"Crusting": Use of Stoma Powder and/or Skin Barrier Films/Sprays on the Peristomal Skin

Introduction: Today, ostomy management is often referred to as an art and not a science. As WOC nurses, we want to further understand the concept of using stoma powder and skin protectant spray/wipes in ostomy management and the clinical indications for its use. Peristomal skin is often treated with a technique referred to as “crusting”. There is little consensus among WOC nurses as to what “crusting” encompasses as well as minimal research to address the efficacy of “crusting”.

Objectives:

1. Identify what is considered the “crusting” technique

2. Determine if WOC nurses are using “crusting” technique.

Method: A 12 question survey was developed and reviewed by a panel of independent educators. The survey was forwarded electronically to WOC nurses who are members of the WOCN Society and nurses who are members of the CAET of Canada. 894 responses were obtained. Raw percentages were used to analyze the data.

Conclusion: Of the respondents, up to 50% of their time was spent providing ostomy care to both urine and fecal diversions patients. 71% are using stoma powder and 71% use skin barrier film/spray when using stoma powder to seal in the powder. 98% have heard of the term “crusting”. Two techniques for performing “crusting” were identified to treat peristomal moisture associated skin damage and medical adhesive related skin injury. There were over a 100 variations on these two techniques identified. Initiation of using “crusting” was based on anecdotal experience, taught in WOC training or by their preceptor, and supplies are easy to obtain. 31% identified as best practice.

It is clear that the majority of the WOC nurses surveyed is using the “crusting” technique and describes it in the same manner. However, we ascertain that there were over 100 variations in the description that they relayed to us.