Prevention and treatment of incontinence-associated dermatitis: literature review

The effectiveness of faecal collection devices in preventing moderate to severe incontinence-associated dermatitis: A systematic review and network meta-analysis

BACKGROUND

Incontinence-associated dermatitis (IAD) is a common problem among critically ill patients with faecal incontinence (FI). However, there are few studies comparing the effects of different faecal collection devices impact the prevention of moderate to severe IAD in this patient population.

AIM

This review aims to compare the effectiveness of various devices for collecting faecal matter in preventing moderate to severe IAD in critically ill patients suffering from FI through a network meta-analysis.

STUDY DESIGN

We conducted a systematic search of PubMed, Embase, ProQuest, CENTRAL, CINAHL Plus with Full Text, China National Knowledge Infrastructure (CNKI), Wan fang, Wei Pu, and China Biomedicine (CBM) from their inception until May 4, 2023. The selected studies were randomized controlled trials (RCTs). Two researchers independently performed study selection and data extraction. We assessed the risk of bias using the Cochrane risk of bias tool Version 2.0. RevMan 5.4 was utilized for conventional pairwise meta-analysis of direct comparisons, while Stata16.0 was employed for network meta-analysis.

RESULTS

A total of 14 studies, involving 1345 patients, were included in the analysis. Pairwise meta-analysis showed that an anal bag[odds ratio(OR): 0.07(0.03, 0.20)], a balloon catheter[(OR:0.30(0.15, 0.62)], and an anal bag connected to negative pressure and flushing [(OR: 0.09(0.01,0.68)] all reduced the incidence of moderate to severe IAD in critically ill patients compared with usual care measures, respectively. The cumulative rank probabilities indicated that moderate to severe IAD prevention was more effective when employing balloon catheters connected to negative pressure [surface under the cumulative ranking curve(SUCRA): 20.8%] and anal bags connected to negative pressure (SUCRA: 27.0%) among critically ill patients with FI.

CONCLUSION

FI is a common problem among severely ill patients, and the reduction of moderate and severe IAD incidence is deemed essential. In this review, it is suggested that both balloon catheters connected to negative pressure and anal bags connected to negative pressure are associated with a higher effectiveness in preventing moderate and severe IAD.

RELEVANCE TO CLINICAL PRACTICE

The findings of this review can assist healthcare professionals in the selection of suitable stool management devices for the prevention of moderate to severe IAD in critically ill patients with FI.

Pressure ulcers/injuries prevention in emergency services: A scoping review

AIM OF THE STUDY

To map the available evidence on nursing care provided to prevent the development of pressure ulcers/injuries in emergency services.

MATERIAL AND METHODS

Scoping review that follows the Preferred Reporting Items for Systematic reviews and the Meta-Analyses extensions for Scoping Reviews and the Joanna Briggs Institute guidelines. The inclusion criteria were based on the PCC mnemonic. The main variables of interest were the nursing care provided to prevent the development of pressure ulcers/injuries (Condition) reported in studies developed in hospital emergency services (Context) with adult participants (Population). The scoping review protocol was registered on the OSF platform.

RESULTS

During the selection process, 175 articles were identified in different databases. Applying the inclusion and exclusion criteria, 20 studies were included in this scoping review. The preventive measures for the development of pressure ulcers/injuries were grouped into 9 categories: "risk factors and risk assessment", "support surfaces", "dressings for pressure ulcer/injury prevention", "skin and tissue assessment", "repositioning and early mobilization", "preventive skin care", "nutrition in pressure ulcer/injury prevention", "health education" and "vital signs management". The instruments for assessing the risk of developing pressure ulcers/injuries mentioned in the studies are the Braden, Waterlow and Norton scales. The most documented tool for assessing the risk of developing pressure ulcers/injuries in hospital emergency services was the Braden Scale.

CONCLUSION

International literature identified several preventive interventions that could be implemented in emergency services to avoid pressure ulcers/injuries development. However, is crucial that those preventive interventions were systematic implemented (in combination) since hospital admission.

Risk Factors for Incontinence-Associated Dermatitis in Critically Ill Patients with Incontinence: A Systematic Review and Meta-analysis

PURPOSE

This systematic review analyzed evidence related to risk factors for Incontinence Associated Dermatitis (IAD) in critically ill incontinent patients.

METHOD

Systematic review and meta-analysis.

SEARCH STRATEGY

Eight databases, including PubMed, Embase, CINAHL, Cochrane Library, and Web of Science, were searched for studies published in the English language. The China National Knowledge Infrastructure, WanFang Data, and Chinese Scientific Journal Database were also searched for studies evaluating risk of IAD in critically ill incontinent patients published in the Chinese language.

FINDINGS

Twenty-four studies with moderate-to-high methodological quality were included. Significant risk factors for developing IAD were being older [odds ratio (OR) = 1.06, 95% confidence interval (CI): 1.02-1.10, P = .007], fever (OR = 2.57, 95% CI: 1.87-3.57, P < .00001), diagnosed with consciousness disorder (OR = 5.70, 95% CI: 2.28-14.22, P = .0002), having higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR = 1.71, 95% CI: 1.25-2.35, P = .0009), lower Braden score (OR = 0.73, 95% CI: 0.56-0.96, P = .02), lower oxygen saturation (OR = 2.76, 95% CI: 1.52-5.00, P = .0008), double incontinence (OR = 4.10, 95% CI: 2.34-7.17, P < .00001), liquid stool (OR = 6.55, 95% CI: 4.12-10.41, P < .00001), frequent incontinence (OR = 1.21, 95% CI: 1.03-1.43, P = .02), and higher perineal assessment tool (PAT) score (OR = 3.18, 95% CI: 1.76-5.76, P = .0001).

IMPLICATIONS

Findings of this systematic review and meta-analysis suggest that healthcare providers should consider risk factors such as older age, fever, consciousness disorder, higher APACHE II score, lower Braden score and double incontinence matter when developing strategies for the prevention and management of IAD in critically ill incontinent patients.

