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Clinical guidelines

What is the importance of maintaining skin integrity in vulnerable patients at risk of pressure injury or moisture lesions.

Maintaining skin integrity

The skin is the largest organ of the body and provides an effective barrier between the internal tissues and the external environment (Flour, 2009).

It protects the body from the effects of temperature, as well as chemical, physical and mechanical hazards and prevents harmful substances such as micro-organisms from entering the body.

It also acts as a water resistant barrier so essential nutrients are not washed out of the body (DermNet NZ, 2012).
The structure of the skin varies depending on the anatomical region of the body and changes with ageing as a response to recurrent trauma/stressors and continued exposure to UV radiation. The maintenance of skin integrity is critical for the prevention of pressure injuries.

Maintaining skin integrity involves a balance of ensuring that external loads and forces on the skin are not damaging the skin as well as intrinsic factors such as the general health of the person and the ability of the skin to resist damage.

In the past, there has been a focus on providing optimal support surfaces to patients at risk of pressure injury formation that reduce the mechanical load on the skin.

There is now a need to consider interventions that affect the microclimate by modifying the environment at or near the skin surface (Wounds International, 2010).

What is a microclimate?

In wound care, microclimate is a term used to describe the interface between the skin and the surface with which it is in intimate contact. It refers, primarily to the temperature (of the skin or the soft tissues) and humidity (or skin surface moisture levels) (Clark and Black, 2011).

A poor microclimate that results in skin that is too warm and too moist reduces the resilience of the skin and increases its susceptibility to damage from pressure, shear or friction.

Managing the skin microclimate* may involve controlling the general environment such as maintaining an optimum room temperature, avoiding the use of synthetic materials against the skin or using specific equipment to control the microclimate.

This may include the warming devices used to prevent the tissues becoming too cold when patients have long periods in theatre (NICE, 2008) or specialist devices that keep the skin dry and at an optimum temperature (eg Skin IQ™ MCM) (Clark and Black, 2011). Controlling the microclimate is very important for pressure injury prevention and treatment.