Prolonged contact of the skin with urine or faeces leads to a specific form of moisture-associated skin damage, known as incontinence-associated dermatitis (IAD). While this is a common condition encountered in all areas of nursing practice, gaps remain in our understanding of the many contributing factors.
A lack of standardised definitions of IAD, differences in terminology, and a bewildering increase in products available to prevent and manage IAD, make it difficult for nurses to deliver evidence-based care. However, it is an area where nursing research has made a considerable contribution over the past few years, culminating in the development and publication of a set of international best practice principles based on expert consensus.1 This article explores the main principles developed and the implications for nursing practice.
First off, let me wish all of you a Happy and Prosperous Chinese New Year! This is our first editorial post for 2022 and I want to start off by talking about a problem that incontinence caregivers at home or maybe, even incontinence patients themselves, may sometimes neglect – skincare.
A person with incontinence is not able to prevent urine and stool from leaking, and is at risk for skin problems around the buttocks and genital areas. Urine and stool can damage the skin at these areas, causing redness, irritation and soreness. This can be distressing, uncomfortable and isolating.
While waste absorbent products like pads are great at absorbing leaks, they can also trap moisture close to the skin. This can become a problem if it is not taken care of quickly. Built-up moisture can cause skin irritation. Redness, peeling, irritation and even yeast infections can occur. Bedsores may also develop if a patient has not been eating well, and spends most or all day in a wheelchair, chair or bed without changing position.
Hence, caring for the skin can be as important as preventing leaks. Maintaining cleanliness is essential to keeping healthy skin, avoiding skin damage, preventing bad odour and making a patient feel comfortable. These are all important to the patient’s quality of life.
Fortunately, there are simple steps we can take to help take care and protect the skin of incontinence patients. Take note of the following when taking care of an incontinent patient:
- Choose waste absorbent products (like pads or diapers) that fit well, feel good and are secure against leakage. Seek the patient’s feedback.
- Check the patient regularly and change the waste absorbent products as and when required.
- Ensure the skin is cleaned often with a good cleanser. Avoid harsh skin products that contain alcohol, perfumes and disinfectants. These can dry the skin and cause rashes.
- Be gentle and careful when cleaning the skin. Remember to pat dry.
- Be aware of natural bladder and bowel routines so that the patient can be helped to discharge in a toilet, instead of solely relying on waste absorbent products.
- Ensure the patient has good nutrition and fluid intake daily.
- Change the position of bedridden/immobile patients often to avoid the development of bedsores. Use pillows to reduce pressure on certain parts of the body where bedsores may develop.
- Check often for signs of skin breakdown and act promptly.
- Look out for signs of UTI (urinary tract infection).
You may also want to take note of the various types of skincare products out there that are suitable for use on incontinent patients. These include the likes of non-alcoholic wet wipes, perineal cleansers, moisturizing creams/lotion, skin protectants, antibacterial/antifungal creams and skin powder.
Finally, if you still observe skin problems that do not seem to be going away or have become more severe despite taking all necessary steps, see your doctor right away for help.
Pressure ulcer education 6: incontinence assessment and careDigital Edition: Pressure ulcer education 6: incontinence assessment and care
10 February, 2020
This article, the sixth in an eight-part series on a new core education curriculum for pressure ulcer prevention and management, discusses incontinence assessment and care
Abstract
Assessing the patient and Identifying skin damage associated with increased moisture, often caused by incontinence is an essential part of good skin care. Excessive moisture on the skin due to factors such as urinary and/or faecal incontinence or wound exudate greatly increases the risk of pressure ulcers, so moisture-associated skin damage is now reported alongside pressure ulcers. This article â the sixth in an eight-part series on developing a core education curriculum for pressure-ulcer prevention and management â describes how incontinence-related, moisture-associated skin damage occurs, outlines other causes of moisture-related skin damage and details key factors for prevention and management.
Citation: Fletcher J (2020) Pressure ulcer education 6: incontinence assessment and Care. Nursing Times [online]; 116: 3, 42-44.
Author: Jacqui Fletcher is chair, Pressure Ulcer Education Core Curriculum Group, and senior clinical adviser, NHS England and NHS Improvement.
This article has been double-blind peer reviewed
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