Incontinence-Associated Dermatitis

Abstract

In 2009, a multinational group of clinicians was charged with reviewing and evaluating the research base pertaining to incontinence-associated dermatitis (IAD) and synthesizing this knowledge into best practice recommendations based on existing evidence. This is the first of 2 articles focusing on IAD; it updates current research and identifies persistent gaps in our knowledge. Our literature review revealed a small but growing body of evidence that provides additional insight into the epidemiology, etiology, and pathophysiology of IAD when compared to the review generated by the first IAD consensus group convened 5 years earlier. We identified research supporting the use of a defined skin care regimen based on principles of gentle perineal cleansing, moisturization, and application of a skin protectant. Clinical experience also supports application of an antifungal powder, ointment, or cream in patients with evidence of cutaneous candidiasis, aggressive containment of urinary or fecal incontinence, and highly selective use of a mild topical anti-inflammatory product in selected cases. The panel concluded that research remains limited and additional studies are urgently needed to enhance our understanding of IAD and to establish evidence-based protocols for its prevention and treatment.

Incontinence-associated dermatitis: reducing adverse events

“…However, Rohwer et al (2013) support the view that faecal incontinence and frequency of incontinence episodes are risk factors for IAD. Animal models also support this view with increased irritation of the skin being due to digestive enzymes in faecal matter (Gray et al, 2012).…”

“…Most detailed studies of incontinence prevalence have been undertaken internationally, and they suggest that up to 79% of residents in nursing homes and 35% of community-dwelling adults have been found to experience incontinence (Newman et al, 2007;Langemo et al, 2011), putting them at risk of IAD. The prevalence of IAD varies dramatically depending on the setting with international surveys suggesting rates between 5.6% and 50%, while the incidence is 3.4% to 25 % (Gray et al, 2012). However, it can be difficult to truly estimate these levels as most studies involve small samples in specific settings.…”

“…Incontinence causes disruption of the skin barrier function and leads to superficial skin damage (Figure 1). This occurs because of the effects of urine, faeces, and containment devices on the skin (Gray et al, 2012). The skin's pH contributes to its barrier function and defence against infection; an ideal pH is 5.0 to 5.9 (Boer et al, 2016).…”

“…Nurses should know that IAD can be prevented and healed with timely and appropriate skin cleansing and skin protection (Gray et al, 2012;Beeckman et al, 2015). Prevention and treatment should also focus on a proper use of incontinence containment materials (Fader et al, 2008).…”

Fiabilidad Y Validez De Un Instrumento Que Utiliza Fotografías Para Medir La Habilidad De Diagnóstico Diferencial De Lesiones Causadas Por Presión Y/O Por Incontinencia

“…La National Pressure Ulcer Advisory Panel (NPUAP) y la European Pressure Ulcer Advisory Panel (EPUAP) expresan que la lesión Dermatitis Asociada a Incontinencia (DAI) es una condición que debe ser diferenciada de la Úlcera por Presión (UPP) o de una laceración de la piel, ya que comúnmente se confunde su diagnóstico (1)(2)(3)(4).…”