The hygienic effectiveness of 2 different skin cleansing procedures

Skin Health Connected to the Use of Absorbent Hygiene Products: A Review

Over the past 50 years, absorbent hygiene products such as baby diapers and incontinence products have become essential features of modern day life. Through innovation and enhanced technology, their design, composition and performance have been dramatically upgraded from their early forms, and they have transformed the lives of millions of people, improving their quality of life. Skin health related to the use of absorbent hygiene products has accordingly also greatly improved. Still, the wearing of absorbent hygiene products will affect the skin, and for some users the changes in microclimate, mechanical interactions and the exposure to urine and faeces may result in irritant contact dermatitis, i.e. diaper dermatitis (DD) or incontinence-associated dermatitis (IAD). Babies with developing skin and the elderly with deteriorating skin functions who are the most frequent users of absorbent hygiene products are more vulnerable to the causal factors. Although irritant reactions are the most common, allergic contact dermatitis should be considered if a DD/IAD fails to improve by recommended actions. There is also a connection between IAD and pressure ulcer development of which it is important to be aware. A holistic approach of using high-quality absorbent hygiene products in combination with appropriate skin care will help maintaining good skin health.

Recommendations for managing cutaneous disorders associated with advancing age

The increasingly aged population worldwide means more people are living with chronic diseases, reduced autonomy, and taking various medications. Health professionals should take these into consideration when managing dermatological problems in elderly patients. Accordingly, current research is investigating the dermatological problems associated with the loss of cutaneous function with age. As cell renewal slows, the physical and chemical barrier function declines, cutaneous permeability increases, and the skin becomes increasingly vulnerable to external factors. In geriatric dermatology, the consequences of cutaneous aging lead to xerosis, skin folding, moisture-associated skin damage, and impaired wound healing. These problems pose significant challenges for both the elderly and their carers. Most often, nurses manage skin care in the elderly. However, until recently, little attention has been paid to developing appropriate, evidence-based, skincare protocols. The objective of this paper is to highlight common clinical problems with aging skin and provide some appropriate advice on cosmetic protocols for managing them. A review of the literature from 2004 to 2014 using PubMed was performed by a working group of six European dermatologists with clinical and research experience in dermatology. Basic topical therapy can restore and protect skin barrier function, which relieves problems associated with xerosis, prevents aggravating moisture-associated skin damage, and enhances quality of life. In conclusion, the authors provide physicians with practical recommendations to assist them in implementing basic skin care for the elderly in an integrated care approach.

Using no-rinse skin wipes to treat incontinence-associated dermatitis

Individuals who suffer with incontinence, especially in relation to faeces, will often be at risk of skin breakdown and develop incontinence-associated dermatitis (IAD) which, if left untreated, can lead to pressure ulcer formation ( Gray, 2004 ). IAD is caused by increased, unrelieved moisture against the skin, usually from liquid faeces and urine, which can then weaken the skin integrity. The integrity of the skin in this area is also at risk of pressure ulcers caused by shear or friction ( Beeckman et al, 2010a ). Treatment and prevention of IAD lesions involves a three-step process used in post-incontinence episodes, which includes cleansing, moisturisation and protection of the skin ( Beeckman et al, 2011a ). Using a wipe covers all of these steps immediately following incontinence episodes ( Rönner et al, 2010 ). This reduces the need to gather a number of different items required for post-incontinence skin care, which usually includes a dry wipe to be soaked in soapy water to wash the skin, a moisturiser to replace lost moisture and a skin protectant to prevent moisture from direct contact with the skin ( Foxley and Baadjies, 2009 ). This article will give some examples of the use of a particular continence and cleansing wipe in clinical practice.

Effect of bathing on atopic dermatitis during the summer season

BACKGROUND

There are little objective data regarding the optimal practice methods of bathing, although bathing and the use of moisturizers are the most important facets to atopic dermatitis (AD) management.