Prognostic factors for the development of incontinence-associated dermatitis (IAD): A systematic review

Incontinence-associated dermatitis (IAD) is an irritant contact dermatitis from prolonged contact with urine or faeces, which can significantly impact patient comfort and quality of life. The identification of prognostic factors for the development of IAD has the potential to enhance management, support preventive measures and guide future research. The objective of this systematic review was to summarize the empirical evidence of prognostic factors for the development of IAD. This study included prospective and retrospective observational studies or clinical trials that described prognostic factors associated with IAD. There were no restrictions on setting, time, language, participants or geographical regions. Exclusion criteria included reviews, editorials, commentaries, methodological articles, letters to the editor, cross-sectional and case-control studies, and case reports. Searches were conducted from inception to April 2024 on MEDLINE, CINAHL, EMBASE and the Cochrane Library. The studies were assessed by two independent reviewers using the QUIPS and the CHARMS-PF for data extraction. A narrative synthesis approach was employed due to study heterogeneity and using the 'vote counting based on direction' method and the sign test. The overall certainty of evidence was assessed using adapted GRADE criteria. The review included 12 studies and identified 15 potential predictors. Moderate-quality evidence suggests that increased stool frequency, limited mobility and friction/shear problems are risk factors for IAD development. Female sex, older age, vasopressor use and loose/liquid stool are risk factors supported by low-quality evidence. Increased stool frequency, limited mobility and friction/shear problems seem to be risk factors for the development of IAD. There is insufficient evidence to support the predictive validity of female sex, older age, loose/liquid stool and vasopressor use. There is substantial methodological variability across studies, making it challenging to make comparisons. Large-scale cohort studies in different settings that incorporate our review findings should be conducted in the future.

Friction between human skin and incontinence pads in the presence of barrier protection products

This novel experimental work aims to bring further knowledge of frictional performance of common barrier products used in the treatment of incontinence-associated dermatitis and determine how the skin-pad interface changes when a treatment is applied to the skin. Key data is reported and there is an in-depth analysis into friction profiles which reveals great differences between how different skin-pad tribosystems operate when exposed to commercially available barrier treatments. In a wet-pad state Barrier cream A (3M™ Cavilon™ Barrier cream) reduced friction and had much lower dynamic and static coefficients of friction than the other barrier treatments (Barrier cream B (Sorbaderm Barrier cream) and the Barrier spray C (Sorbaderm Barrier spray)). Barrier cream A provided stable friction coefficients in reciprocating sliding, whereas the other treatments, and untreated skin, did not display this unique characteristic. The barrier spray gave rise to high static friction coefficients and exhibited the most stick-slip. All three candidate barrier protection products were found to reduce directional differences in the static coefficient of friction: indicative of reduced shear loading. Knowledge of the desirable frictional properties would drive innovation in product development, and benefit companies, clinicians and users.

Detecting and monitoring incontinence associated dermatitis: Does impedance spectroscopy have a part to play?

In this review, current understanding of the prevention and treatment of Incontinence Associated Dermatitis (IAD) is discussed. The need for preventative measures which target specific faecal/urinary irritants is highlighted, including the role of urease inhibitors. There is no existing internationally and clinically accepted method to diagnose and categorise the severity of IAD. Diagnosis currently relies on visual inspection; non-invasive techniques to assess skin barrier function could remove subjectiveness, particularly in darker skin tones. Impedance spectroscopy is a non-invasive technique which can be used to monitor skin barrier function, supporting visual assessments. Six studies (2003-2021) which used impedance to assess dermatitis were reviewed; inflamed skin was distinguishable from healthy skin in each case. This suggests that impedance spectroscopy could be useful in diagnosis early-stage IAD, potentially enabling earlier intervention. Finally, the authors present their initial findings on the role of urease in skin breakdown in an in vivo IAD model, using impedance spectroscopy.

Risk factors of incontinence-associated dermatitis in older adults: a protocol for systematic review and meta-analysis

INTRODUCTION

Due to their ageing skin, older adults are more likely to develop incontinence-associated dermatitis (IAD). Although previous attempts to look at the risk factors for IAD in older adults were done, methodological barriers hindered an in-depth understanding. By investigating risk factors for IAD in the ageing population, the development of precise clinical interventions and guidance could be facilitated, which in turn would enhance patient care standards for incontinence management in this target group. To address this knowledge gap, this systematic review with meta-analysis aims to explore the major risk elements linked to IAD among older adults.

METHODS AND ANALYSIS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols are adhered to in this systematic review and meta-analysis. To achieve its objectives, a comprehensive search strategy PubMed, Embase, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Medline, Chinese Scientific Journal Database (VIP database), WanFang Data Knowledge Service Platform, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, along with other relevant sources published until 18 July 2023 in both English and Chinese languages will be performed. The screening of articles, data abstraction and risk of bias evaluation will be done by two impartial reviewers. RevMan V.5.3 software will be used for data synthesis. The quality of the included study will be assessed using the Newcastle-Ottawa Quality Assessment tool and the Agency for Healthcare Research and Quality. The I 2 test will identify the heterogeneity.

ETHICS AND DISSEMINATION

There is no need for ethical approval. Individual patient information or the rights of participants will not be compromised by this protocol. The findings will either be published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42023442585.

Meta-analysis Investigating the Efficacy of Liquid Dressing and Ostomy Powder for the Treatment of Incontinence-Associated Dermatitis

OBJECTIVE

To study the effect of liquid dressing and ostomy powder on the treatment of incontinence-associated dermatitis (IAD).

METHODS

The authors searched PubMed, Web of Science, CNKI (China National Knowledge Internet), and Google Scholar databases for literature through July 28, 2022. After literature screening, two investigators independently extracted data from the included studies and applied the Newcastle-Ottawa Scale to assess the quality of the included studies. The χ2-based Q statistic test and the I2 statistic were used to measure the heterogeneity of the included studies. Publication bias was measured with funnel plots and the Egger test. Sensitivity analysis was conducted by eliminating each study one by one.

RESULTS

Four high-quality studies were included in the meta-analysis, involving a total of 307 participants. The meta-analysis results showed that compared with traditional care, treatment with liquid dressing and ostomy powder significantly improved the effective rate (pooled odds ratio, 21.42; 95% CI, 8.58 to 53.44), shortened the healing time (pooled mean difference, -10.73; 95% CI, -12.92 to -8.54), and reduced the recurrence rate (pooled mean difference, -2.03; 95% CI, -2.30 to -1.77) of IAD. Among the included studies, no publication bias was detected. Sensitivity analysis results confirmed the robustness of the pooled estimates.

CONCLUSIONS

Treatment with liquid dressing and ostomy powder has clinical value for patients with IAD.

Improving knowledge of continence care to prevent skin damage associated with incontinence

Older people are at an increased risk of developing skin damage related to incontinence, including pressure ulceration and incontinence-associated dermatitis (IAD). Factors exacerbating risk in older people include: a higher rate of faecal and urinary incontinence, reduced mobility, long-term conditions and changes to skin barrier function, as a result of the ageing process. Nurses have a key role to play in the assessment of continence, IAD prevention and management. This article explores nursing knowledge in relation to continence care on six inpatient wards for older people, and describes the implementation of improvement strategies, in order to reduce voidable harm.

What are the prognostic factors for the development of incontinence-associated dermatitis (IAD): a protocol for a systematic review and meta-analysis

INTRODUCTION

Incontinence-associated dermatitis (IAD) is irritant contact dermatitis and skin damage associated with prolonged skin contact with urine and/or faeces. Identifying prognostic factors for the development of IAD may improve management, facilitate prevention and inform future research.

