Moisture-Associated Skin Damage

Holly Hovan's picture
Causes of Incontinence

by Holly M. Hovan MSN, APRN, ACNS-BC, CWOCN-AP

With World Continence Week upon us, it is an appropriate time to discuss some types and causes along with treatment of urinary incontinence. The most common types of incontinence that we learn about are stress, urge, mixed (stress and urge), transient, neurogenic, and functional.

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Susan Cleveland's picture
Moisture-Associated Skin Damage Prevention

by Susan Cleveland, BSN, RN, WCC, CDP, NADONA Board Secretary

Incontinence-associated dermatitis (IAD) is a prevalent complication of incontinence that compromises skin integrity, predisposes patients to cutaneous infection, and increases pressure ulcer risk. IAD is an inflammation of the skin as a result of long-term or repeated exposure to urine or feces. Reported IAD incidence rates in long-term care settings vary from 3.4% to 25% and up to 65% in the presence of double incontinence (urine and stool).

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Susan Cleveland's picture
Preventing MASD by Moving

by Susan Cleveland, BSN, RN, WCC, CDP, NADONA Board Secretary

The long-term care setting has changed over the years: it has become an even more concerning issue because our population is no longer just older adults looking for a place to age, but now includes a wave of acutely ill individuals with multiple comorbidities. And yet despite these changes, skin issues continue to be a problem. Moisture from any source increases the skin’s permeability and decreases the barrier function. The outmost layer of the epidermis, the stratum corneum, is normally slightly acidic and protects the body from pathogens when intact. If the skin is compromised by moisture or moisture with friction, a break in the surface can allow pathogens to enter.

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Fabiola Jimenez's picture
Nurses communicating about patient

by Fabiola Jimenez, RN, ACNS-BC, CWOCN

To tell you the truth, I was not exactly sure what I was getting into when I decided to go to Wound Ostomy and Continence (WOC) nursing school. My reference was my experience during my Clinical Nurse Specialist (CNS) clinical rotations where I worked with a colorectal surgeon and the Nurse Practitioner (NP). The patients we saw had everything to do with a WOC’s expected body of knowledge.

WoundSource Practice Accelerator's picture
moisture-associated skin damage

by the WoundSource Editors

It has long been known in clinical practice that long-term exposure of the skin to moisture is harmful and can lead to extensive skin breakdown. The term moisture-associated skin damage was coined as an umbrella term to describe the spectrum of skin damage that can occur over time and under various circumstances. To have a moisture-associated skin condition, there must be moisture that comes in contact with that skin.

WoundSource Practice Accelerator's picture
incontinence-associate dermatitis prevention

by the WoundSource Editors

Although clinical practice is hampered by a lack of rigorous studies, standardized terminology, or definitions of incontinence-associated skin damage, it is well known among health care providers that this damage places patients at increased risk for pressure ulcer/injury development.

WoundSource Practice Accelerator's picture
complications associated with MASD

by the WoundSource Editors

Best practice in skin care focuses on the prevention of skin breakdown and the treatment of persons with altered skin integrity. When we ask what causes skin damage we should consider the conditions that can harm the skin, including excessive moisture and overhydration, altered pH of the skin, the presence of fecal enzymes and pathogens, and characteristics of incontinence such as the volume and frequency of the output and whether the output is urine, feces, or both

WoundSource Practice Accelerator's picture
skin assessment and moisture-associated skin damage

by the WoundSource Editors

The performance of an accurate and complete skin assessment is of utmost importance to obtaining and maintaining healthy skin. Understanding the structure and function of the skin is key to the differentiation of normal from abnormal findings. Having this baseline knowledge aids in determining the patient's level of risk, how skin is damaged, the impact of moisture on the skin, the resulting type of moisture-associated skin damage (MASD), and whether current skin care protocols are effective and adequate.

WoundSource Practice Accelerator's picture

by the WoundSource Editors
Denuded: The loss of epidermis, caused by prolonged moisture and friction.

Excoriation: Linear erosion of skin tissue resulting from mechanical means.

Maceration: The softening and breaking down of skin resulting from prolonged exposure to moisture.

Holly Hovan's picture
Moisture on Skin

When nurses hear the term moisture, they usually almost always think of urinary or fecal incontinence, or both. There are actually several other reasons why a patient could be moist. Continued moisture breaks down the skin, especially when the pH of the aggravating agent is lower (urine, stomach contents—think fistula, stool). When there is too much moisture in contact with our skin for too long, we become vulnerable to this moisture, and our skin breaks down. Increased moisture places a patient at risk for a pressure injury as the skin is already in a fragile state.

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