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BARRIER TO COMPLIANCE
For incontinent patients, protecting skin is just as important as cleansing and moisturizing.1 Yet traditional methods require so many steps, barrier application is often overlooked. The result is process variation—administering inconsistent methods of care. Meanwhile, failure to apply a barrier can lead to incontinence-associated dermatitis (IAD). In one study, 54% of incontinent patients suffered from IAD, while 21% had two or more peri-skin injuries.2,3
"The primary impediments in the attainment of quality outcomes in incontinent patients are the lack of standardization, the need for multiple products, and increased costs to the patient."4 |
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Rationale for IAD
The term IAD earned approval because “it adequately describes the response of the skin to chronic exposure to urine or fecal materials (inflammation and erythema with or without erosion or denudation), specifically identifies the source of the irritant (urine or fecal incontinence), and acknowledges that a larger area of the skin than the perineum is commonly affected.”5 |
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What is IAD?
Newly published, expert consensus defines IAD as “an inflammation of the skin that occurs when urine or stool comes into contact with perineal or perigenital skin.”5 IAD is often grouped with pressure ulcers (PUs). However, “a pressure ulcer is defined as any lesion caused by unrelieved pressure resulting in damage of underlying tissue.”6 Skin damage from PUs occurs from the inside out. With IAD, the skin injury starts on the surface and works inward. Thus, “IAD should be distinguished from wounds caused by differing etiologies, such as full-thickness wounds (caused by pressure and shear) or linear lesions (caused by a skin tear).”5
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IAD Prevalence in Hospitals
Studies at long-term care facilities report IAD prevalence at 5.6% to 50%, while incidence rates range from 3.4% to 25%.5 However, one study has addressed IAD in acute care. As this 976-patient study found, 20.3% were incontinent.2,3 IAD prevalence for incontinent patients was 54% at three hospitals, affecting 11% of the general patient population.2,3 |
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IAD Risk Factors
Fecal incontinence, frequency of incontinence, poor skin condition, pain, poor skin oxygenation, fever, and compromised mobility have a statistically significant correlation with IAD.5 Other significant risk factors include double (urinary and fecal) incontinence and tissue tolerance impairments.5 While moisture is the principal factor, an alkaline pH also increases IAD risk.5 For patients with double incontinence, the alkaline pH activates fecal enzymes, increasing the likelihood of damage when exposed to intact skin.5 |
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| Comfort Shield® barrier cloths Delivering outcomes with proven IAD treatment and prevention |
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| REFERENCES: 1. Haugen V, Gastroenterology Nursing. 1997;20(3):87-90. 2. Gray M, Lerner-Selekof J, Junkin J, CE symposium in conjunction with the 2006 WOCN Conference, Minneapolis, MN, 2006 Jun. 3. Junkin J, Moore-Lisi G, Lerner-Selekof J, What we don’t know can hurt us: pilot prevalence survey of incontinence and related perineal skin injury in acute care. Poster presented at the Clinical Symposium on Advances in Skin and Wound Care (ASWC), Las Vegas, NV, 2005 Oct. 4. Dieter L, Drolshagen C, Blum K, Research poster abstract presented at the 2006 WOCN Conference, Minneapolis, MN, 2006 Jun. 5. Gray M, et al., J Wound Ostomy Continence Nurs. 2007 Jan-Feb;34(1):45-54. 6. Getting started kit: prevent pressure ulcers, how-to guide. Protecting 5 Million Lives From Harm Campaign, Institute for Healthcare Improvement. 2006 Dec. 7. Amlung SR, Miller WL, Bosley LM, Adv Skin & Wound Care. Nov/Dec 2001;14(6):297-301. 8. Maklebust J, Magnan MA, Adv Wound Care. Nov 1994;7(6):25, 27-8, 31-4 passim. 9. Robinson C, et al., Ost/Wound Mgmt. May 2003;49(5):44-51. 10. Lyder CH, et al., Ost/Wound Mgmt. April 2002;48(4):52-62. 11. Clever K, et al., Ost/Wound Mgmt. Dec 2002;48(12):60-7. 12. Nix D, Ermer-Seltun J, Ost/Wound Mgmt. Dec 2004;50(11):32-41. 13. Nursing opinion poll reveals pressure ulcer prevention not seen as top priority. Inf Cont Today Online. July 30, 2004. www.infectioncontroltoday.com/hotnews/47h308371.html. 14. Sluser S, Consistency the key for treating severe perineal dermatitis due to incontinence. Poster presented at the Clinical Symposium on Advances in Skin and Wound Care (ASWC), Las Vegas, NV, 2005 Oct. 15. West DP, Northwestern Univ Dept of Dermatology, Chicago, IL, Feb 2000. 16. Courtney BA, Ruppman JB, Cooper HM, Nurs Manage. 2006 Apr;37(4):36,38,40 passim. |
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