METHODS AND ANALYSIS

This protocol follows the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Prospective and retrospective observational studies or clinical trials in which prognostic factors associated with the development of IAD are described are eligible. There are no restrictions on study setting, time, language, participant characteristics or geographical regions. Reviews, editorials, commentaries, methodological articles, letters to the editor, cross-sectional and case-control studies, and case reports are excluded. MEDLINE, CINAHL, EMBASE and The Cochrane Library will be searched from inception until May 2023. Two independent reviewers will independently evaluate studies. The Quality in Prognostic Studies tool will be used to assess the risk of bias, and the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies-Prognostic Factors checklist will be used for data extraction of the included studies. Separate analyses will be conducted for each identified prognostic factor, with adjusted and unadjusted estimated measures analysed separately. Evidence will be summarised with a meta-analysis when possible, and narratively otherwise. The Q and I² statistics will be calculated in order to quantify heterogeneity. The quality of the evidence obtained will be evaluated according to the Grades of Recommendation Assessment, Development and Evaluation guidance.

ETHICS AND DISSEMINATION

No ethical approval is needed since all data is already publicly accessible. The results of this work will be published in a peer-reviewed scientific journal.

Friction Dynamics of Foaming Body Cleansers under Sinusoidal Motion

The friction characteristics of foaming body cleansers determine skin physical irritation, as well as the usability of the products. In this study, the friction of foam formed by a commercial body cleanser was evaluated using a sinusoidal-motion friction evaluation system. The friction profile of the foam was a hydrodynamic stable pattern, where the friction force increased with increasing velocity. In addition, soapbased cleansers, containing polyols, showed large friction coefficients. These properties suggest that the mechanical properties of the interfacial film and viscosity of the cleanser bulk affect friction properties. These findings assist in controlling the texture of body cleansers.

The effectiveness of a hydrocolloid crusting method versus standard care in the treatment of incontinence-associated dermatitis among adult patients in an acute care setting: A randomised controlled trial

INTRODUCTION

Incontinence-associated dermatitis (IAD) is a type of irritant contact dermatitis due to prolonged exposure of the skin to moisture induced by urine or/and faeces. The main principles when treating IAD involves protecting the skin from further exposure to irritants, establishing a healing environment, and eradicating skin infections. This study aimed to evaluate the effectiveness of the hydrocolloid crusting method (HCM) versus the standard care method (SCM) in treating IAD.

METHOD

A randomised controlled trial was conducted in an acute tertiary hospital in Singapore between August 2019 to September 2021. Using computer-generated numbers, patients were randomised into either HCM or SCM treatment groups. HCM treatment involved cleansing the affected area with a pH-neutral non-rinse moisturising cleanser, and the application of alternate layers of hydrocolloid powder, and non-sting film barrier spray (repeated three times during each use). Patients in the SCM treatment group received the same cleanser followed by a 30% zinc oxide barrier cream. IAD was assessed daily for up to seven days by the wound care nurses using the IAD severity tool. The primary outcome of the study was the mean difference in IAD score per day between both methods.

RESULTS

Forty-four patients were eligible and recruited (22 in HCM; 22 in SCM). Patients in both groups were comparable in age and gender. IAD Category 2 was more predominant in both methods. The most common location of IAD was at the perianal skin and diarrhea related to gastroenteritis was the most prevalent cause of IAD. More patients in the SCM group (n = 12; 54.5%) had their IAD healed within seven days compared to HCM, (n = 7; 31.8%) group. However, the average decrease in IAD scores per day for both methods were found to be similar.

CONCLUSION

HCM can be considered as a treatment of IAD along with the use of SCM. A skin care regimen should include effective cleansing, skin protection, and moisturization in IAD management.

Analgesic effect of structured anal skin care for perianal dermatitis after low anterior resection in the rectal cancer patients: prospective, single-center, open-label, therapeutic confirmatory, randomized clinical trial

Purpose

This prospective, single-center, open-label, therapeutic confirmatory, randomized clinical trial aimed to assess the alleviation of anal pain by applying structured anal skin care including skin protectants in rectal cancer patients with low anterior resection syndrome (LARS) combined with anal pain.

Methods

From December 2017 to May 2020, 42 patients with LARS (scores of ≥21) and anal pain (visual analogue scale [VAS] score of ≥3) were randomly assigned and observed for 4 weeks. The conventional treatment consisted of dietary management, sitz baths, prohibition of anal scrubbing, loperamide, and dioctahedral smectite. In the anal care group, cleanser, barrier cream, and barrier spray were applied to the anal skin after defecation following the conventional treatment. The primary outcome was analgesic effect on anal pain after 2 weeks of structured treatment (anal care group) or conventional (control group). The cutoff for analgesic effect was a decrease in the anal pain score (VAS score of ≥2 or ≥30% reduction).

Results

As a primary outcome, the analgesic effect was significantly higher in the anal care group (P = 0.034). The incontinence-associated dermatitis skin condition score was significantly improved in the anal care group than control group after 4 weeks (P = 0.023). There were no significant differences in LARS scores and quality of life scores between 2 groups.

Conclusion

Structured anal skin care has a significant analgesic effect in reducing anal pain and improving anal skin conditions in patients with LARS after rectal cancer surgery.

Smart Continence Care for People With Profound Intellectual and Multiple Disabilities: Protocol for a Cluster Randomized Trial and Trial-Based Economic Evaluation

Background

People with profound intellectual and multiple disabilities (PIMD) cannot communicate the need to change their incontinence products. The smart continence care (SCC) product Abena Nova signals caregivers when change is needed. This provides the opportunity for more person-centered care, increased quality of life, and a decreased number of leakages. However, there is a need for evidence of the effectiveness and cost-effectiveness of such technology compared with regular continence care (RCC) for people with PIMD.

Objective

This paper presents the research protocol for an effectiveness and cost-effectiveness study with people with PIMD living in long-term care facilities in the Netherlands.

Methods

A cluster randomized trial will be conducted in 3 consecutive waves across 6 long-term care providers for people with disabilities and 160 participants with PIMD. Long-term care providers are randomized at a 1:1 ratio, resulting in an intervention group and a group continuing RCC. The intervention group will receive implementation guidance and use SCC for 3 months; the other group will continue their RCC as usual and then switch to SCC. This study consists of three components: effectiveness study, economic evaluation, and process evaluation. The primary outcome will be a change in the number of leakages. The secondary outcomes are quality of life, the difference in the number of changes, the work perception of caregivers, cost-effectiveness, and cost utility. Data collection will occur at T0 (baseline), T1 (6 weeks), T2 (12 weeks), and T3 (9-month follow-up) for the first 2 intervention groups. An intention-to-treat analysis will be performed. The economic evaluation will be conducted alongside the trial from the societal and long-term care provider perspectives. Qualitative data collection through interviews and field notes will complement these quantitative results and provide input for the process evaluation.

