Incontinence-Associated Dermatitis

Holly M. Hovan MSN, APRN, GERO-BC, CWOCN-AP

Moisture-associated skin damage (MASD) is sometimes accompanied by serous exudate, a denuded appearance of skin, or a secondary cutaneous infection. As the most common form of MASD, incontinence-associated dermatitis (IAD) is characterized by erythema and edema of the skin’s surface. IAD is a top-down injury, often presenting with inflammation, erosion, or denudation in the setting of fecal or urinary incontinence.

By Holly Hovan, MSN, GERO-BC, APRN, CWOCN-AP

Moisture-associated skin damage (MASD) is becoming increasingly prevalent in today’s health care system. Often associated with discomfort and pain, MASD ultimately negatively impacts quality of life. MASD is usually broken down into 3 or 4 categories, most commonly incontinence-associated dermatitis (IAD), intertriginous dermatitis, periwound dermatitis, and peristomal dermatitis. In this blog, I focus on the prevention and treatment of IAD and subsequent pressure injuries in critical care through a nurse-led approach.

Elizabeth Day Dechant, BSN, RN, CWOCN, CFCN

Diaper rash, more officially known as incontinence-associated dermatitis (IAD), affects hospitalized and incontinent patients of all ages. In my years as a WOC Nurse in a pediatric hospital, IAD has been by far the most frequently treated condition. However, outside of a health care setting, IAD is the most common skin problem in infants and young children who are not yet toilet trained. Diaper rash has plagued babies and new parents for centuries, yet its treatment remains highly debated. For the purpose of this article, I am focusing on the prevention and treatment of diaper rashes in infants and young children, although the principles of topical treatment discussed here apply to all patients.

by Holly Hovan, MSN, GERO-BC, APRN, CWOCN-AP

The literature suggests that patients with a high degree of adiposity are more at risk for inflammatory conditions, and the numbers of these patients continue to rise. Increased adipose tissue may impact activities of daily living, continence, and overall quality of life (QoL), among other complications. Abdominal (central) obesity may be associated with incontinence, mechanical and neurogenic changes (chronic strain or weakening of nerves in the pelvic area), and skinfold inflammation or irritation.

Vulnerable skin within the skin microclimate is caused by a multitude of factors that are often aggravated by one another. Urine and feces, for example, have a negative impact on the skin as a result of the microorganisms and enzymes they contain. These factors break down the skin barrier and cause inflammation through the release of cytokines that trigger an immune response leading to symptoms of dermatitis (i.e., moisture-associated skin damage [MASD]). Incontinence-associated dermatitis (IAD) is one type of MASD, and the external factors that contribute to IAD include microclimate (water, temperature, pH), mechanical forces (friction, pressure, shear), and biochemical factors (fungi, irritants, bacteria, enzymes).

Urinary incontinence is a relatively common condition marked by loss of control of the bladder. In severe cases, it can have a detrimental impact on the quality of life of patients with this condition. Because of the sensitive and embarrassing nature of the topic, urinary incontinence tends to be underreported.

Absorbent briefs: Briefs used to absorb urine and stool and to help prevent moisture-associated skin damage in patients with incontinence issues. Briefs with high breathability and wicking help to maintain the skin microclimate.

Barrier products: Creams, sprays, wipes, or other products used to seal the skin and protect it from breakdown caused by moisture or incontinence.

Cyanoacrylates: A skin sealant that bonds to the skin surface and integrates with the epidermis. Cyanoacrylates are strong and resistant to washing off.

By: M. Sanantonio RN, C. Gunner RN, S. Trousaant LVN, M. Moore LVN

It is important for skilled nursing facilities to utilize quality incontinent products for their residents that are facing the daily challenges of both bladder and bowel incontinence. However, products alone do not make for a successful continence management program. It is imperative that the caregivers receive education in multiple areas that ultimately have an effect on the resident’s quality of life, quality outcomes and overall facility cost efficiencies. This study demonstrates the combination of quality incontinent products and education and its overall effectiveness in skilled nursing facilities.

By Margaret Heale, RN, MSc, CWOCN

Not very long ago, when working in an in-patient rehab center, I was shocked to discover patients calling the adult incontinence garments "hospital underwear." We were making good inroads into reducing the use of these products with the hope that if we used less it would be possible to acquire higher-quality products that would function optimally for patients who really needed them. It was of concern that some facilities had become diaper-free because many of our patients benefited from briefs, particularly as a "just in case security blanket" and we felt it was unrealistic for our patient population to be brief-free.

Ivy Razmus, RN, PhD, CWOCN

Moisture-associated dermatitis has been described as "inflammation and erosion of the skin due to prolonged exposure to moisture and its contents which include urine, stool, perspiration, wound exudate, mucus, or saliva." Incontinence dermatitis is caused by overhydration of the skin, maceration, prolonged contact with urine and feces, retained diaper soaps, and topical preparations. Indeed, diaper dermatitis has been used to describe an infant's skin breakdown related to moisture exposure.