OBJECTIVE

We performed this study to evaluate the effect of bathing on AD.

METHODS

Ninety-six children with AD were enrolled during the summer season. Parents were educated to bathe them once daily with mildly acidic cleansers, and to apply emollients for 14 days. Parents recorded the frequency of bathing and skin symptoms in a diary. Scoring AD (SCORAD) scores were measured at the initial and follow-up visits. Patients were divided into two groups, based on the compliance of bathing; poor compliance was defined as ≥ 2 bathless days.

RESULTS

There was an improvement of SCORAD score, itching, and insomnia in the good compliance group (all p < 0.001). The mean change in SCORAD score from the baseline at the follow-up visit was greater in the good compliance group than the poor compliance group (p = 0.038).

CONCLUSION

Daily bathing using weakly acidic syndets can reduce skin symptoms of pediatric AD during the summer season.

Incontinence-associated dermatitis: consensus statements, evidence-based guidelines for prevention and treatment, and current challenges

In 2010, an international consensus conference was held to review current evidence regarding the pathology, prevention, and management of incontinence-associated dermatitis (IAD). The results of this literature review were published in a previous issue of this Journal. This article summarizes key consensus statements agreed upon by the panelists, evidence-based guidelines for prevention and management of IAD, and a discussion of the major challenges currently faced by clinicians caring for these patients. The panelists concur that IAD is clinically and pathologically distinct from pressure ulcers and intertriginous dermatitis, and that a consistently applied, structured, or defined skin care program is effective for prevention and management of IAD. They also agreed that differential assessment of IAD versus pressure ulceration versus intertriginous dermatitis remains a major challenge. Panel members also concur that evidence is lacking concerning which products and protocols provide the best outcomes for IAD prevention and treatment in individual patients. Issues related to differential assessment, product labeling and utilization, staff education, and cost of care are the primary focus of this article.

Incontinence-associated dermatitis: step-by-step prevention and treatment

Incontinence-associated dermatitis (IAD) is one of the clinical manifestations of moisture-associated skin damage. It is a common problem in community dwelling patients with faecal and/or urinary incontinence, and IAD management is an important challenge for community nurses. The aim of this practice focused article is to provide a brief update about the evidence of: (1) the pathophysiology of IAD, (2) the differentiation between IAD and pressure ulcers, and (3) the prevention/treatment of IAD. Recommendations for patient care in the community is described with reference to a patient case study.

Approach to fecal incontinence and constipation in older hospitalized patients

Although constipation and fecal incontinence are commonly encountered in older hospitalized patients, there is a paucity of clinical studies in this field. In this article we discuss the approach to and management of patients with these problems based on evidence and studies performed on patients in the ambulatory care setting, nursing home setting, and our experience. Our recommendations are applicable to older hospitalized patients. Successful management of these patients depends on identifying and treating underlying cause(s), such as infection, dietary factors, medication, or immobility-induced incontinence, constipation, or fecal impaction. For a hospitalized patient, a digital rectal examination should be performed to rule out fecal impaction and overflow incontinence. If there is no impaction but a weak anal sphincter, stool softeners or laxatives should be discontinued, as they cause diarrhea/fecal incontinence. In a patient with diarrhea/incontinence and suspected infection, management includes checking stool for Clostridium difficile toxin, E0157, ova and parasites, and culture. If the patient is on enteral nutrition, osmotic diarrhea-induced incontinence should be considered. Nursing care includes use of absorbent pads, special undergarments, anal hygiene, and skin care. Medications such as loperamide or diphenoxylate/atropine are useful for diarrhea with incontinence. Laxatives (eg, polyethylene glycol, lactulose), secretagogues (eg, lubiprostone), enemas, suppositories, and timed toileting assistance may be effective for constipation. Despite appropriate management, older hospitalized patients may remain incontinent because of dementia, immobility, or comorbid issues. Treatment should be tailored to the underlying mechanism(s) and needs of each patient.