Results

This research was funded in December 2019 by ZonMw, the Netherlands Organization for Health Research and Development. As of June 2022, we enrolled 118 of the 160 participants. The enrollment of participants will continue in the third and fourth quarters of 2022.

Conclusions

This study will provide insights into the effectiveness and cost-effectiveness of SCC for people with PIMD, allowing long-term care providers to make informed decisions about implementing such a technology. This is the first time that such a large-scale study is being conducted for people with PIMD.

Trial Registration

ClinicalTrials.gov NCT05481840; https://clinicaltrials.gov/ct2/show/NCT05481840

International Registered Report Identifier (IRRID)

DERR1-10.2196/42555

An exploratory study of the effects of the pH of synthetic urine on skin integrity in healthy participants

Background: Incontinence-associated dermatitis (IAD) develops from prolonged exposure of skin to urine and/or stool and represents a common complication in older adults, reducing the quality of life. Increased pH is an important etiologic factor of IAD, however, the relationship between urinary pH and skin barrier disruption remains unclear. Objective: To examine the effects of synthetic urine (s-urine) at various pH on transepidermal water loss (TEWL), stratum corneum hydration (SCH) and skin surface pH. Methods: S-urine solutions (pH 5.0-9.0) were applied to the volar forearms of 15 healthy participants for 2 hrs, with another site serving as the untreated control. Measurements of TEWL, SCH and skin surface pH were obtained at baseline and after each challenge. Skin buffering capacity was also examined in 5 volunteers by recording skin pH at baseline, after 2 hrs exposure and every 5 mins for 40 mins. Results: TEWL and SCH were increased following exposure to s-urine compared to baseline values. Although there was tendency for pH to an increase after exposure, further investigation showed that changes are only temporal as pH value is restored to baseline within 5 mins. There were no significant differences between solutions. Conclusions: This study revealed that urine disrupts healthy skin integrity; however, its effects are not pH dependent. Transient changes were observed on the acid mantle of the skin due to its innate buffering capacity. Future studies need to examine the effects of urine combined with bacteria responsible for pH elevation in patients with urinary incontinence.

A novel mathematical model including the wetness parameter as a variable for prevention of pressure ulcers

Pressure ulcers are injuries caused by external conditions such as pressure, friction, shear, and humidity resulting from staying in the same position for a long time in bedridden patients. It is a serious problem worldwide when assessed in terms of hospital capacity, nursing staff employment and treatment costs. In this study, we developed a novel mathematical model based on one of our previous models to prevent pressure ulcers or delay injuries. The proposed model uses a human thermal model that includes skin temperature, hypothalamus temperature, regional perspiration coefficient, and unconsciously loss of water amount. Moreover, in our model, we defined a variable wetness parameter in addition to the parameters, pressure, temperature, and humidity. The proposed model is mathematically defined in detail and tested for a wide range of parameters to show the model's effectiveness in determining the pressure ulcer formation risk. The model is also compared with a model from the literature that based on only the general parameters, pressure, temperature, and humidity. The obtained results showed that the model determines the risk of the occurrence of the pressure ulcer more precisely than the compared one.

Conceptual Framework for Incontinence-Associated Dermatitis Based on Scoping Review and Expert Consensus Process

Incontinence-associated dermatitis (IAD) has been studied over the last decades, but gaps in the knowledge related to its identification, etiological agents, and risk factors remain. We carried out a scoping review about IAD that included systematic reviews, experimental, and observational studies about IAD and its potential risk factors. We retrieved 24 articles that described 100 potential risk factors and which were synthesized by the authors and proposed to a panel of experts. Panelists used a structured process of consensus development to create a conceptual framework of factors associated with IAD. This framework proposes that liquid fecal material, when combined with exposure to urine and stool, and bacterial contaminated urine are etiological factors for development of IAD. The framework also proposes 2 pathophysiological mechanisms and 8 main risk factors for IAD development. The proposed model could improve the quality of care for patients with or at risk of IAD, assisting healthcare professionals to identify at-risk patients, diagnose the type of lesion, and establish adequate and effective prevention and treatment measures.

Assessing absorbent products' effectiveness for the prevention and management of incontinence-associated dermatitis caused by urinary, faecal or double adult incontinence: A systematic review

OBJECTIVE

Adults who suffer from incontinence are at substantial risk of developing incontinence-associated dermatitis (IAD). In healthcare settings, several interventions have been implemented to prevent or manage IAD, and several absorbent products have been developed for incontinent patients; however, there is no systematic review that has reported on which absorbent products are effective for the prevention or management of incontinence-associated dermatitis. We conducted a systematic review to investigate the effectiveness of absorbent products in the prevention and management of IAD.

METHODS

MEDLINE (1946-August 31, 2020), CINAHL (1982-August 31, 2020), and Cochrane Library (August 31, 2020) were searched for relevant articles.

RESULTS

Eight studies met the eligibility criteria and were included in this review, including two randomized controlled trials that were designed to evaluate the efficacy of absorbent products on the prevention or management of incontinence-associated dermatitis. Quality of evidence was assessed as low or very low. The findings revealed that some outcomes related to IAD prevention or improvement of IAD can be positively affected by the introduction of a new absorbent product or a difference in the frequency of pad changing, which can control the overhydration of the skin.

CONCLUSIONS

The studies included in this review indicated that the problem of control of overhydration of the skin associated with urine and/or faeces can be controlled by absorbent products and these products may be effective for the prevention or management of incontinence-associated dermatitis. Future research with high-quality studies is required.

Does the presence of bacterial urinary infection contribute to the development of incontinence-associated dermatitis? A scoping review

OBJECTIVE

Incontinence-associated dermatitis (IAD) is an inflammatory skin condition caused by the repeated exposure to urine and faeces. It is not common for urinary incontinence only to cause IAD, however patients with urinary tract infections (UTIs) are also at increased risk for IAD. This scoping review aimed to provide a summary of the relationship between bacterial urinary infections and IAD.

METHODS

We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. PubMed, CINAHL, Medline, and Web of Science were searched for relevant articles from January 2007 through February 2020.

RESULTS

Based on eligibility criteria, 13 research studies and review articles were included. Despite the acknowledged role of bacterial infections can play in IAD and the importance of eradicating infections for the prevention of skin breakdown, there have been limited studies that have investigated how uropathogenic bacteria, in combination with urine, lead to skin damage and IAD. The use of urinary catheters also predisposes to UTIs; however, prevalence/incidence rates of IAD in these patients are not clear, as they were considered as continent of urine in the included studies.

CONCLUSION

Further research is needed to elucidate the mechanisms of how bacteria, in combination with urine, lead to IAD.

