Impact of an Absorbent Underpad on the Prevention and Improvement of Incontinence Associated Dermatitis in SNF Residents

Purpose: Incontinence Associated Dermatitis (IAD) is a known risk factor for pressure ulcer (PU) development. In SNFs, >50% of residents are incontinent of either urine or stool.¹

Methodology: A one-month prospective multicenter, IRB approved open label convenience sample evaluated IAD prevention and/or improvement in bed, chair-bound or ambulatory residents normally wearing diaper-type briefs. A superabsorbent underpad* replaced briefs when the resident was in bed. Change frequency was individualized and the usual skin care regimen followed. Skin integrity and risk for perineal skin breakdown were assessed at baseline and weekly using Perineal Assessment Tool (PAT) ² and scored using IAD Skin Assessment Tool (SAT).³

Results: A total of 40 subjects (n=31 females; n=9 males; average age 83), were evaluated. At enrollment, 25 subjects had IAD; 15 did not. Study outcomes were:

• Mean PAT Score for 25 subjects with IAD at enrollment decreased from 8.7 to 7.5 at week 4.
• Mean IAD SAT score for 25 subjects with IAD at enrollment decreased from 3.3 to 0.7 at week 4.
• Subjects with IAD decreased significantly over study duration from 62.5% (baseline) to 37.5% (week 1) (p=0.0016); 35.0% (week 2) (p=0.0023); 32.5% (week 3) (p=0.0005); and 15.4% (week 4) (p
• 15 subjects without IAD at enrollment maintained intact skin from baseline to week 4.
• PAT score risk level for 11 of 15 non-IAD subjects decreased from high to low by week 4.
• Average cost per day using the superabsorbent underpad was $1.40 versus $2.48 for usual care, primarily due to decreased frequency of pad changes.

Conclusion: In this study, use of superabsorbent pads instead of briefs helped reduce IAD in SNF residents with incontinence.

References:
1. Offermans MP, DuMoulin ME, Hamers JP, Dassen T, Halfens RJ. Prevalence of urinary incontinence and associated risk factors in nursing home residents: a systematic review. Neurourol Urodyn. 2009;28(4):288-94
2. Doughty D, Junkin J, Kurz P, Selekof J, Gray M, Fader M, Bliss DZ, Beeckman D, Logan S. Incontinence-associated dermatitis: consensus statements, evidence-based guidelines for prevention and treatment, and current challenges. J Wound Ostomy Continence Nurs. 2012 May-June;39(3):303-15.
3. Nix DH. Validity and reliability of the Perineal Assessment Tool. Ostomy Wound Manage. 2002;48(2):43-49.
4 . Lutz JB, Leighton B, Kennedy KL. Comparison of the efficacy and cost-effectiveness of three skin protectants in the management of incontinence dermatitis. Macmillan Magazines LTD. 1997:66-69.

Acknowledgements
*Disposable Wings™ Quilted Moisture Vapor Permeable Underpad (Medtronic, Mansfield, MA)
This study was sponsored by Medtronic