical-Surgical ICU are particularly at risk for skin breakdown.
- The nursing staff turn patients regularly if it is safe to do so. Many of our staff have taken additional education to assess and manage skin breakdown in intensive care. The ICU has a group of nursing staff who assess each patient’s skin weekly and manage skin treatments.
Prevention and Therapies:
- Patients are helped with bathing as needed. Bed linen is changed regularly. Keeping moisture away from the skin helps keep it healthy and intact.
Turning and Repositioning
- Staff turn and reposition patients every couple of hours if it is safe to do so. This reduces the risk of developing pressure ulcers and help the person get comfortable. There will always be some area that is under pressure, but it can be rotated so the skin is not damaged.
Cleaning and dressing incisions, IVs, and central lines is essential to prevent infections. Staff also emphasize hand washing and the use of gloves.
If a person has been infected with some kinds of bacteria, there may be extra precautions taken to protect staff and other patients from infection. This may include gowns that are worn once then washed, face masks, and eye protection. Please visit Infection Control for more information:
Nutrition and hydration
- Adequate nutrition is essential to keep the skin healthy and intact. If a person is dehydrated or malnourished, it is easier for the skin to break down.
Pressure relief beds
- If it is difficult or impossible for a person to be safely repositioned to relieve skin pressure, they will be given a pressure relief bed. These specialized hospital beds change the amount of pressure under the person at regular times so all parts of their skin get some relief.
- A person may be given antibiotics to treat infection as well as skin washes that kill harmful surface bacteria. Examples of skin cleansers include chlorhexidine and iodine.
IV fluids and electrolytes
- A proper fluid balance is essential to keep the skin healthy and intact. Correcting an imbalance of fluids is an essential step in managing all kinds of critical illnesses.
Topical skin care products
- There are a number of skin care products that are used to minimize skin irritation, help wounds heal, and protect the skin when it shows signs of breaking down.
Diagnostic Tests and Monitoring:
- The skin is inspected every shift as the nurse performs other assessments. He or she will check for any change in the skin, including redness and dryness.
- Tests measuring electrolytes such as sodium can tell staff if a person is well hydrated. These tests are essential to monitoring the health of all body systems.