Incontinence-Associated Dermatitis: A Comprehensive Review and Update

University of Virginia Department of Urology and School of Nursing, Charlottesville, VA, USA.
Journal of wound, ostomy, and continence nursing: official publication of The Wound, Ostomy and Continence Nurses Society / WOCN (Impact Factor: 1). 12/2011; 39(1):61-74. DOI: 10.1097/WON.0b013e31823fe246
Source: PubMed

ABSTRACT In 2009, a multinational group of clinicians was charged with reviewing and evaluating the research base pertaining to incontinence-associated dermatitis (IAD) and synthesizing this knowledge into best practice recommendations based on existing evidence. This is the first of 2 articles focusing on IAD; it updates current research and identifies persistent gaps in our knowledge. Our literature review revealed a small but growing body of evidence that provides additional insight into the epidemiology, etiology, and pathophysiology of IAD when compared to the review generated by the first IAD consensus group convened 5 years earlier. We identified research supporting the use of a defined skin care regimen based on principles of gentle perineal cleansing, moisturization, and application of a skin protectant. Clinical experience also supports application of an antifungal powder, ointment, or cream in patients with evidence of cutaneous candidiasis, aggressive containment of urinary or fecal incontinence, and highly selective use of a mild topical anti-inflammatory product in selected cases. The panel concluded that research remains limited and additional studies are urgently needed to enhance our understanding of IAD and to establish evidence-based protocols for its prevention and treatment.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Incontinence-associated dermatitis (IAD) is a painful yet preventable form of cumulative skin irritation prevalent amongst those with limited movement. Consequently, it has a significant impact on the quality of life for those affected as well as substantial cost implications. Prevention and intervention is typically through good skin hygiene regimes and regular use of barrier products. In this paper, we describe the development of an in vivo model of IAD in healthy volunteers by occluded application of alkaline synthetic urine to the volar aspect of volunteer's forearms for 6 h per day over a five-day period to reproduce the moist and irritant conditions causative of IAD. Irritation was assessed and quantified on a daily basis by a series of non-invasive biophysical measurements and compared to a contralateral saline-treated (control) site. Dermal irritation was assessed by subjective (visual) and objective measurements (laser Doppler and polarisation spectroscopic imaging, infrared thermography, skin reflectance spectroscopy, transepidermal water loss and skin surface pH). The provocation of reproducible, cumulative skin irritation was successfully demonstrated and quantified. This five-day model of irritation is considered appropriate for the initial clinical assessment of topical products to prevent or treat IAD.
    Archives for Dermatological Research 11/2014; DOI:10.1007/s00403-014-1526-y · 2.27 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background No-rinse disposable wash gloves are increasingly implemented in health care to replace traditional soap and water bed baths without proper evaluation of (cost) effectiveness. Objectives To compare bed baths for effects on skin integrity and resistance against bathing and costs. Design Cluster randomized trial Setting 56 nursing home wards in the Netherlands. Participants: 500 adult care-dependent residents and 275 nurses from nursing home wards. Methods The experimental condition ‘washing without water’ consists of a bed bath with disposable wash gloves made of non-woven waffled fibers, saturated with a no-rinse, quickly vaporizing skin cleaning and caring lotion. The control condition is a traditional bed bath using soap, water, washcloths and towels. Both conditions were continued for six weeks. Outcome measures were prevalence of skin damage distinguished in two levels of severity: any skin abnormality/lesion and significant skin lesions. Additional outcomes: resistance during bed baths, costs. Results Any skin abnormalities/lesions over time decreased slightly in the experimental group, and increased slightly in the control group, resulting in 72.7% versus 77.6% of residents having any skin abnormalities/lesions after six weeks, respectively (p = 0.04). There were no differences in significant skin lesions or resistance after six weeks. Mean costs for bed baths during six weeks per resident were estimated at € 218.30 (95%CI 150.52–286.08) in the experimental group and € 232.20 (95%CI 203.80–260.60) in the control group (difference € 13.90 (95%CI: -25.61–53.42). Conclusion Washing without water mildly protects from skin abnormalities/lesions, costs for preparing and performing bed baths do not differ from costs for traditional bed bathing. Thus, washing without water can be considered the more efficient alternative.
    International Journal of Nursing Studies 01/2014; 52(1). DOI:10.1016/j.ijnurstu.2014.08.001 · 2.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We measured the effect of a silicone border foam dressing on the development of pressure ulcers (PUs) and incontinence-associated dermatitis in intensive care unit (ICU) patients.
    Journal of WOCN 09/2014; 41(5):424-429. DOI:10.1097/WON.0000000000000046 · 1.00 Impact Factor