Clinicians Discuss Diaper Dermatitis

Diaper dermatitis in infants is commonly seen by clinicians in both primary care and acute care settings. The condition can cause significant discomfort for infants and distress for their parents and caregivers. Nursing for Women's Health convened a group of nursing clinicians who work in a variety of settings to discuss the issues and challenges related to preventing and treating diaper dermatitis in both healthy term newborns and premature newborns.

An overview of neonatal and pediatric wound care knowledge and considerations

Despite significant technological advances in the care of premature neonates and chronically ill children, the knowledge and evidence base for the management of this population's wound care lag far behind its adult counterpart. Updating antiquated care regimens is an uphill battle. This review of the literature seeks to illuminate key anatomical/structural differences in neonatal skin with particular attention paid to percutaneous absorption and tolerance of adhesives. The article also presents anatomically and physiologically based recommendations for the selection of prevention and treatment modalities, including specific dressing types, appropriate dressing change and securement procedures, and pain management. Commonly encountered wound types (epidermal stripping; surgical wounds; extravasation and thermal injuries; chemical burns; pressure ulcers; diaper dermatitis; and wounds secondary to congenital conditions) are discussed. Opportunities for research abound and are considered.

What can be done to keep babies' skin healthy?

Establishing a skincare routine that keeps babies' skin healthy remains a challenge for midwives and parents, since up to 50% of babies suffer from at least one episode of nappy rash at some time. Nappy rash is an irritant contact dermatitis caused by the interaction of several factors, particularly the prolonged contact of the skin with urine and faeces, which makes the skin more prone to disruption through friction with the nappy. Infection is not a primary cause of nappy rash, though secondary infection by Candida albicans can occur. Prevention of nappy rash is the ultimate goal, but if the condition does develop, treatment should aim to reverse the skin damage and prevent recurrence. We propose that routine baby skincare should comprise gentle cleansing whenever the nappy is soiled (using warm water or alcohol-free baby wipes), the use of good-quality super-absorbent nappies, and the application of a barrier preparation at every nappy change. Ideally, a barrier preparation should be clinically proven to be effective in babies and mimic the skin's natural function by forming a long-lasting barrier to maintain optimum moisture levels. It should not contain any unnecessary ingredients, including antiseptic, preservative or perfume (or other potential sensitisers), or any ingredients that are toxic or have undocumented safety. Treatment of nappy rash should comprise essentially the same actions as its prevention. Application of a barrier ointment at every nappy change can help to both prevent and treat this condition. Topical steroid therapy should be reserved for use where the condition has failed to respond to other approaches, and antifungal treatment should only be employed where Candida infection is established or suspected. Implementing these measures would form a simple skincare routine that could help keep babies' skin healthy.

Promoting wound healing in the neonatal setting: process versus protocol

The principles of wound healing have been studied and evaluated extensively in the animal and human adult models. Practical application has been long in coming to the neonatal and critical care settings. Neonatal nurses have the ability to significantly affect the outcome of wound healing through the care they provide and the approaches that they take to caring for wounds. The article reviews pertinent literature to provide an evidence base for optimal wound care activities. An outcome-oriented, functional approach to product selection is described to help nurses meet the goals of protection, cleansing, moist wound healing, and appropriate dressing and care of wounds specific to the neonatal population.

Prevention and management of infant skin breakdown

There are anatomic and physiologic differences in the skin of both premature and full-term infants that place them at increased risk for skin injury and breakdown. This article reviews these differences and discusses some of the infant skin care practices that can cause injury to infant skin with preventive strategies identified. Care of skin breakdown is outlined, and topical treatments reviewed in detail. Diaper dermatitis is also discussed with treatment of the underlying causes as well as the goals of treating diaper dermatitis described.

Pediatric dermatoses: three common skin disruptions in infancy

Skin disruptions account for 20% to 30% of pediatric primary care visits [1]. These disruptions may result from skin infections, inflammatory responses, insect bites, and infestations. This article focuses on the identification and management of skin disruptions related to inflammatory dermatoses. The most common dermatoses in infancy are seborrheic dermatitis, (also known as cradle cap); diaper or primary contact dermatitis; and atopic dermatitis, more commonly referred to as eczema, an entity that has yet to be clearly defined. Recognition and appropriate treatment of these common pediatric dermatoses must not just focus on the skin disruptions; it is important that the infant be assessed within the context of the family. The primary care provider must be aware that these conditions have the potential to affect the developing relationship between the infant, parent(s), and family. The practitioner within the provider-family relationship, through education and support, can empower the parent(s) to provide the necessary care for their infant.

Perineal skin care for patients with frequent diarrhea or fecal incontinence

In this article, the author presents an overview of normal skin and a description of perineal skin injury. The focus is to identify the goals for treatment for persons with frequent diarrhea or fecal incontinence as it relates to their perineal skin care. Specific algorithms for acute care and ambulatory settings are defined, and two case studies are presented. The treatment goals include evaluation of and recommendations for reviewing and choosing perineal skin products.

Diapers and diaper rashes

The diaper-wearing population has expanded from infants and children to include adults, especially the elderly. Nurses caring for patients over a wide age range are commonly asked for advice about diapering choices, and for guidance in evaluation, prophylaxis, and treatment of diaper rashes. Two different diaper types, disposables and reusables, and the advantages and disadvantages of each are discussed. A systematic approach is presented for the nursing evaluation of common diaper rashes and their differentiation from rarer skin eruptions of the groin and perineum in diaper-wearing persons.

Standardizing skin care across settings

While healthcare providers are struggling to provide optimum patient care and health outcomes in a cost efficient manner, patients are demanding assurance that the care they receive offers the best chance for health improvement. The way to achieve the most effective and efficient treatments is through knowledge of current research and treatment options and standardized care. Resources are the AHCPR's Clinical Practice Guidelines on urinary incontinence and pressure ulcers in adults. Kaiser Permanente's Northern California Region created a Task Force to demonstrate nursing's contribution to positive patient outcomes, investigate and capture opportunities to participate in an interdisciplinary approach to measuring the effectiveness of patient care, and focus efforts on measurement, improvement, research, and development. Part of this effort was the conductance of a study which demonstrated that the absorbent product with the least expensive purchase price that had traditionally been used for incontinent patients was the most expensive product to use. The results of that study have been used, not only to improve purchase decisions, but also to teach nurses how theory, research, and practice are related to issues that concern caring for their patients.

Perineal dermatitis risk factors: clinical validation of a conceptual framework

As part of a larger study previously published in December of 1994, the question was asked whether commonly used pressure ulcer assessment tools (the Braden and Medley) were applicable to a broader definition of "skin risk assessment" and altered skin integrity related to perineal dermatitis (PD), and, if so, which risk factors were actually related to PD. The three site randomized clinical trial compared the use of diapers and underpads for 166 adult patients hospitalized on medical and surgical floors who were incontinent of urine and/or feces. Variables related to skin breakdown were the number of incontinence episodes, fecal incontinence, poor skin condition, pain, poor oxygenation, fevers, and mobility problems. Results also suggest that older patients may not have the sensory perception to experience discomfort in the same intensity as younger patients. Based on the findings of this study, pressure ulcer risk assessment tools are not good risk assessment tools for PD. The previously published conceptual framework for PD was modified and validated to form a basis for preventive measures.