Practice development Innovations Practice development How to...
in the number of patients developing grade 1 pressure ulcers (p=0.042) and incontinence- related dermatitis (p=0.021), as well as a time reduction in patient care associated with incontinence-related skin damage (p<0.001; mean reduction — 4 minutes 2 seconds per patient). In addition to a reduction in the amount of consumables used prior to implementation, this resulted in cost savings of £8.85 for qualified staff and £3.43 for unqualified staff. The researchers also noted patients' skin condition was maintained or improved following implementation. Similarly, Durnal et al[18]
evaluated a faecal
management system in a hospital intensive care unit and demonstrated a 45% reduction in costs compared to traditional methods (absorbent briefs, skin cleansers, moisturisers). The cost savings identified were mainly due to a reduction in nursing time, which was substantially reduced by using a faecal management system.
EVALUATING MOISTURE- RELATED SKIN DAMAGE When skin damage has occurred, accurate skin assessment is essential. Clinicians should use a recognised assessment tool to aid grading and decision making for treatment of tissue damage. Table 3 describes the tools available. Despite the availability of these tools, which
are specifically designed to assess IAD, the most common instruments used to assess moisture-related skin damage are pressure ulcer staging systems[17]
. Early identification of skin damage using a References
25. NATVNS. Skin Excoriation tool for incontinent patients. Edinburgh: NHS Quality Improvement Scotland. 2008; Available at:
tinyurl.com/QIS-excoriation-tool (accessed 12 September, 2012)
26.Mathison R, Bianchi J Bateman S, Harker J, Johnstone A. Skin integrity: A clinical guide to
'best practice'. 2011; Wounds UK Conference, Harrogate
27. Borchert K, Bliss DZ, Savik K,
Radosevich DM. The incontinence- associated dermatitis and its
severity instrument: development and validation. 2010; J Wound
Ostomy Continence Nurs 37: 527–35
recognised tool, as well as timely intervention, can prevent an area of excoriation developing in to a pressure ulcer. Reduction in pressure ulcer incidence is a priority in many healthcare settings in the UK now, with services setting targets to eliminate all avoidable category 3 and 4 pressure ulcers and other regions attempting to prevent all category 2,3 and 4 pressure ulcers[19]
. In addition, the Declaration
of Rio provides further evidence of the global recognition of the need to dramatically reduce the prevalence and incidence of pressure ulcers[20]
. The Declaration of Rio set
out the rights of people not to experience pressure ulcers. In addition it suggests steps to implement and help protect patients.
GUIDE TO MANAGING FAECAL INCONTINENCE It is essential to identify the underlying cause of faecal incontinence and, where
20 Wounds International Vol 2 | Issue 2 | ©W ol 3 | Issue 3 | ©Wounds International 2011 tional 2012
Faecal management systems Several products are available to clinicians for the containment of faecal matter. Anal bags may be used, however, the skin will require protection by other means if there is a chance of leakage around the device. Body worn pads are also useful but should be changed promptly after each episode of faecal incontinence to avoid or minimise skin damage. However, where diarrhoea is severe and high volume, IAD and widespread skin
possible, take measures to correct it. An inter-professional approach is required. This may mean changing the drug regimen, for example, or working with continence advisors to re-establish normal bowel habits — possibly even corrective surgery. With some causes of faecal incontinence, restoring normal function may not be possible, for example, where there is anal sphincter damage or in neurological conditions. In all cases measures should be taken to minimise the risk of tissue breakdown. If skin damage has occurred , early
intervention using a structured approach is required to minimise the damage. Gray et al[17]
recommend using a structured skin care
programme with active treatment for IAD, including the following measures for patients
with mild to moderate IAD: n Routinely cleanse and moisturise the skin — avoid the use of soap and water and use perineal skin cleansers, which combine detergents and surfactants to loosen and remove dirt and irritants. Many are pH- balanced and contain moisturising agents
n Routinely apply a skin protectant — these include acrylate polymer-based liquid film; petroleum ointment; zinc oxide in 1% dimethicone; and petroleum ointment
n Treat cutaneous candadiasis when present — this will present as a bright red rash with outlying satellite papules or pustules. The skin will be sore rather than itchy
n Apply moisturiser after each episode of incontinence. If candidiasis is present, apply a moisture-barrier combination product with anti-fungal agent, eg azole or allylamine
n Educate carers to use a structured regimen, assessing skin frequently for resolution or progression of IAD, especially after each episode of incontinence
n Evaluate or begin management programme for underlying incontinence.
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