Feature: Incontinence-related skin damage: Essential knowledge

University of Virginia, Department of Urology and School of Nursing, Charlottesville, VA 22908, USA.
Ostomy/wound management (Impact Factor: 1.23). 01/2008; 53(12):28-32.
Source: PubMed

ABSTRACT Incontinence-associated dermatitis, a clinical manifestation of moisture-associated skin damage, is a common consideration in patients with fecal and/or urinary incontinence. Among hospitalized patients, the prevalence rate has been found to be as high as 27%. Exposure to skin surface irritants may be a predictor and the condition, in turn, may be a factor in pressure ulcer risk because skin integrity is compromised. Differential diagnosis, usually based on visual examination, can help determine whether incontinence-associated dermatitis or a pressure ulcer is present. Prevention comprises following a structured skin care regimen that includes gentle cleansing, moisturization, and application of a skin protectant or moisture barrier. Treatment goals include protecting the skin from further exposure to irritants, establishing a healing environment, and eradicating any cutaneous infection. This concise review of relevant literature underscores the scant amount of evidence-based information available and highlights the need for further studies that involve comparing protocol and product efficacy to determine best practice for this oft-encountered condition.

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    • "However, empirical evidence suggests that there are serious problems regarding differentiation between superficial pressure ulcers and moisture lesions (e.g. Defloor et al. 2006, Beeckman et al. 2007, Gray et al. 2007). Accurate distinction between both lesions is deemed important because prevention and treatment strategies differ (Defloor "
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    ABSTRACT: The aim of this study was to examine interrater reliability and agreement of the diagnosis of moisture lesions as defined by the European Pressure Ulcer Advisory Panel. Differentiation between superficial pressure ulcers and moisture-related skin damages is difficult. To enhance the precision of the identification of moisture lesions, the European Pressure Ulcer Advisory Panel provided wound- and patient-related characteristics. Empirical evidence regarding interrater reliability and agreement among nurses for the detection of moisture-related skin damages in clinical practice is lacking. Observational. Home care clients (n = 339) were independently assessed twice by trained nurses. A head to toe skin inspection was conducted. For the diagnosis of moisture lesion (yes/no), nurses exactly agreed in 95% of all assessed clients. Interrater reliability was intraclass correlation coefficient (1,1) = 0.67 (95% CI 0.61-0.73). Nurses were able to differentiate between home care clients with and without moisture lesions but assessment results contained a high degree of measurement error. It seems that the descriptions for the identification of moisture lesions provided by the European Pressure Ulcer Advisory Panel do support the diagnostic process but reliability must be enhanced. Because of low interrater reliability, it is questionable whether the diagnosis of moisture lesions in clinical practice is valid. Measurement error is too high to make adequate inferences for individuals. Definitions and descriptions provided by the European Pressure Ulcer Advisory Panel, provisions of a single training and images are not sufficient to achieve acceptable interrater reliability in clinical practice.
    Journal of Clinical Nursing 03/2010; 19(5-6):716-20. DOI:10.1111/j.1365-2702.2009.03109.x · 1.23 Impact Factor
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    ABSTRACT: Skin lesions are often difficult to diagnose, and even decubitus ulcers (bedsores) can have different manifestations. Two such variations are `skin-fold' ulcerations and those caused by the prolonged apposition of skin surfaces. When pressure is applied to apposed or folded skin, surface ulcers can occur. There is evidence that such lesions are particularly found on debilitated elderly subjects with easily tented skin, as well as on similar patients with chronic contractures. A careful consideration of skin-fold causation helps in preventing ulceration problems, especially where pelvic skin is involved. The effective treatment and/or management of underlying factors, such as pelvic deformities, contractures, dehydration and incontinence, should also help prevent both skin-fold ulcers and apposition lesions.
    Expert Review of Dermatology 05/2008; 3(3):287-291. DOI:10.1586/17469872.3.3.287
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    ABSTRACT: PURPOSE:: To provide wound care practitioners with information comparing characteristics of perineal dermatitis and pressure ulcers. TARGET AUDIENCE:: This continuing education activity is intended for physicians and nurses with an interest in wound care. OBJECTIVES:: After reading the article and taking this test, the reader should be able to:
    Advances in skin & wound care 09/2008; 21(8):389-390. DOI:10.1097/01.ASW.0000323534.43745.da · 1.63 Impact Factor
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