July 27, 2007 — In a recent opinion poll conducted by Sage Products Inc., 57 percent of the 200 wound ostomy continence nurses who responded said their hospital has a specific protocol in place for prevention of incontinence-associated dermatitis (IAD). Forty-three percent do not have any protocols in place. The poll was conducted at the Wound Ostomy & Continence Nurses (WOCN) Society’s annual conference, June 9-13, 2007.
IAD is an inflammation of the skin that occurs when urine or stool comes into contact with perineal or perigenital skin. The condition is under-reported and research shows that 20 percent of acute patients are incontinent. In addition, new research in the Journal of Wound, Ostomy and Continence Nursing(May/June 2007)1, shows that 42.5 percent of incontinent patients suffer from some type of skin injury.
IAD costs are grouped with costs for other skin injuries, such as pressure ulcers (PUs). A study in Ostomy/Wound Management found that the average hospital spends $400,000 to $700,000 annually treating pressure ulcers—and most of this cost cannot be reimbursed. In addition, national quality initiatives, such as the Institute for Healthcare Improvement’s (IHI) Protecting 5 Million Lives from Harm Campaign, are raising awareness of patient care and hospital-acquired events. Preventing PUs is one of the IHI’s campaign interventions.
IAD can develop within a short time-frame and speed of development is driven by:
-Urine – Skin exhibiting symptoms of dermatitis (red, sore, cracked) when exposed to urine can develop IAD within 72-hours.
-Stool – Fecal matter contains digestive enzymes that erode or eat away at skin upon contact. IAD can begin to develop within eight hours, sooner if liquid stool is present.2
-Containment devices – Disposable briefs/pads keep urine and fecal matter close to skin and raise temperature in the area, which causes perspiration. This sequence further prompts development of IAD.
IAD prevention requires continuous monitoring and care. Ninety-two percent of poll respondents said that they use barrier paste or creams to prevent IAD. Use of pastes and creams does not encourage compliance because nurses have to take time to collect materials and bring those items to the patient’s bedside for treatment. Having materials at bedside makes prevention and treatment of skin injury easier, and is recommended in the IHI’s “Getting Started Kit: Prevent Pressure Ulcers How-to Guide.” Fifty percent of nurses said they use premoistened cloths while others reported using wipes (30 percent) and basin/water/cloth combinations (29 percent). Premoistened barrier cloths optimize IAD prevention and treatment because they are designed to be skin-friendly and have built-in protection so they are included in the IHI’s pressure ulcer prevention initiative recommendations. The barrier cloths gently cleanse the skin, moisturize, deodorize and protect skin. In addition, the barrier cloths are easily stored at the patient’s bedside for ease of use. Bedside barrier stations promote barrier compliance because cloths are stored at patients beside.
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