Diagnosis and treatment of xerosis cutis - a position paper

BACKGROUND AND RATIONALE

Xerosis cutis (also referred to as xeroderma, dry skin, asteatosis) affects more than 10 million individuals in Germany. It is among the most common dermatological diagnoses and a cardinal symptom of many dermatological, internal and neurological diseases. Even though it has been established that basic skin care plays a significant role in the management of patients with xerosis cutis, there are as yet no evidence-based algorithms for diagnosis and treatment.

OBJECTIVE

The present position paper provides physicians across all specialties with a practical, symptom-based approach to the prevention, diagnosis and treatment of xerosis cutis.

METHODS

Within a structured decision-making process, a panel of experienced dermatologists first defined questions relevant to everyday clinical practice, which were then addressed by a systematic review of the literature. Based on the evidence available as well as expert consensus, diagnostic and treatment algorithms were subsequently developed and agreed upon.

RESULTS

Xerosis cutis is generally diagnosed on clinical grounds. Possible trigger factors must be avoided, and comorbidities should be adequately and specifically treated. Suitable skin care products should be chosen with a view to improving skin hydration and restoring its barrier function. They should therefore contain both rehydrating and lipid-replenishing components. The "drier" the skin appears, the greater the lipid content should be (preferably using water-in-oil formulations). The choice of ingredients is based on a patient's individual symptoms, such as scaling (e.g., urea), fissures/rhagades (e.g., urea or dexpanthenol), erythema (e.g., licochalcone A) and pruritus (e.g., polidocanol). Other factors to be considered include the site affected and patient age. Ingredients or rather combinations thereof for which there is good clinical evidence should be preferentially used. The best evidence by far is available for urea, whose efficacy in the treatment of xerosis is further enhanced by combining it with other natural moisturizing components and ceramides. The "xerosimeter" is a tool developed in an effort to facilitate patient management and for training purposes. It not only includes practical tools for diagnosis and follow-up but also a classification of ingredients and a structured treatment algorithm.

CONCLUSION

The structured symptom- and evidence-based approach proposed herein contains a road map for diagnosis and treatment of xerosis cutis. It aims to raise awareness in terms of prevention and early treatment of this condition and may thus improve quality of life and prevent potential sequelae.

Prospective trial for the clinical efficacy of anogenital skin care with miconazole nitrate-containing soap for diaper candidiasis

Anogenital skin care for the elderly remains an umbrella term concerning protective and non-interventional regimens, particularly for ordinary diaper users. Our recent investigation has demonstrated the preventive effect of daily anogenital washing with miconazole nitrate-containing soap to the development of diaper candidiasis. We extended this work to cover our hypothesis as to whether the miconazole soap has a therapeutic benefit in genital candidiasis. The study outline includes: (i) the enrollment of 21 bedridden inpatients (84 ± 9 years; eight men and 13 women) who were diagnosed clinically and mycologically with genital candidiasis, and who had never received topical and/or systemic antifungal agents; (ii) administration of anogenital washing with 0.75% miconazole-containing soap once daily for 4 weeks; and (iii) assessment of clinical symptoms and detection of Candida materials by culture and microscopic examination. As assessed by clinical symptom scoring for incontinence-associated dermatitis (IAD), the ratio of patients with severe to moderate symptoms dramatically decreased by 2 weeks and 10 of 21 patients became symptom-free at 4 weeks. The IAD clinical severity score was significantly decreased at 4 weeks. Compared with the baseline positivity, both microscopic and cultured Candida-positive rates were significantly decreased at 4 weeks after washing. All culture-detected fungi were Candida albicans. Severe adverse events did not occur in all participants. Individual medical and risk factors had no significant correlation with clinical severity and duration of candidiasis on variance analysis. In conclusion, topical washing with miconazole soap is a safe and reliable non-medical approach for soothing diaper-associated genital candidiasis in bedridden inpatients in whom it is difficult to perform prompt medical examination.

Combination of minimum wiping pressure and number of wipings that can remove pseudo-skin dirt: A digital image color analysis

BACKGROUND

Excessive wiping friction in skin care may lead to skin damage. Bed baths are required to remove skin dirt without affecting the skin barrier function; the wiping pressure and number of wipings that satisfy these two requirements have not been clarified. This study aimed to determine the minimum wiping pressure and number of wipings that can remove skin dirt.

MATERIALS AND METHODS

In this quasi-experimental study, 50 healthy adults received an adhesion of pseudo-oily and aqueous dirt, randomly assigned to the left and right forearms. Each participant was wiped three times with wiping pressure classified into six randomly assigned categories. The dirt removal rate was calculated by color-analyzing images captured before and after each wiping, and its dependence on the combination of wiping pressure and number of wipings was assessed using a linear mixed model.

RESULTS

The combinations achieving oily dirt removal rates of 80% or more were wiping once and pressure ≥50 mmHg, wiping twice and pressure ≥40 mmHg, and wiping thrice and pressure ≥10 mmHg. Aqueous dirt was removed almost completely by wiping once, even with pressure ≥5 mmHg.

CONCLUSION

Wiping with at least 10 mmHg or more three times can sufficiently remove both oily and aqueous dirt. Dirt removal rates with weak pressure can be made about as effective as those achieved with strong pressure by increasing the number of wipings. This result can be applied to daily nursing, home care, and long-term care health facilities.

Managing Urinary Incontinence

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home.The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers. This article is the second of two that provide an update on urinary incontinence and its management in older adults. It includes an informational tear sheet-Information for Family Caregivers-that contains links to the instructional videos. To use this series, nurses should read the articles first, so they understand how best to help family caregivers, and then encourage caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.

Examining Prevalence and Risk Factors of Incontinence-Associated Dermatitis Using the International Pressure Ulcer Prevalence Survey

PURPOSE:

To evaluate prevalence and risk factors of incontinence-associated dermatitis (IAD).

DESIGN:

Retrospective analysis of 2016 International Pressure Ulcer Prevalence survey data.

SUBJECTS AND SETTING:

Adult patients who were in acute care, long-term acute care, long-term care, and rehabilitation facilities in the United States and Canada.

METHODS:

IAD prevalence was calculated among all patients surveyed, among the incontinent patients only, across multiple care settings, and by incontinence type. A logistic regression examined risk factors for IAD in the incontinent population.

RESULTS:

Nearly 1 in 5 incontinent patients had IAD documented. Incontinence-associated dermatitis prevalence in the entire patient population was 4.3% while incontinence prevalence was 18%. Of incontinent patients, prevalence of IAD ranged from 8.4% in long-term care facilities to 19% in acute care facilities. Facilities with higher rates of incontinence did not necessarily have higher prevalence of IAD. Incontinence-associated dermatitis prevalence by incontinence type ranged from 12% for patients with urinary incontinence to 26% for patients with fecal management systems. Regression results support the association of the following factors with an increased likelihood of IAD documented: all types of incontinence, fecal management systems, higher body weight, diminished mobility, additional linen layers, longer length of stay, and lower Braden Scale scores.

