Skin care creams and lotions - Guidance for homecare providers on fire safety
This guidance covers the use of skin care creams and lotions in a homecare setting and is particularly concerned with identifying and minimising the fire risks associated with their use.
The guidance reflects advice from the Medicine and Healthcare Products Agency. The term 'skin care creams and lotions' is sometimes used instead of 'emollients'.
The guidance was prepared for Homecare Association members with advice from the London Fire Brigade and is available free to all domiciliary care providers.
It is intended to be guidance rather than instructions for those providing homecare.
This guidance covers the use of skin care creams and lotions, also known as emollient products, and seeks to identify and minimise the fire risks associated with their use in a homecare setting.
Care providers and practitioners can employ the principles outlined in this document in their policies, care planning and risk assessment processes. The approach needed for individual people’s care will vary from case to case according to specific circumstances. For example, some people receiving homecare services may be more willing and/or able to adopt safer practices than others.
Skin care creams and lotions are non-cosmetic moisturising treatment which is applied to the skin. Often they are prescribed by a person’s GP. Skin care creams can also come in the form of ointments and gels and are used to manage dry skin conditions such as eczema or psoriasis where they are an important part of medical treatment.
Sometimes they are used under bandages as a recognised treatment to control the itching of more severe eczema.
Skin care creams and lotions may also be used to prevent and treat conditions such as pressure sores which are more common amongst people who are relatively immobile, or who have difficulty adjusting their position independently, and who therefore spend extended periods of time in bed or in a chair. Other uses include relieving symptoms such as dryness and soreness where a nasal cannula is used to supply oxygen. Applying skin care creams and lotions directly onto affected skin also reduces water loss by covering it in a protective film.
The main risk to people who regularly use skin care products is that of accidental ignition which may be due to:
- the use of candles or incense sticks,
- being close to heat sources such as heaters or cookers,
- electrical sources such as electric blankets and rechargeable batteries.
Skin care creams and lotions commonly contain high concentrations (typically 50% or higher) of petroleum or liquid paraffin as these ingredients are very efficient at retaining moisture in the skin. Prolonged use of these products causes the product to soak into fabrics such as dressings, clothing and bedding which leaves residues which are not always completely removed during laundering.
When exposed to a heat source such as matches, lighters, cigarettes or other heat sources, the paraffin and/or petroleum promote rapid spread of fire. Combining this with a condition affecting the ability to respond to, or escape from a fire, substantially increases the risk of serious injury or death.
The risk posed by the use of skin care creams and lotions is very difficult to quantify as a large number of factors need to be taken into consideration. These factors include but are not limited to:
- the concentration of potentially flammable ingredients contained in the product
- the amount and frequency of application
- the ability of the person receiving homecare support to understand the dangers posed by certain behaviours such as smoking
- the person’s willingness to adopt or accept safer practices.
In assessing potential risk, care staff should be mindful that the needs and wishes of the person are taken into account when carrying out a risk assessment with regard to the use of skin care products.
In addition, care staff should also observe the person's environment, and in particular whether there is any evidence that there have been any previous incidents of unsafe use or disposal of smoking materials such as burns or singe marks on bed linen, furniture, flooring or clothing.
Other factors for consideration should be:
- Whether and how much the person smokes
- The location that they smoke in
- Whether they are supervised whilst smoking and/or assisted to light cigarettes
- The method of lighting cigarettes
- The general health, awareness and dexterity of the person
- Whether they use any other medical aids which could contribute to the spread and intensity of a fire such as therapeutic oxygen or an airflow mattress
- Potential exposure to other sources of ignition such as cooking, candles, heaters or the possibility of faulty electricals eg. overloaded sockets or a poorly maintained electric blanket.
The risks from using skin care creams and lotions should be considered as part of a Person Centred Risk Assessment Checklist.
The care plan of the person receiving homecare should take the findings of this assessment into account and clearly indicate their vulnerability in relation to the risks associated with the use of skin care products, and the steps which should be employed to limit them.
The plan should include the person's preferences as far as they can be accommodated safely, and involve all those concerned in the care of the person. If a person lacks the mental capacity to express their wishes or consent, then a ‘best interests’ decision may need to be made based on the Mental Capacity Act.
The care plan is however only effective where care workers follow the plan requirements and record their actions in the care log. Employers should satisfy themselves that this practice is embedded within their organisation.
An alert system should also be included to ensure that any changes to the care plan are clearly identified when they are made, and communicated to, and noted by the care workers.
The care plan should identify a safe system of work according to the user’s circumstances. For example, by limiting the person to smoking only when the careworker or another responsible person is present.
Example of a care plan risk assessment
Note: The term 'resident' is used below, but the risk assessment can be adapted for use where the person is supported by homecare services.
|Hazards and Risk Factors||Circumstances||Control Measures|
|Risk of fire because of the use of a skin care cream or lotion.||Resident smokes and has a skin care cream applied 3 times per day to her upper body.||Discussion around smoking cessation with family|
|Deep ashtray provided|
|There is a risk of cigarette dropping onto bedding/clothing and skin care product causing fire to spread quickly.||Fire Apron provided|
|To smoke only when supervised|
|Fire retardant bedding supplied and fitted|
|Laundering guidelines followed for bedding (including fire retardant bedding) and clothing|
|Resident uses an electric blanket||Removal of electric blanket – replaced with microwaveable heat pack|
|Resident uses an airflow mattress to reduce pressure sores.||Advice given to resident not to smoke in bed, especially with the added risk of an airflow mattress|
|Incontinence pads used which could potentially add fuel to any fire taking place.||Incontinence pads now stored in a cupboard close to the bed rather than stacked on a bedside table|
|Resident has limited mobility which reduces her ability to escape should a fire occur.||Consideration of Telecare system linked to smoke detection – to discuss with family|
|Consideration of Personal Protection (watermist/sprinkler) System – to discuss with family.|
Items which have come into direct contact with a skin care cream or lotion such as clothing, bed clothes and bed linen should be laundered daily to prevent potentially hazardous build-up. If dressings are used with an skin care cream or lotion, they should be changed daily. The following advice is also recommended for the removal of residues from fabrics:
- Turn laundry inside out prior to washing
- Wash items at the highest temperature possible allowed by the type of fabric (as shown on the care label)
- Wash with a good quality laundry detergent - liquids and gels are more effective than powder products
- Refer to the detergent instructions, and use the recommended amount for heavy soiling
- Provide an extended wash time by either using a prewash product before the main wash cycle, or soaking laundry overnight in a prewash product before washing as above.
Advice should be sought from the local Fire and Rescue Service who will provide a free Home Fire Safety Visit. Information will be provided about potential fire risks, and measures which can be put in place to keep these risks to a minimum. In addition, advice can be provided to the person receiving homecare services about how they can be alerted to a fire, and how to evacuate. Where possible, the person’s primary carer, or the careworker or other responsible person should be present during the Home Fire Safety visit. Smoke detectors, including those suitable for the hard of hearing will also be supplied and fitted free of charge during the visit.
In addition, the need for other safety equipment such as flame retardant bedding/apron, deep ashtrays and water misters/sprinklers will be assessed.
Person Centred Risk Assessment Checklist, London Fire Brigade
Safe use of emollient skin creams to treat dry skin conditions, Medicines and Healthcare Products Agency. This page contains additional resources, including a leaflet for individuals and families.