Proshield Questions & Answers

1. What are the Proshield range indicated for?

   Proshield Plus is a barrier cream and Proshield Foam and Spray is a no rinse foam cleanser. The range are indicated for both intact and injured skin associated with incontinence.

   Proshield provides protection for at risk skin, is effective for incontinence associated dermatitis, skin lesions and up to grade 2 pressure ulcers.

2. What is incontinence associated dermatitis?

   The increase in moisture resulting from episodes of incontinence combined with bacterial and enzymatic activity can result in the breakdown of vulnerable skin. Incontinence associated dermatitis is a skin condition that affects people who are incontinent and results in: inflamed, excoriation, infected and damaged skin. IAD causes pain, discomfort and increases the risk of pressure ulcers.

3. What is the difference between incontinence associated dermatitis and a stage 1 pressure ulcer?

   Incontinence associated dermatitis is caused by inflammation and may be located around genital, skin folds. The appearance may progress from pink to dark red (inflamed) may look like a rash. Borders of injury are diffuse.

   Pressure Ulcers, Stage I, are caused by ischemia and is localised over bony prominences. The appearance is non-blanchable erythema of intact skin. Discolouration of skin, warmth, oedema, induration or hardness may also be indicators.

4. What is the difference between a moisture lesion and a stage 2 pressure ulcer

   Moisture Lesions. For moisture lesions to occur moisture must be present and can be caused by friction and moisture. Located over bony prominence (shear and friction excluded). Those limited to anal cleft. The appearance is diffuse, irregular edges, different superficial spots and kissing ulcers. No necrosis. Peri-anal redness/skin irritation is most likely to be ML due to faeces.

   Pressure Ulcer: Grade II are caused by: pressure and/or shear must be present, localised over bony prominences. The appearance: partial thickness skin loss involving epidermis, dermis or both. Superficial and presents clinically as an abrasion or blister. Distinct edges, limited to one spot, circular or wounds with regular shape if friction has been excluded.

5. What are best practice recommendations for incontinence and pressure ulcers?

   Incontinence forms part of pressure ulcer protocols:

• Risk assessment - Waterlow /Braden - Level of risk based upon protocols
• Structured skin care regime - Gentle cleansing and moisturising; Skin protection / moisture barrier
• Pressure repositioning strategies
• Nutrition

7. What are best practice recommendations for skin cleansing?

   Best Practice Guidance recommends the use of foam cleansers as cleansing with soap and water can contribute to the development of pressure ulcers.

8. How does Proshield cleanser fit with recommendations?

   Proshield is a gentle formulation ideal for cleansing skin at risk of break down from continence related issues:

• No-rinse formula
• Gentle and pH balanced
• Minimises irritation of intact or injured skin
• Formulated to and break down dried stool and help to eliminate odour
• Moisturisers leaves skin supple and hydrated

9. How do I apply Proshield Foam and Spray?

   Proshield can be used as either a spray for stubborn faeces or use or switch to a foam mode. Foam is used more frequently as it stays in place whilst cleaning awkward body areas.

   Spray Proshield foam and spray cleanser onto the affected area and wipe off. Proshield Foam & Spray cleanser is used prior to the application of Proshield Plus. No rinse or use of a moisturiser is necessary.

10. What is different about Proshield Plus?

    Proshield Plus has a dimethicone (silicone) base however, unlike other dimethicone based products contains co-polymers adhesives which result in a “sticky” consistency which keeps the barrier on the skin and ensures excellent protection for both injured and intact skin associated with incontinence.

11. What are the indications for Proshield Plus?

    The only barrier cream in the UK indicated for use on intact and injured skin associated with continence

• Effective barrier cream
• Smooth, greaseless, fragrance free barrier
• Adheres to moist and dry skin
• Indicated for intact or injured skin to grade II pressure ulcer
• Provides protection from urine, faeces and prevents incontinence associated dermatitis(IAD)
• Provides protection from friction and shearing forces

12. How frequently should Proshield Plus be applied?

    For the best results we recommend thorough cleansing to be carried out after each episode before the barrier cream is re-applied.

    The instructions for use however state that re-application should be repeated as often as necessary. Therefore as long as there is a ‘sheen’, protection is still provided and fits with your current local protocol.

13. Does Proshield heal wounds?

    No. Proshield Plus does not actively heal wounds but provides a protective barrier and a moist wound healing environment allowing the body’s own healing to occur.

14. Will Proshield Plus block pads?

    Proshield Plus is dimethicone based, therefore will not clog up or impair function of continence briefs and pads.

15. If you had I.A.D. but also a fungal infection (e.g. thrush) in a skin fold, would Proshield exacerbate this if applied?

    Proshield alone should not be used in the presence of a yeast/fungal infection. However if applied over an antifungal/anti-yeast cream it will "lock-in" the medicated cream. The combination works very well and is used extensively in Canada. Proshield has been used to help to prevent infection when applied to skin folds.

16. Can Proshield Plus be used for any other indications?

• Prevention of pressure ulcers (reduces friction & shear)
• Treatment of Partial-thickness wounds- Skin Tears
• Maceration peri-wound skin
• Maceration and friction around drains, J and G tubes, Supra-pubic catheters, Tracheostomy and Nasal Cannula sites - (contains no petrolatum-safe to use near oxygen)
• Skin folds
• Clinically dry skin