CONCLUSIONS:

Incontinence-associated dermatitis remains a concern in acute care settings. Risk factors associated with IAD were similar to risk factors previously reported for hospital-acquired pressure injuries, such as limited mobility, longer lengths of stay, and additional linen layers. By consistently documenting IAD as well as pressure injury prevalence, facilities may benchmark overall skin prevention models.

Management of incontinence-associated dermatitis patients using a skin protectant in acute care: a case series

Objective:

Incontinence-associated dermatitis (IAD) is a common type of irritant contact dermatitis. It is categorised by persistent erythema and can be associated with denudation and/or colonisation and infection. IAD is challenging to treat and affects 3.4–50% of patients. This case series evaluates a novel, elastomeric, advanced skin protectant (3M Cavilon Advanced Skin Protectant) in a UK acute health-care setting, for the management of IAD in patients suffering from moisture-associated skin damage (MASD) in the sacral/genital area.

Method:

The patient's skin was assessed by clinicians using the GLOBIAD classification tool at the point of recruitment and to monitor progress throughout the study period. The product was applied as a single layer in accordance with the instructions for use. Patients, when able, were asked to assess their own pain level using the Wong-Baker FACES pain scale. Photographs were taken as part of the ongoing assessment.

Results:

The skin protectant was used on average every 2.28 days. Of the 18 IAD patients recruited, 79% (n=11) were classified as IAD-free, based on the GLOBIAD categorisation tool, by the end of the evaluation period. Skin deterioration during the evaluation period was seen in one patient (6%), and of the patients able to complete pain assessments, 55% (n=6) reported a reduction in pain.

Conclusion:

These results suggest that the elastomeric skin protectant, applied every three days, plays a role in the improvement of IAD. The skin protectant adheres to wet and weeping partial-thickness wounds and may aid IAD management. Reducing application to every third day supports a change in practice which may offer benefits to patients and caregivers.

Use of Potassium Hydroxide (KOH) Test Reduces Antifungal Medication Prescription for Suspected Monilial Diaper Dermatitis in the Neonatal Intensive Care Unit: A Quality Improvement Project

BACKGROUND

Despite availability of rapid fungal potassium hydroxide (KOH) tests, many care providers rely on visual assessment to determine the diagnosis of monilial diaper dermatitis (MDD).

PURPOSE

To determine whether a KOH test, when MDD is suspected, would result in more accurate diagnoses, with decreased antifungal medication prescription and exposure.

METHODS

Quality improvement project from 2016 through 2017 with protocol implemented in 2017 for treatment of MDD after positive KOH testing. If monilial rash suspected, after 2 negative KOH tests, then antifungal ordered (considered false negative). χ testing and cost determination were performed.

SAMPLE

Neonates in 2 level III neonatal intensive care units.

OUTCOME VARIABLES

KOH test results, use of antifungal medication, and cost.

RESULTS

The patient census included 1051 and 1015 patients in the year before and after the protocol initiation. The medical orders for antifungal medication decreased from 143 to 36 (P < .001; 95% odds ratio confidence interval, 2.24-4.38). There was a 75% reduction in both use and cost, as charged, of antifungal agents. Overall charges, including KOH test costs, decreased by 12%. Three infants received multiple negative KOH tests, then a positive one. These met the definition of false-negative tests, per protocol. There were no cases of fungal sepsis.

IMPLICATIONS FOR PRACTICE

Use of a quality improvement protocol, in which the use of KOH testing is required, before antifungal agents are prescribed, results in decreased exposure and costs.

IMPLICATIONS FOR RESEARCH

To test the feasibility of bedside "point-of-care" KOH testing, and whether KOH testing and reduced antifungal medication use affects antimicrobial resistance or invasive fungal sepsis.

How to manage incontinence-associated dermatitis in older adults

An estimated 14 million adults experience incontinence in England alone, and this population is at a very high risk of developing incontinence-associated dermatitis (IAD). The risk associated with developing IAD is further increased among older adults, due to the effects of the ageing process, which leave the skin thinner and more fragile. Understanding the causative factors of IAD in addition to understanding the impact of IAD on the skin enable the clinician to make informed choices regarding treatment, management and prevention. Additionally, understanding the association between IAD and pressure ulcers is a critical component of IAD management, as IAD and pressure ulcers often coexist or develop alongside each other.

Prevention and Management of Incontinence-Associated Dermatitis in the Pediatric Population: An Integrative Review

An integrative review was conducted to synthesize evidence on prevention and management of incontinence-associated dermatitis (IAD) in the pediatric population. A 5-step integrative process was used to guide the review. Articles published from January 2000 to April 6, 2017, were identified and retrieved from CINAHL, PubMed, ProQuest (MEDLINE), and Scopus; key terms were associated with IAD, pediatric, prevention, and management. Supplemental and manual searches were carried out to identify other relevant studies. The studies' findings were extracted and summarized in a table of evidence, with their quality evaluated using the Joanna Briggs Institute's Critical Appraisal Checklist. Sixteen articles were included in the review. Articles explored prevention and management strategies including skin cleansing technique, diaper selection, and the application of topical skin care products. Inconsistent and limited evidence was found regarding the benefits of using disposable wipes in preference to water-moistened washcloths in the cleansing process and on the use of superabsorbent polymer diapers with breathable outer lining in IAD prevention. Findings were inconclusive with regard to the best topical skin care product for IAD care. However, the application of skin protectants was encouraged by the authors, as well as promoted in various clinical guidelines. The development of a structured skin care regimen supplemented by a comprehensive patient education program was advised to enhance the prevention and management of IAD.

The Ghent Global IAD Monitoring Tool (GLOBIAD-M) to monitor the healing of incontinence-associated dermatitis (IAD): Design and reliability study

The aim of this study was to design and evaluate the reliability of the Ghent Global incontinence-associated dermatitis (IAD) Monitoring Tool (GLOBIAD-M). The tool was designed based on the internationally validated Ghent Global IAD Categorisation Tool (GLOBIAD). After designing and validation by experts, one trained researcher carried out 36 observations of 9 patients affected with IAD. Photographs of the IAD lesions were independently assessed by a second trained researcher. Measures for inter-rater agreement (p_o ) and reliability [Cohen's Kappa (ĸ) and intra-class correlation coefficients (ICC)] were analysed. The p_o ranged between 0.86 for the item 'maceration' and 0.97 for the item 'clinical signs of infection'. The ĸ for the item 'GLOBIAD classification' was 0.61 [95% confidence interval (CI) 0.28-0.95] and 0.72 (95% CI 0.50-0.95) for 'maceration'. The lowest ĸ was found for the item 'oedema' (0.27; 95% CI -0.24-0.79). The ICC of the item 'redness' was 0.83 (95% CI 0.69-0.91) and 0.87 (95% CI 0.76-0.93) for 'skin loss'. The inter-rater agreement and reliability of the GLOBIAD-M appears to be good for the assessment of photographs by experts. This tool could support clinical decision-making for IAD treatment. Further validation with clinicians is, however, needed.

