How to deal with infection

I am 4 weeks post ileostomy surgery and have developed a nasty infection around my stoma. I have puss coming out from under the stoma and angry cracked red skin around that. I saw my doctor on Friday and she put me on oral antibiotics and gave me hydrocortisone cream to put on my skin. 

I am looking for some tips on how best to manage my skin as it heals? I am using the Coloplast sensura mio wafer and bag and the Coloplast barrier ring.
When I changed my bag tonight I saw I had a lot of output under the ring which was irritating my skin so I now put a piece of Coloplast protective sheet under the ring. I am not sure if this is recommended or not. 

I think I remember someone saying to use the elastic barrier strips on the wound, but wasn’t sure if I remembered correctly and don’t want to hurt my skin even more. 

Any advice would be appreciated! 
Thank you  

What is happening is the cream is messing with the adhesion of the ring to the skin.

Try avoiding putting cream so close to the stoma or on any adhesive area. Even though you used a protective sheet it's likely not going to work and output will get under that also.

You need clean, dry, dust free and oily free skin for adhesive to stick to skin.

So next time wash the area in the shower with nothing but liquid antibacterial soap, that should kill the infection and dry out the wound. You need to blow dry the area well that any wounds form a dry surface. Apply nothing else. Don't worry your skin will heal just fine. If you drink coffee your burns may be far worse than normal, switch to tea but understand anything caffeine is going to cause diarrhea of the bag and make putting on a fresh bag difficult as the stoma keeps spewing.

You really need Brava no-sting paste at this point to apply a thin cover around the stoma using a flat stick pressing it down and testing if it will stick to wounds, if not you discard and dry and try again until it does. Then you put the protective sheet on top, press flat and down, then the ring and the wafer.

The protective sheet has no sideways protection from output. Thus why you need a paste barrier between it, it's edge and the output. In fact it swells up when it gets wet.

If output gets on the skin or anything before the bag is attached, then you need to start all over. 😢 

I would get extra large barrier strips to put around the flange of your wafer to give it more strength to hold it down.

Rings work fine with clean, dry, flat surfaces but suffer otherwise when things get complicated. Especially if you have little dips caused by wounds.

Bonding an adhesive to wounds is very difficult and I've found antibacterial soap and a dam good blow drying works. Kills the infection, drys out the wound and causes a scab to form which will hold paste. Paste is good at filling in unevenness unlike a ring that's flat underneath.

Note you may have to mix a tiny bit of stoma powder into the paste well first before applying, it doesn't set fast enough sometimes.

The infection internally will be handled by the medication. Outside the antibacterial soap with no moisturizers.

Thank you Shamrock

I want o clarify that I only started using the cream tonight and I put the protective sheet over it. Output was getting under the barrier ring before I had put the cream on my skin. 
I did wait for the cream to fully dry before putting the protective sheet on it. 

About the paste, I have very flat sooth skin around my stoma, does the paste do anything other than smooth out the skin? Does it help heal the skin? 

It'll sting for a second because I believe there's an alcohol component to the paste.  It should protect the area for a few days though and can be very helpful.  I recommend wetting your fingers before smoothing it out though it makes things go much easier.  

I'm not sure if this will help, but every once in a while, if I remove my flange too soon, it rips some skin off with it.  The last time this happened the area got a little inflamed.  I applied Neosporin to the skin then applied a waterproof band-aid to cover the skin, THEN applied my new flange.  It seemed to work really well.  I'm not sure if you could get a band-aid over the area you're talking about, but you could try cutting it to form if necessary.  It might help to keep the cream on for a longer duration.  

Put some power medom 

Stories of Living Life to the Fullest from Ostomy Advocates I Hollister

Power medom? What exactly is that?

You had a leak under the ring, the digestive enzymes bacteria was eating the skin and likely incurred a wound which is infected.

Then you applied cream after that that is designed only to relieve pain but it interferes with adhesive binding to skin or dried wounds regardless if you dried it off or not, it has to be washed off with plain soap and water.

The paste does not heal the skin, the skin does that all by itself. But sticking anything to wounds with an infection is especially difficult. The only method I've found that works is antibacterial liquid soap, rinsing and then blow drying well until a thin crust forms over the wound, then mixing in a little stoma powder into some no-sting paste, which DOESN'T contain alcohol so it won't burn, then applying it with a flat stick and testing it, discarding it if it doesn't and drying and trying again until it does. Then apply the protective sheet over it pressing it down. Then the ring and the wafer.

Normally with your flat skin a ring would work marvelously, however if a wound occurs it causes a dip and underneath the ring its flat, so there is a gap where output gets under the ring again. 

Paste works better for wounds as it flows smoothly into gaps, dips and depressions. So all you need is a thin coat, a thin coat that sticks. Then the protective sheet or even the ring on top.

With the paste you can trial and error, if it doesn't stick your not wasting an expensive ring. Just a tiny bit of paste. 😁 

No sting paste doesn't contain alcohol and thus doesn't sting. Alcohol based paste traps alcohol under the wafer next to the skin and doesn't evaporated thus stinging longer, why it's cheap.

