SKIN CARE

Non-medical and Medical Responders

A bath should occur at least once every 24 hours with spot cleaning as necessary. Unconscious patients should be checked every 2 hours in case of involuntary bowel or bladder emptying. Cleaning the skin is an opportunity to evaluate additional injuries and visualize any new areas of erythema or skin breakdown. This includes a complete wipe down on all non-injured areas using the minimum, better, best method as stated below.8 Conscious patients should actively assist with baths and may use a shower if available. In the event that a shower is used, care should be taken to prevent introduction of water into dressings or invasive lines. Plastic covering and tape may be used to protect these areas.

Unconscious or bedbound casualties:

- Minimum: Use rinsed “baby” wipes*. Be sure to cleanse skin folds, armpits, and groin.
- Best: Full bath with soap, gauze or washcloths, and warm water, followed by changing linen, applying pads to bony areas, applying compression stockings, using pillows to elevate extremities, and providing padding around the casualty.

Guide for bed bath:

- Remove any additional pillows or wedges being used to position casualty.
- Wash face first and genitalia last. (Cleaning genitalia is detailed under Foley care.)
- Prepare a basin or bowl with warm water and a small amount of soap.
- Obtain multiple 4×4 gauze pads or clean washcloths and place in water.
- Expose body part to be washed, keeping the rest of the casualty covered, and place absorbent pad or towel under the area to absorb water.
- Take one gauze or washcloth out of the basin and wring out excess water. Wash small areas of skin at a time starting with the face. Gently wipe the casualty’s face, being sure to clean the eyelids, nose, mouth, and ears. Work your way down the rest of the body.
- Throw away dirty gauze and replace washcloths as you progress to different areas of the body or once contaminated. DO NOT place contaminated gauze or washcloths back into basin or bowl. If supplies are limited, different areas of the washcloth can be used to clean once one section is dirty.
- Alternate cleaning option: Wash/clean the casualty using two-gauge bandage rolls. Dip both rolls into clean water. Dip the second roll into soapy water and wrap around gloved hand. Keep unrolling the cleaned gauge bandage roll while using the opposite hand to clean the skin until the casualty is clean. Use the same method to rinse the casualty.
- Note skin condition, especially areas of reddening or skin breakdown. These areas will need to be checked frequently, and pressure should be relieved from these areas if possible. Document these areas and include size and characteristics.
- Dry skin after cleaning each area, taking extra care to ensure skin folds are dry.
- Comb casualty’s hair. Female hair should be braided on the side to prevent excessive tangling. Braids should not be placed down the back of the head (such as a single French braid) since this can lead to pressure spots.
- Consider changing out old tape and EKG leads every 24 hours, taking available resources into consideration.
- Ensure the skin is dry and apply lotion.
- Replace any pillows or wedges being used to position casualty.

*Caution: If baby wipes or skin wipes are used to wash the skin, the wipes should be thoroughly rinsed with water first, because most contain alcohol and residues that can irritate the skin.