Towards an international language for incontinence-associated dermatitis (IAD): design and evaluation of psychometric properties of the Ghent Global IAD Categorization Tool (GLOBIAD) in 30 countries

BACKGROUND

Incontinence-associated dermatitis (IAD) is a specific type of irritant contact dermatitis with different severity levels. An internationally accepted instrument to assess the severity of IAD in adults, with established diagnostic accuracy, agreement and reliability, is needed to support clinical practice and research.

OBJECTIVES

To design the Ghent Global IAD Categorization Tool (GLOBIAD) and evaluate its psychometric properties.

METHODS

The design was based on expert consultation using a three-round Delphi procedure with 34 experts from 13 countries. The instrument was tested using IAD photographs, which reflected different severity levels, in a sample of 823 healthcare professionals from 30 countries. Measures for diagnostic accuracy (sensitivity and specificity), agreement, interrater reliability (multirater Fleiss kappa) and intrarater reliability (Cohen's kappa) were assessed.

RESULTS

The GLOBIAD consists of two categories based on the presence of persistent redness (category 1) and skin loss (category 2), both of which are subdivided based on the presence of clinical signs of infection. The agreement for differentiating between category 1 and category 2 was 0·86 [95% confidence interval (CI) 0·86-0·87], with a sensitivity of 90% and a specificity of 84%. The overall agreement was 0·55 (95% CI 0·55-0·56). The Fleiss kappa for differentiating between category 1 and category 2 was 0·65 (95% CI 0·65-0·65). The overall Fleiss kappa was 0·41 (95% CI 0·41-0·41). The Cohen's kappa for differentiating between category 1 and category 2 was 0·76 (95% CI 0·75-0·77). The overall Cohen's kappa was 0·61 (95% CI 0·59-0·62).

CONCLUSIONS

The development of the GLOBIAD is a major step towards a better systematic assessment of IAD in clinical practice and research worldwide. However, further validation is needed.

Independent risk factors for the development of incontinence-associated dermatitis (category 2) in critically ill patients with fecal incontinence: A cross-sectional observational study in 48 ICU units

BACKGROUND

Critically ill patients suffering from fecal incontinence have a major risk of developing incontinence-associated dermatitis (IAD). The presence of moisture and digestive enzymes (lipase, protease) negatively influences skin barrier function. Additional risk factors will make some patients even more vulnerable than others. In order to provide (cost) effective prevention, this specific patient population should be identified timely.

OBJECTIVES

To identify independent risk factors for the development of IAD category 2 (skin loss) in critically ill patients with fecal incontinence.

DESIGN

A cross-sectional observational study.

SETTING AND PARTICIPANTS

The study was performed in 48 ICU wards from 27 Belgian hospitals. Patients of 18 years or older, with fecal incontinence at the moment of data collection, were eligible to participate. Patients with persistent skin redness due to incontinence (IAD category 1) were excluded.

METHODS

Potential risk factors were carefully determined based on literature and expert consultations. Data were collected over a period of eight months by trained researchers using patient records and observation of skin care practices. At the time a patient was included in the study, all relevant data from the past six days, or since admission at the ICU, were recorded. Simultaneously, direct skin observations were performed and high definition photographs were ratified by an expert IAD researcher. A multiple binary logistic regression model was composed to identify independent risk factors. Variables with P < .25 in single binary logistic regression analyses were added to the multiple model using a forward procedure. A cut-off value of P < .1 was established to retain variables in the final model. Nagelkerke's R² and Hosmer-Lemeshow statistic were calculated as measures of model fit.

RESULTS

The sample comprised of 206 patients, of which 95 presented with IAD category 2, and 111 were free of IAD. Seven independent risk factors were identified: liquid stool [odds ratio (OR) 4.69; 95% confidence interval (CI) 2.28-9.62], diabetes (OR 2.89; 95% CI 1.34-6.27), age (OR 1.05; 95% CI 1.02-1.08), smoking (OR 2.67; 95% CI 1.21-5.91), non-use of diapers (OR 2.97; 95% CI 1.39-6.33), fever (OR 2.60; 95% CI 1.23-5.53), and low oxygen saturation (OR 2.15; 95% CI 1.03-4.48). Nagelkerke's R² was 0.377. The Hosmer-Lemeshow statistic indicated no significant difference between the observed and expected values (p = .301).

CONCLUSIONS

Liquid stool, diabetes, age, smoking, non-use of diapers, fever, and low oxygen saturation were independently associated with IAD category 2 in critically ill patients with fecal incontinence.

Incontinence-associated dermatitis in the critically ill patient: an intensive care perspective

BACKGROUND

Incontinence-associated dermatitis is a skin disorder evident as a complication of incontinence. It is characterized by perineal, buttock and groin erythema and skin breakdown. Incontinence-associated dermatitis is a ubiquitous, nosocomial condition commonly present in critically ill patients in the intensive care unit. Critically ill patients, by the nature of their critical illness and therapies used to treat their presenting condition, are commonly predisposed to faecal incontinence and are consequently at high risk of developing incontinence-associated dermatitis. However, this condition is under-explored and under-reported in the intensive care literature.

OBJECTIVE

The aim of this paper is to provide a review of the literature relating to incontinence-associated dermatitis from the critically ill patients in the intensive care setting.

DISCUSSION

There is a paucity of literature addressing this condition in the intensive care context, with only 11 studies identified. This paper will provide an overview of the definitions, prevalence and incidence of incontinence-associated dermatitis. Furthermore, an exposition of incontinence-associated dermatitis from the critically ill patient and intensive care nursing perspectives will be presented through a review of the skin barrier function, clinical presentation, risk factors, clinical assessment and severity categorization, prevention and management of incontinence-associated dermatitis.

CONCLUSION

It is imperative that critical care nurses have an appreciation of incontinence-associated dermatitis as a common, yet preventable condition, and are equipped with knowledge to appropriately prevent and manage this common complication.

Associations between skin barrier characteristics, skin conditions and health of aged nursing home residents: a multi-center prevalence and correlational study

BACKGROUND

Geriatric patients are affected by a range of skin conditions and dermatological diseases, functional limitations and chronic diseases. Skin problems are highly prevalent in elderly populations. Aim of this study was to investigate possible associations between health, functional and cutaneous variables in aged long-term care residents.

