Reducing ostomy infection risk

Having an ostomy may not be the most desirable situation for a resident, but proper care of the ostomy site can avoid unnecessary infections and maintain the resident’s dignity and comfort.

“When it comes to an ostomy, much of it comes down to attitude,” says Estelle “Mickey” Galindo, RN, a certified wound and ostomy care nurse (CWOCN) at Nu-Hope Laboratories, Paciona, Calif., and the Keck Cancer Center at the University of Southern California. “People see this opening in their bodies, and they can be fearful of it. But they need to remember that having an ostomy is a lifesaver, because it has eliminated a disease process from their bodies. In addition, it gives them control and enables them to live a normal life again.”

Galindo says she encourages people who have an ostomy to recognize it as simply a different way to do something they have done all their lives: eliminate waste from their bodies. “Elimination is a natural process,” she says. “Having an ostomy represents a new process, but it’s like anything new—once you learn it and get used to it, it’s not so scary.”

Older adults can face some challenges with ostomies because their skin tends to be thinner, less elastic and have less active sebaceous glands than the skin of younger people, making older skin drier and more fragile. In addition, elderly people typically have less immune response than younger people.

KEYS: FIT, SIMPLICITY, NO WIPES

The good news is that caring for an ostomy site is relatively easy as long as the pouching system is properly fitted, Galindo says. A key here is to ensure that the appliance is examined for proper fit when the resident is in a variety of physical positions. Sitting, for example, may cause a crease in the skin that doesn't exist when a resident is standing or lying down. Proper fit is essential, and many different types of pouching systems are available to ensure an accurate fit regardless of a resident’s age or body type.

Beyond proper fit, Galindo says the second most important aspect of ostomy site care is keeping it simple.

“In many cases, people with a new stoma are cleaning the site with different kinds of soaps and [are] applying preps and creams to the extent that if the skin becomes irritated, you’re unsure about the contributing factors,” Galindo says. “I like to eliminate all the chemistry. Clean the site with plain water, dry by blotting or air-drying, and then apply the appliance without adding powders, preps or lotions.”

Dianne L. Feeser, MS, RN, CWOCN, a member of the national board of directors of the Wound, Ostomy and Continence Nurses Society (WOCN), says that the main goal in ostomy care is preserving the skin around the stoma, and she strongly agrees with the concept of keeping things simple.

“Simple is better,” says Feeser, who also is a gerontologic clinical nurse specialist (GCNS-BC). “When you clean the skin surrounding the stoma during a pouching system change, most CWOCNs advocate using plain water and then drying thoroughly. If you do use soap, choose one that doesn't have any oils or lotions in it, because those ingredients interfere with the adherence of the pouching system to the skin.” Original Ivory or Dial bar soaps are good choices here, she says.

In addition, avoid using any type of incontinence wipes around an ostomy site. “Many nurses—including myself, until I learned otherwise—grab those to wipe off the surface of the skin around the stoma,” Feeser says. “It’s quick, it’s efficient—and it pretty much ensures that your pouching system will not stay adhered. Those wipes are designed to repel effluent and, therefore, they also repel the adhesive on the barrier of a pouching system.”

MORE TIPS

Other tips and insights from Feeser:

  • If a resident’s pouch is leaking in any way, it must be changed to a different pouching system. “Some people think, ‘I can put a little tape or paste where the leak is and dam it up,’ ” Fesser says. “That is not appropriate. Any time the abdominal skin is exposed to drainage from an ostomy, the pouching system needs to be changed.”
  • Don’t let the pouch get too full. Extra weight increases the chance of the pouching system pulling away from the skin. Empty the pouch when it is no more than one-third full.
  • Size the opening in the barrier correctly. Depending on the product, the barrier may be pre-sized or may be sized by rolling or stretching it. “The key is that you want the opening as close to the stoma as possible, because our number one concern is preserving the peristomal skin,” she says.
  • Change a pouching system first thing in the morning, before the resident has had anything to eat or drink. This is when the gastrointestinal tract is at is “quietest” and reduces the risk of the stoma producing its daily output onto a resident’s just-cleaned peristomal area.
  • Change the pouching system regularly—at least every three days for waste that is higher in liquid content and at least every five days for more solid waste. Waiting longer than that increases the risk that the barrier will erode away.

TWO PLEAS

Feeser concludes with two pleas to caregivers. The first: “Please call the devices ‘pouching systems,’ not ‘bags,’ ” she says. “It’s far more dignified. Nobody wants to hear, ‘I’m here to change your bag.’ ”

Second, if you need help with residents who have ostomies, seek out the advice of a CWOCN in your area. A list of CWOCNs can be found on the website’s “Patient Information.

“Get help if you need it,” Feeser says. “Don’t let the residents suffer through the discomfort of irritated skin or the humiliation of a leaking pouching system. There are hundreds of different ostomy care products available, and often, to determine which ones are best for any specific resident, it’s necessary to seek professional advice.”

Ostomy care resources

Several resources regarding caring for residents who have ostomies are available:

  • The Wound, Ostomy and Continence Nurses Society (WOCN) is an international nursing society of more than 4,000 nurse professionals who are experts in the care of patients with wound, ostomy and continence problems. The society’s website features a wide range of resources for both residents with ostomies and caregivers, ranging from pouching systems to psychosocial issues. Also available: ostomy travel tips and an ostomate bill of rights.
  • Dianne L. Feeser, MS, RN, CWOCN, a member of the WOCN's national board of directors, recommends two specific resources on the WOCN website focused on residents of nursing homes and assisted living centers and their caregivers: a 17-page brochure titled “Basic Ostomy Skin Care, A Guide for Patients and Health Care Providers, and a 15-page booklet, “Colostomy and Ileostomy Products and Tips: Best Practice for Clinicians.”
  • For nurses interested in becoming certified in ostomy care, the Wound, Ostomy and Continence Nursing Certification Board (WOCNCB) is a not-for-profit professional, international nursing organization that began certifying nurses in 1978 as a way to recognize and differentiate the value of expert nurses from those at an entry level. The WOCNCB is accredited by the Accreditation Board for Specialty Nursing Certification and offers five wound, ostomy and continence care certifications.
  • United Ostomy Associations of America (UOAA) is an association of affiliated, non-profit support groups dedicated to improving the quality of life of people who have or will have an intestinal or urinary diversion, and their caregivers. The association’s website features general information and information about diet, nutrition and sexuality as well as access to support groups and discussion boards. View the “Living With an Ostomy” video.
  • The National Institutes of Health offers information on disease management and coping as well as tutorials, videos, patient handouts and links to other government and private resources. Visit www.nlm.nih.gov/medlineplus/ostomy.html.

Ron Rajecki is a contributing writer based in Cleveland.


Topics: Clinical , Clinical Leadership , Clinical Resident Safety , Resident Care , Uncategorized