Prevention and Management of Incontinence-Associated Dermatitis

Abstract

Perineal dermatitis, recently relabelled 'incontinence-associated dermatitis' (IAD), is an inflammation of the skin that occurs when urine and/or stool comes into contact with the skin. It can range in severity from erythema with or without loss of skin integrity to infection. IAD affects as many as 41% of adults in long-term care; it is costly, painful and, for the most part, preventable. An effective plan of care for individuals with IAD must include assessment and management of incontinence aetiology, perineal skin and risk assessment, gentle cleansing and moisturization, application of skin barriers and treatment of secondary infection, and the use of containment devices if indicated.

Elderly Women and Urinary Incontinence in Long-Term Care

“…UI predisposes elderly women to physical side effects such as rashes, dermatitis, skin infections, decubitus ulcers, and urinary tract infections (Du Moulin et al, 2009;Getliffe et al, 2007;Goldstein et al, 1992;Nix & Haugen, 2010;Schnelle, 1991). There is also an increased risk of falls associated with UI in the elderly, due to wet and slippery floors from dribbling and impaired mobility due to wearing bulky or poor fitting incontinence products (Hu, 1990;Loughrey, 1999;Parker, 2007).…”

“…Conversely, elderly women experiencing UI in LTC may subjectively define UI with respect to psychological, social, economic or physical implications and contexts (DuBeau et al, 2006;Getliffe et al, 2007;Hagglund & Ahlstrom, 2007;Howard & Steggall, 2010;Lifford et al, 2008;MacDonald & Butler, 2007;McDermott, 2010;Norton & Brubaker, 2006;Palmer, 1996;Parker, 2007;Wilson, 2003;Zeznock et al, 2010). The loss of bodily control, decrease in activities of daily living, social isolation, skin infections and dermatitis, falls, cost of incontinent products, and embarrassment maybe considered important in a UI definition to elderly women (MacDonald & Butler, 2007;McDermott, 2010;Nix & Haugen, 2010;Palmer, 2008;Parker, 2007;Stewart, 2010;Wilson, 2003). Also, it has been well documented in the literature that elderly women experience feelings of being less attractive and different from others resulting in shame, depression, and loss of self-confidence and inferiority, which must be considered when defining UI from the individuals perspective (Gallagher, 1998;Goldstein et al, 1992;Grimgy et al, 1993;Lifford et al, 2008;Palmer, 2008;Hunskaar & Vinsnes, 1991).…”

A 3-in-1 Perineal Care Washcloth Impregnated With Dimethicone 3% Versus Water and pH Neutral Soap to Prevent and Treat Incontinence-Associated Dermatitis

“…1,2 Clinical manifestations range from erythema (with or without loss of skin integrity) to cutaneous infections (such as candidiasis). [2][3][4][5] Incontinence-associated dermatitis is often associated with redness, rash or vesiculation, and symptoms such as pain or itching. 1 Older people, and especially those in long-term care facilities, are at risk for urinary or fecal incontinence and IAD.…”

“…4,6 Incontinence-associated dermatitis is reported to affect incontinent patients from 5.7% in nursing homes 4 to more than 42% in acute geriatric care. 7 Savik and colleagues 1 and Beeckman and associates 8 reported that IAD occurrence was significantly associated with (1) impairments in tissue tolerance, (2) problems of the perineal environment, and (3) altered toileting ability from daily use of restraints. Incontinence-associated dermatitis appears also to be strongly associated with age 4,9 and this correlates with a more fragile epidermal barrier and a reduced capacity of the skin to regenerate and repair.…”

Prevention of Incontinence-Associated Skin Damage in Nursing Homes

“…Additionally, avoidance of preventable problems, such as IASD, is a priority of consumer advocates and cost-effective healthcare delivery (Gallagher, 2011). Interventions and types of products to prevent IASD have been described by clinical experts (Beeckman, Woodward, & Gray, 2011; Nix & Haugen, 2010) Various cost-effective strategies have been used in developing skin care products for treating IASD that are also used for its prevention (Bliss, Zehrer, Savik, Smith, & Hedblom, 2007; Gray et al, 2012; Zehrer, Lutz, Hedblom, & Ding, 2004) To our knowledge, there are no studies comparing the cost of prevention versus treatment of IASD. However, others have shown that prevention of several clinical conditions, including other types of skin damage such as pressure ulcers, results in cost savings in a variety of ways (Gallagher, 2011).…”