Incontinence Associated Dermatitis
Demographics & Prevelence
Do your patients deserve optimal skincare?
Healthy skin needs protecting. Skin provides protection from mechanical impacts, pressure, variations in temperature, micro-organisms and irritants. The natural ageing process decreases the skin's ability to protect against such impacts.
Chronic diseases are more common in an increasingly elderly population, and are more likely to co-exist with two other problems:
1) Increased burden of care due to bed bound patients needing bed bathing
2) Incontinence related to chronic diseases, which in turn could lead to Incontinence Associated Dermatitis
An ageing population
Key statistics around the ageing population call for a change in approach. Figures published by the World Health Organisation have indicated that more staff are required to care for our elderly population.
increase in the population aged 85 years and older, from 14m to 40m
increase in the population aged 65 and over, from 129m in 2010 to 224m by 2050
of people aged 85 or older have some degree of cognitive decline. The risk of dementia rises sharply with age
Incontinence Associated Dermatitis (IAD) Prevalence
"The odds of having a pressure ulcer were 22 times greater for hospitalised adult patients with faecal incontinence compared to hospitalised patients without faecal incontinence … and 37.5 times greater in patients who had both impaired mobility and faecal incontinence." JoAnn Maklebust, MSN, RN, CS, NP and Morris A. Magnan, MSN, RN22
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What is IAD?
Incontinence Associated Dermatitis (IAD)
When your patient's skin is exposed to urine and/or faeces it will have a negative impact on skin integrity:
Moisture makes the skin more vulnerable to friction which could lead to moisture associated skin damage and abrasion. Urine may also decrease tissue tolerance to friction, shear or pressure
Altered pH of skin potentially promotes pathogenic growth
Faecal enzymes can cause direct damage to skin
The combination of chemical (traditional soap) and physical (washing) irritation results in a weakened skin status1,3,11
Although incontinence associated dermatitis and pressure ulcers are clinically and pathologically different conditions there is evidence that indicates an association between IAD, its most important aetiological factors, and PUs.12
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A study (Maklebust 1994) showed that the odds of having a pressure ulcer were 22 times greater for hospitalised adult patients with faecal incontinence compared to hospitalised patients without faecal incontinence and 37.5 times greater in patients who had both impaired mobiity and faecal incontinence.2
Wipes: The Approved Standard of Care
Three simple steps to reduce IAD
The three simple and recommended steps to prevent IAD are:
1. Cleanse the skin
2. Moisturise the skin daily and as needed to replace lost lipids in the upper layers of the skin
3. To protect the skin, apply a moisture-barrier cream or spray if the patient has significant urinary or faecal incontinence (or both).1, 4, 13
Considering the evidence that suggests an association between IAD, its most important aetioogical factors and PUs, continence care management should be performed comprising these three steps.
Reduce IAD prevalence with a 3-in-1 Perineal Care Washcloth
A study has shown that implementing these three steps by using a 3-in-1 perineal care washcloth versus water and pH neutral soap to prevent and treat IAD resulted in a significantly reduced prevalence of IAD and a trend toward less severe lesions. These findings provide indicative evidence for the use of a 3-in-1 perineal care washcloth as an effective intervention against the use of water and a pH neutral soap to prevent and/or treat IAD.8
1. One-Step Intervention: Cleanse, Moisturise, Protect
2. Reduces the cleansing time by 43%6
3. Hygienic procedure compared to wash basins5, 9, 10, 11
4. Effective IAD Prevention8
5. Increases patient and nurse comfort6
6. Higher bedside compliance11
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3% Dimethicone Wipes are Effective
A study has shown that implementing these three steps by using a 3-in-1 perineal care washcloth versus water and pH neutral soap to prevent and treat IAD resulted in a significantly reduced prevalence of IAD and a trend toward less severe lesions. These findings provide indicative evidence for the use of 3-in-1 perineal care washcloth as an effective intervention against the use of water and a pH neutral soap to prevent and/or treat IAD.8
Link between wash basins and hospital acquired infections
Several published studies prove a strong link between the usage of wash basins and transferring pathogens from one patient to the other.
