Prevention of Incontinence-Related Skin Breakdown for Acute and Critical Care Patients: Comparison of Two Products

Abstract

A s is so often the case, research projects are born out of nurses asking "why" questions about their practice. This project was no different and is best illustrated with this patient story.Max, in his early 60s, was an un-kept, homeless man admitted to the hospital with a large myocardial infarction for a nearly five-week stay. His size (six foot, 4 inches, 420-pound frame) and illness had a strong effect on the staff's ability to provide care. He did not fit in the bed, and the pressure on his legs and heels, as well as the presence of 3+ pitting edema, led to sloughing of his skin. The insertion site from the coronary angiogram and intraaortic balloon pump procedures done on admission had not healed due to the presence of a body rash from the use of multi-. Prevention of incontinence-related skin breakdown for acute and critical care patients: Comparison of two products. Urologic Nursing, 32(3).Perineal protection products were compared for their efficacy in preventing skin breakdown in the hospitalized patient with urinary and/or fecal incontinence. Each product was used for the duration of the hospital stay with daily observations for perineal skin condition. Results indicated the spray product and wipe product were comparable in rate of skin breakdown prevention. Findings suggest the wipe product is more cost-effective for use during hospitalization, and the spray product preserves skin integrity over a longer period of time, beyond average hospitalization duration.Key Words: Urinary/fecal incontinence, dermatitis, skin care/nursing, cost-benefit analysis, dermatologic agents/therapeutic use.

In vivo methods to evaluate a new skin protectant for loss of skin integrity

“…They have not, however, studied any products intended to manage these skin lesions in their model. This type of work has typically been done in humans and compared products already on the market . Our work now offers a preclinical strategy to screen new formulations intended for this application.…”

The influence of incontinence on the characteristic properties of the skin in bedridden elderly subjects

“…Incontinence is a troublesome and frequent symptom in elderly people . A previous study showed that 46–72% of nursing home residents have urinary and/or fecal incontinence .…”

“…Overhydration, the penetration of stimuli into the skin, higher pH, colonization of microorganisms, and friction due to the cloth (diaper), which are induced by the occlusion environment, urine, and fecal matter, have been identified as risk factors for skin breakdown . These phenomena cause skin tears and abrasions followed by infections and/or pressure ulcers …”

“…Incontinence is a troublesome and frequent symptom in elderly people. [1][2][3] A previous study showed that 46-72% of nursing home residents have urinary and/or fecal incontinence. 4 Other reports showed that the estimated rate of urinary incontinence in subjects older than 65 years is approximately 35% for those residing in the community but more than 60% for those living in longterm care facilities.…”

“…9,10 These phenomena cause skin tears and abrasions followed by infections and/or pressure ulcers. 2,3,10,11 Proposed mechanisms for these problems show that water and moisture induce overhydration of the stratum corneum (SC) and then accelerate the penetration of low molecular weight stimuli into the skin followed by the induction of inflammation of the skin. 9,10 Water and moisture also induce an increased coefficient of friction, 12,13 and increases in friction force between diapers and the skin due to wetting is also considered to induce serious skin breakdown.…”