If you are involved with the administration of neurodiagnostic testing, you are familiar with the frustration of dealing with skin breakdown. Understanding why it happens, and therefore how to prevent it, is critical to providing the best care possible.
This is why the ASET Standards and Practices Committee established the Skin Safety Task Force to delve into the issue. Petra Davison, BS, R. EEG/EPT, FASET, presented on behalf of the Task Force at the 2019 ASET meeting. She described the committee’s activities and the results they yielded.
At the outset, the committee was given three key directives:
- Complete a survey of skin breakdown and how it affects neurodiagnostics as a whole. By executing this directive, which included a popular survey published on the ASET website, the Task Force found that skin breakdown is an issue in all areas of neurodiagnostics.
- Perform a literature review to determine common etiologies of skin breakdown. The committee found the literature review absolutely crucial to their work. It included a review of 50 academic journals and showed that skin breakdown is a multifactorial issue. Both the materials used and skin preparation were implicated. In addition, the Task Force found that humidity (region of the country) and nutrition (typically worse in the ICU) worsened skin breakdown. The literature was also consulted for best practices so guidelines would be evidence-based. In general, they found that skin breakdown is not 100 percent avoidable, but there are steps that can be taken to prevent or lessen its impact. Davison emphasized that the National Pressure Ulcer Advisory Panel should be a go-to resource, as it offers free education on pressure ulcer prevention and treatment.
- Develop skin safety guidelines to reduce skin breakdown in neurodiagnostics. By using the results of the survey and literature review, the Task Force was able to create evidence-based guidelines that have the potential to change the course of a healthcare problem that has real consequences for patient outcomes.
The directives naturally expanded over the years the Task Force was active, but these initial three formed the basis of their work. After successfully completed their mission, the Task Force disbanded on a high note, having created a library of valuable skin safety resources.
Their work includes the ASET Position Paper on Skin Safety During EEG Procedures. These guidelines have been cited in several journals, including Neurology, the publication of the American Academy of Neurology. The guidelines start with skin preparation. They then address the whole testing process from electrode selection and application to applied electrode impedance. They finish with skin safety checks.
Later, the Task Force added an addendum for skin safety in neonatal continuous EEG. They also created a video reviewing key areas of the position paper, designed a Skin Safety Course, authored several journal articles, and presented a poster at the 2016 ASET annual meeting.
While these are exciting results, their value lies not in the end products, but in the way these products are used to make neurodiagnostic care safer and more effective. That can only happen when those who directly care for patients use these resources to improve their practice and the health of their patients.
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