Moulage is a unique technique within the field of Healthcare Simulation that pairs artistry with medical accuracy so that healthcare learners can have the highest level of realism when treating simulated patients. Moulage can help learners suspend their imaginations and experience the vast array of emotions that can come with providing emergency care while practicing how to exert calm and confidence and maintain control of any medical scenario. Simulated injuries made possible by Moulage can provide added value to training sessions for emergency response teams, military personnel, and healthcare learner programs. Healthcare professionals who focus on education and training via Clinical Simulation methodologies should be familiar with various Moulage concepts and techniques and how they can elevate any learning experience.
Issues and Concerns About Removing Moulage
While moulage does increase the fidelity and realism of a simulation, the use of moulage increases the work of the simulation operations specialist and educator. This includes the application and removal of the moulage. Moulage products and medical supplies can stain, transfer ink, or imprint on the skin of the manikin. Moulage can also leave residue that must be removed from the manikin skin.
What to Know Prior to Starting
One of the most important aspects of working with healthcare simulation manikins is to know the age of the simulator or manikin and if the manikin is under a manufacturer warranty covered in the manikin manual. Each manikin and vendor has specific requirements and limitations of what can and cannot be done to the manikin. The simulation professional must know where the manikin manual and warranty information is housed and follow this information. If someone within the institution performs a function to the manikin outside the warranty, the warranty can be voided. Many times the healthcare or academic institution pays for an additional warranty. Just remember, ask first to avoid a costly error.
The next thing to know is the institution’s Policy and Procedures for manikin use. This should include how to clean the manikins and the products that can be used to clean them. Each simulation center or lab should have Material Safety Data Sheets (MSDS) for any of the products or chemicals used in the cleaning process. The policy and procedure manual will also provide the regulations for maintenance or work on the manikin. This is the responsibility of those working with the manikins to know and follow.
Some of these rules and regulations probably do not apply once a manikin is out of warranty and old enough that the opportunity to purchase another warranty is not possible. This is known as being well outside the warranty age.
Practice First on Safe Areas
In healthcare simulation labs, there are usually old manikin skins from older manikins or old IV arm task trainers. These are an excellent source to test cleaning products and processes to conduct a test patch on the skin. If there are no available older products, the simulationists can practice on an area of the manikin that is less visible such as the back. Remember, if you try something that does not work and causes a disfiguration, it will be visible for the life of the manikin.
The next thing to know is what type of skin is used on the manikin. The two most common manikin skins are silicone-based skin and PVC or plastic-based skin. The care, cleaning, and maintenance of these products are very different. Sometimes simulation labs have both types of manikin skins. The care and maintenance of specific manikins should be covered in the orientation process for those working in the simulation lab.
Another important thing to remember is to remove and clean any product on the manikin skin as soon as possible. The sooner the product can be removed from the manikin skin the better. The sooner this is removed, the easier the cleaning can be. The longer something is on the skin that has an ink or dye, the more transfer, imprint, or bleed-thru can occur. The longer an adhesive is in contact with the manikin skin, the more residue can be left on the skin.
Consider the Use of A Barrier
Remember, an ounce of prevention is worth a pound of cure. The majority of the time a barrier can be applied prior to using most moulage that can stain. These barriers can prevent or limit the staining. Remember to follow the manufacturer’s recommendations and the institution’s policies and procedures. Some of the products that can be used are:
- Vaseline or petroleum-based product
- Cold Cream
- Tegaderm
- Op-site
- Rubber Cement
- Prosthetic Sealant
Cleaning the High-Fidelity Manikin
When starting with the cleaning process, remember to start with the easiest, less abrasive, and scaffold the process to obtain the best results. As always, this is a general guideline for simulation professionals. ALWAYS follow the manufacturer’s warranty and manual. The first step is the use of soap or detergent and water. For this step, you will need:
- Non-scratch sponge
- Soft abrasive sponge
- Toothbrush
- Dish detergent
- Soap
- Towels or paper towels
- Water and water basin
Remember when cleaning higher fidelity manikin to use less water. The sponge or cloth being used should not be dripping with water. If the stains being removed discolor the water when rinsing the sponge or cloth, the water must be changed more frequently. You do not want to cause yourself more work by discoloring more manikin skin.
Some manikin vendors and products include their own disinfectant and cleaning wipes. The simulationist should use these according to the warranty and vendor’s instructions.
Escalating the Cleaning Process
After cleaning with soap and water, if the stain or dirt remains, it is recommended to escalate products from the mildest to the more abrasive cleaners. Again, until experience is gained on what works with the products used, recommendations are to take a step-wise approach with the cleaning products. Isopropyl alcohol is the first step up from soap and water and then continues to climb.
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Isopropyl Alcohol 99% Spray Bottle: Place the alcohol in a spray bottle and apply to the affected area. Then remove with towels or paper towels. This may require multiple attempts. Isopropyl alcohol is used for pen or ink marks, dirt from field use, or when stored for prolonged periods of time.
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Adhesive Remover: Goo Gone with paper towels for Tape Adhesive Residue is the most commonly used product. Other products include the use of Unisolve (institutional purchase that is safe for human use) adhesive remover.
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Chem Wipes or Sanitizing Wipes: These products are often purchased through the institution to clean lab surfaces, high-touch surfaces, and medical equipment. Remember to test each new product prior to use in a highly visible area of the manikin.
Removing Ink Tattoo Imprints and Ink Stains
Some of the hardest and most commonly occurring stains are ink imprints or stains. Many of the healthcare products have a label made with ink. These labels can transfer or imprint the ink from the product to the manikin skin. The good news is that many simulation operations specialists have discovered acne medication with benzoyl peroxide 10% and UV/sunlight. This process takes time and most often must be repeated several times.
First, wipe any excess material off the manikin skin. Then start with soap and water followed by isopropyl alcohol. Then dry the surface and apply the benzoyl peroxide 10%. Let the solution remain on the stain. Apply a UV light source or place the skin or manikin in sunlight. Leave in the light source for four to six hours. Then wipe off the area. Most of the time, the stain has lightened. Repeat to achieve the desired results. This may require multiple applications.
Dealing with Stubborn and Persistent Stains
If all of the above has failed, consider acetone as the last resort. Remember, you can always apply more and let set longer. However, you cannot undo what you have already tried. Cleaning these stains requires persistence, patience, and creativity.
Moulage Products for Purchase
Moulage is available in various types. Some types that are available come from vendors that sell moulage kits, odors, overlays, attachments, and supplies. Some Healthysimulation.com moulage vendors include:
- Nasco Healthcare
- Avkin
- Medical Shipment
- TacMed Solutions
- TraumaSIM
- Moulage Concepts
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