METHODS

This observational, cross-sectional, descriptive prevalence study was conducted in a random sample of 10 institutional long-term care facilities in Berlin. In total, n = 223 residents were included. Demographic and functional characteristics, xerosis cutis, incontinence associated dermatitis, pressure ulcers and skin tears were assessed. Stratum corneum hydration, transepidermal water loss, skin surface pH and skin temperature were measured. Data analysis was descriptive and explorative. To explore possible bivariate associations, a correlation matrix was created. The correlation matrix was also used to detect possible collinearity in the subsequent regression analyses.

RESULTS

Mean age (n = 223) was 83.6 years, 67.7% were female. Most residents were affected by xerosis cutis (99.1%; 95% CI: 97.7% - 100.0%). The prevalence of pressure ulcers was 9.0% (95% CI: 5.0% - 13.0%), of incontinence associated dermatitis 35.4% (95% CI: 29.9% - 42.2%) and of skin tears 6.3% (95% CI: 3.2% - 9.5%). Biophysical skin parameters were not associated with overall care dependency, but with age and skin dryness. In general, skin dryness and measured skin barrier parameters were associated between arms and legs indicating similar overall skin characteristics of the residents.

CONCLUSION

Prevalence of xerosis cutis, pressure ulcers and skin tears were high, indicating the load of these adverse skin conditions in this population. Only few associations of demographic characteristics, skin barrier impairments and the occurrence of dry skin, pressure ulcers, skin tears and incontinence-associated dermatitis have been detected, that might limit the diagnostic value of skin barrier parameters in this population. Overall, the measured skin barrier parameters seem to have limited diagnostic value for the reported skin conditions except xerosis cutis.

TRIAL REGISTRATION

This study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526 . Registration date: 8th November 2014.

Clinical Evaluation of a Skin Protectant for the Management of Incontinence-Associated Dermatitis: An Open-Label, Nonrandomized, Prospective Study

PURPOSE:

The purpose of this study was to evaluate the efficacy of an investigational skin protectant product at managing severe skin breakdown associated with incontinence.

DESIGN:

Open-label, nonrandomized, prospective study.

SUBJECTS AND SETTING:

The sample comprised 16 patients; inclusion criteria were: patients older than 18 years, cared for in the intensive care unit of a level I trauma center hospital or in long-term care facilities in the northeast region of the United States, and had incontinence-associated dermatitis (IAD). Twelve of the patients had epidermal skin loss and 4 had severe redness.

METHODS:

The investigational product is a formulation based on acrylate chemistry. The skin protectant application schedule was twice weekly for up to 3 weeks for a maximum of 6 applications during the study period. The skin was evaluated via a skin assessment instrument specifically designed for use in this study; this instrument has not undergone validation studies. The main outcome measure was changes in the instrument score over time. In addition, complete reepithelialization was recorded when observed, and pain scores (associated with IAD) were noted in participants who were able to report pain.

RESULTS:

The IAD score improved in 13 of 16 patients, remained unchanged in 1 patient, and deteriorated in 2 patients. The median percent improvement in the skin assessment instrument was 96% (P = .013). Four of the patients with epidermal skin loss had complete reepithelialization of the skin surface with 4 to 6 applications of the skin protectant, and 5 had substantial improvement. The 4 patients with severe red skin returned to healthy normal skin with 2 to 4 skin protectant applications. Substantial pain reduction was reported by all 9 patients who reported pain at enrollment. No adverse events associated with the skin protectant application were reported during data collection.

CONCLUSION:

Results of this study suggest that an acrylate-based product, evaluated here for the first time in patients, may be effective as a protective barrier in the presence of continued incontinence. Additional research is needed to confirm these findings.

Efficacy and safety of a new coverlet device on skin microclimate management: a pilot study in critical care patients

OBJECTIVE

To test the effect of a new coverlet device, allowing air circulation at the body/underlying surface interface, on skin microclimate management.

METHOD

This prospective observational pilot study took place in a 15-bed university-affiliated intensive care unit. Overall, 34 mechanically ventilated patients were included. Skin humidity and temperature were monitored before and after the implementation of the tested device at the occiput, scapulas, buttocks and sacrum. Humidity and temperature were evaluated through surface skin impedance and an infra-red thermometer, respectively. Health professionals were asked to evaluate the device.

RESULTS

After implementation of the coverlet device, there was a rapid, sustained and significant decrease in skin humidity at all sites ranging from 6 % to 15 %, excluding the occiput. Skin temperature also significantly decreased from 1 % at both scapulas, but not at the other studied body sites. No side effects were observed. Health professionals reported that the device was easy and quick to install. Although they did not report a subjective improvement in skin moisture or temperature, they considered the device to be efficient.

CONCLUSION

Although limited by its design, this pilot study suggests a good efficacy of the studied device on skin microclimate management. Further data are warranted to test the clinical implications of our findings.

Effectiveness of topical skin products in the treatment and prevention of incontinence-associated dermatitis: a systematic review

BACKGROUND

Incontinence-associated dermatitis (IAD) is inflammation of the skin resulting from repeated contact with urine and/or feces. It causes pain, redness, swelling and excoriation, and may lead to complications such as fungal skin infections and pressure injuries. It is important to prevent and treat IAD to avoid complications and improve patient outcomes. A number of products are available for protecting skin, but evidence on their effectiveness is limited.

OBJECTIVES

The current review aimed to establish the effectiveness of topical skin products in reducing the occurrence and/or severity of IAD.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

Adult patients over the age of 18 years with incontinence and/or diarrhea.

TYPES OF INTERVENTION

Topical skin products as individual interventions or part of a skin care regimen.

TYPES OF STUDIES

Both published and unpublished study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after, prospective and retrospective cohort, case-control, analytical cross-sectional, descriptive study designs including case series, individual case reports and descriptive cross-sectional studies across all care settings for inclusion.

OUTCOMES

The primary outcome of interest was the absence or non-development, reduction or resolution, new development or increase in the occurrence of IAD or the increase in severity of IAD. The secondary outcome was any adverse effect caused by the skin care products used.

SEARCH STRATEGY

A three-step search strategy to find both published and unpublished papers was utilized in this review. Studies were limited to those published in English from 1980 to 2016.

METHODOLOGICAL QUALITY

Papers selected were assessed by two independent reviewers using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI).

DATA EXTRACTION

Data were extracted using the standardized data extraction tool in JBI-MAStARI. The data extracted included specific details about the interventions, populations, study methods and outcomes.

DATA SYNTHESIS

Studies were assessed for methodological quality and statistical significance to determine validity and generalizability of study results. It was not possible to pool studies to conduct meta-analysis or test for heterogeneity.

RESULTS

There were a limited number of clinical trials that compared products for efficacy in preventing and treating IAD. Assessment tools and severity scores used to measure skin damage outcomes were dissimilar and prone to subjectivity. It was difficult to ascertain superiority of any individual product.

CONCLUSION

Information on barrier protective efficacy, side effects and cost can be valuable to both clinicians and care providers. More randomized controlled trials on product effectiveness for prevention and treatment of IAD are highly recommended.