Management of incontinence-associated dermatitis patients using a skin protectant in acute care: a case series

Abstract

Objective: Incontinence-associated dermatitis (IAD) is a common type of irritant contact dermatitis. It is categorised by persistent erythema and can be associated with denudation and/or colonisation and infection. IAD is challenging to treat and affects 3.4–50% of patients. This case series evaluates a novel, elastomeric, advanced skin protectant (3M Cavilon Advanced Skin Protectant) in a UK acute health-care setting, for the management of IAD in patients suffering from moisture-associated skin damage (MASD) in the sacral/genital area. Method: The patient's skin was assessed by clinicians using the GLOBIAD classification tool at the point of recruitment and to monitor progress throughout the study period. The product was applied as a single layer in accordance with the instructions for use. Patients, when able, were asked to assess their own pain level using the Wong-Baker FACES pain scale. Photographs were taken as part of the ongoing assessment. Results: The skin protectant was used on average every 2.28 days. Of the 18 IAD patients recruited, 79% (n=11) were classified as IAD-free, based on the GLOBIAD categorisation tool, by the end of the evaluation period. Skin deterioration during the evaluation period was seen in one patient (6%), and of the patients able to complete pain assessments, 55% (n=6) reported a reduction in pain. Conclusion: These results suggest that the elastomeric skin protectant, applied every three days, plays a role in the improvement of IAD. The skin protectant adheres to wet and weeping partial-thickness wounds and may aid IAD management. Reducing application to every third day supports a change in practice which may offer benefits to patients and caregivers.

Establishment of incontinence‑associated dermatitis rat models and assessment of the therapeutic effects of zinc oxide, painless skin protective film and silicone dressing

“…Incontinence can damage the integrity of the epidermis due to excessive water, high pH and the presence of enzymes in the stool, leading to inflammation and pain and increasing the risk of infection ( 21 ). The cortex is affected by the external environment, causing the cells to actively release related inflammatory mediators ( 10 , 22 ). The keratinocytes in the cortex become increasingly less elastic, the cells shrink and the barrier function of the cortex is also weakened ( 23 ).…”

“…Currently, the prevention and treatment of IAD include: i) Correcting the causes of diarrhea and incontinence; ii) reducing urine and stool irritation; iii) correct cleaning, moisturizing and skin care; iv) maintaining the skin pH; and v) regular observation and evaluation (7)(8)(9). Since the presence of high moisture and corrosive enzymes in the intestinal juice can cause destructive damage to the skin, leading to peeling and erosion of the cortex, barrier products such as petrolatum, polydimethylsiloxane and zinc oxide ointment are necessary to protect patients with IAD (10). Although several studies on the prevention and treatment of IAD have been conducted, there is significant heterogeneity and low comparability between results (11)(12)(13).…”

Moisture‐associated skin damage (MASD): A best practice recommendation from Wund‐D.A.CH.

“…Skin protection products help to prevent or minimize direct contact between the skin and body fluids. They usually contain viscous, lipophilic ingredients such as petrolatum or paraffin, or film formers such as silicones (dimethicone) and acrylates [9, 40]. Most products contain a combination of these ingredients.…”

Flüssigkeits‐assoziierte Hautschäden (FAH): Eine Best Practice Empfehlung von Wund‐D.A.CH

“…Hautschutzprodukte können helfen, den direkten Kontakt der Haut mit Körperflüssigkeiten zu verringern und zu verhindern. Hautschutzpräparate bestehen oft aus lipophilen viskösen Externa, beispielsweise Vaseline und Paraffin oder filmbildenden Substanzen wie Silikon, beziehungsweise Dimeticon oder Acrylate [9, 40]. Meist bestehen diese Produkte aus Mischungen dieser Komponenten.…”