The hospital environment is increasingly recognised as a reservoir for hospital acquired pathogens. During a 44-month study period, a total of 1,103 basins from 88 hospitals in the United States and Canada were sampled. Overall, 62.2% of the basins were contaminated with commonly encountered hospital-acquired pathogens.
Marchaim D, et al., Hospital bath basins are frequently contaminated with multi-drug resistant human pathogens. Poster presented at SHEA 21st Annual Scientific Meeting,2011 April.9
In an another study, infection control practitioners noticed an increase in catheter associated urinary tract infections (CAUTIs). They eliminated the basin from the bedside of catheterised patients. The incidence of CAUTIs was reduced to zero within one month and it remained at zero for five months.10
Link between Pressure Ulcers and IAD
A systematic review and meta-analysis was conducted to identify the association between incontinence associated dermatitis (IAD), its most important aetiologic factors (incontinence and moisture), and pressure ulcers (PUs). In most studies (86%), a significant association between variables of interest was found. This evidence indicates an association between IAD, its most important aetiological factors, and PUs.12
Increase Staff Efficiency
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1. Gray M, et al., JWound Ostomy Continence Nurs. 2007 Jan-Feb;34(1):45-54.
2. Maklebust J, Magnan MA,AdvWound Care. Nov 1994;7(6):25, 27-8, 31-4 passim
3. Incontinence Associated Dermatitis (IAD): Best Practice for Clinicians. Wound, Ostomy and Continence Nurses Society, 2011
4. Doughty D, et al. Incontinence Associated Dermatitis: Consensus Statements, Evidence – Based Guidelines for Prevention and Treatment, and Current Challenges, Journal of Wound, Ostomy and Continence Nursing. 2012; 39(3):303-315
5. Johnson D, Lineweaver L, Maze L, Patients bath basins as potential sources of infection: multicenter sampling study. Am J Critical Care 2009; 18:31-40
6. Knibbe N, et all., LOCOmotion, Ergonomic aspects of washing without water , 2005
7. Lewis-Byers K, Thayer D. Kahl A. An evaluation of two incontinence skin care protocols in long-term care settings. Ostomy Wound Management. 2005; 48 (12): 44-51
8. Beeckman D. A 3-in-1 Perineal Care Washcloth Impregnated With Dimethicone 3% Versus Water and pH Neutral Soap to Prevent and Treat Incontinence-Associated Dermatitis. J Wound Ostomy Continence Nurs. 2011;38(6):627-634.
9. Marchaim D, et al., Hospital bath basins are frequently contaminated with multi-drug resistant human pathogens. Poster presented at SHEA 21st Annual Scientific Meeting,2011 April
10. Stone S, et al., Removal of bath basins to reduce catheter-associated urinary tract infections. Poster presented at APIC 2010
11. Mayrovitz HN , Sims N . Biophysical effects of water and synthetic urine on skin . Adv Skin Wound Care . 2001 ; 14 ( 6 ): 302-308.
12. Beeckman D. et al. A Systematic Review and Meta-Analysis of Incontinence-Associated Dermatitis, Incontinence, and Moisture as Risk Factors for Pressure Ulcer Development. Research in Nursing & Health. 2014
13. Beeckman D, Schoonhoven L,. Prevention and treatment of incontinence-associated dermatitis: literature review. Journal of Advanced Nursing.
Improve Care: Stop IAD
IAD Study Day
2nd October, 2014
Proff Dimitri Beeckman D
Dr Jan Kottner J
Dr Lisette Shoonhoven
Highlighting the importance of IAD and the link to pressure ulcers, with best practice on prevention and management techniques.
Places are limited, so for more information on attending this event, please speak to your local 3M Representative or email us at C3SD@mmm.com