Adapt paste contains alcohol and does sting on wounds.

Wetting ones fingers ruins the paste adhesion.. never introduce water with adhesives with otosmy products..it's designed to repel water like output.

There is no need to smooth paste out with your wet fingers. When a wafer or protective sheet is applied and pressed on, it will smooth things out underneath. All that is needed is the right amount evenly spread as needed.

Skin needs to be clean, dry, dust free and oily free for adhesive to stick. Same for whatever else adhesive is binding to. 

Neosporin is unnecessary and will interfer with adhesive bonding, so will a waterproof bandage. Output will go right through that. It will also go right through a protective sheet or a barrier strip if paste isn't used around the stoma first.

Skin will heal all by itself provided one use antibacterial liquid soap in the shower to wash around the stoma which will kill the infection and dry out the wound. Then blow dry to form a scab so paste can stick to it.

Let your body handle things after that.

The tenancy to put something on leak wounds is caused by pain.

Pain caused by coffee drinking making the output very acidic. Stop drinking coffee. Output is pH 2-3 very bad. Tea is better. Output is pH 8.

Pain caused by alcohol, iodine, or any products (like paste) containing alcohol.

Pain caused by digestive enzymes still eating the skin. Use antibacterial liquid soap to wash skin after each spewing.

So two of these can be easily eliminated, the spewing onto the skin is difficult but with careful timing can be done while stoma is inactive.

Skin is not removed with otosmy bag removal as long as approved products are used. Likely what occurs is a scab is removed or a leak wound is mistaken for skin being removed.

Skin is very tough and unless your using super glue or some sort of other high adhesive, I doubt very much your actually tearing regular skin off. Use adhesive remover and approved products on your skin.

I've used hydrocortisone cream in the past around my stoma and for my eczema it's really good clears skin problems up fast I'm sure Dr warned you to use it sparingly and for as short a time as possible as long term it would thin your skin, after applying any cream wipe over skin with a tissue.

It's not that unsul for output to leak under barrier especially in the early days if it did continue to be a daily or regular problem speak to your stoma to find a bag that's more suitable for you. 

I have dry skin so always wash around my stoma with Dermol 500 lotion and very rarely have any skin problems.

Eat creamy peanut butter, you'll be as greasy as a pig in no time. 😆 

Then after that washing the area with antibacterial liquid soap will remove any extra oils on the surface while keeping skin below moisturized naturally as it should be.

We go a little crazy applying stuff when humans have been working just fine for tens of thousands of years.

Hi there,

For cleaning around the skin I recommend the dial antibacterial soap the gold bar . One it isn't harsh like and a dish washing liquid soap which that soap also is hard to get off the skin all the way. The gold bar is an antibacterial soap and doesn't leave a residue off soap which causes problems with adhesion and won't strip your skin nor does it contain anything that will compromise your wafer. Question with the ouss coming around the base of your stoma is it in one spot or is it all the way around ?

Hi Clara,  You've gotten some good advice here about dealing with your infection.  Going forward, you may still have skin irritation issues, as is common with ileostomies.  I also have an ileo, and I had a pretty bad problem with raw irritated skin.  What worked for me to clear it up and keep my skin healthy, is Salts brand 'aloe rings'.  They are barrier rings infused with aloe and are very kind to your skin.  They were the only thing that worked to clear up my skin and I continue to use them to keep it healthy.  They also increased my wear time by a couple of days. Good luck.

Terry

Check this out:

https://nightingalemedical.ca/product/medline-marathon-liquid-skin-protectant-0-5g/

Crusting (as Shamrock mentioned) and use of a skin prep spray/wipe will also help

Medline Marathon is extremely expensive and better used for more serious bloody type wounds around stoma after surgery and it forms a scab. It's really nice stuff but for a simple leak burn it's excessive.

She will most definitely have to use paste, no sting paste that is, because it crusts up and is way to uneven for a ring.

She said her skin is normally flat and smooth, had been using rings fine, so it appears to be a leak caused wound and perhaps infection as it was perhaps let go for too long.

Crusting is done by washing the stoma area with antibacterial soap and drying well, then lightly stoma powder the wounds and dry brush off as much as possible, then coat with skin protectant and blow dry well, then use paste to try to adhere to it. But in my experience it often fails. But it does help until then, and after a few repeats the skin will heal more and more until it's normal longer needed and just blow drying well will cause the wound to dry up enough to adhere paste to. 

Problem is tension. The strain of the wafer onto anything connected to that weakened skin is the big problem.

I've mostly solved that issue using a totally different technique which is too involved to go into here.

I agree marathon and they also have a 3m advanced skin protectant . And no it's not excessive when your leaking. If your leaking actually this stuff is going to be the best when it comes to protecting the skin from output, and the your wafer will stick to it ,so no problem with adhesion at all.