Medline has collaborated with authors Karen Ousey and Louise O’Connor to address this challenging topic.
Karen Ousey is Professor and Director for the Institute of Skin Integrity and Infection Prevention at the University of Huddersfield.
Louise O’Connor is an Advanced Nurse Practitioner Tissue Viability at Central Manchester Hospital Trust.
They are both experts in the field of Moisture Associated Skin Damage and face this issue on a daily basis as healthcare professionals.
What is IAD?
Incontinence-associated dermatitis (IAD) describes skin damage associated with exposure to urine or faeces. It causes patients significant discomfort and can be difficult and time-consuming to treat1. It is a significant health challenge and a well documented risk factor for pressure ulcer development2.
The exact size of the challenge for HCPs and patients is hard to define. This is due partly to inconsistencies in terminology, and difficulties in recognising the condition and distinguishing it from Category I/II pressure ulcers in diagnosis: all of which have subsequently resulted in less than robust data collection. This is compounded by the lack of a nationally recognised, validated and accepted method for IAD data collection, which adds to the wide variation in prevalence and incidence figures.
Studies have estimated prevalence of IAD at 5.6% to 50%3-7 while reported incidence varies from 3.4% to 25%8-10.
Patients with IAD may experience discomfort, pain, burning, itching and tingling in affected areas, even when the dermis is intact. In addition to physical symptoms, patients may feel loss of independence, disruption to activities and/or sleep and reduced quality of life that becomes worse as the frequency and quantity of soiling increases. They may also feel/believe they are a burden on family and friends.
1Doughty D, Junkin J, Kurz P et al. Incontinence-associated dermatitis. Consensus statements, evidence-based guidelines for prevention and treatment, current challenges J WOCN 2012; 39(3):303-15
2Beeckman D, Van Lancker A, Van Hecke A, Verhaeghe S. A systematic review and meta analysis of incontinence associated dermatitis, incontinence, and moisture as risk factors for pressure ulcer development. Res Nurs Health 2014; 37:204–18
3Bliss DZ, Savik K, Harms S, et al. Prevalence and correlates of perineal dermatitis in nursing Home residents. Nurs Res 2006; 55(4):243-51
4Peterson KJ, Bliss DZ, Nelson C, Savik K. Practices of nurses and nursing assistants in preventing incontinence associated dermatitis in acutely/critically ill patients. Am J Crit Care 2006; 15(3):325
5Junkin J, Selekof JL. Prevalence of incontinence and associated skin injury in the acute care inpatient. J WOCN 2007; 34(30): 260–9
6Gray M, Beeckman D, Bliss DZ, et al. Incontinence-associated dermatitis: a comprehensive review and update. J WOCN 2012; 39(1): 61–74
7Campbell JL, Coyer FM, Osborne SR. Incontinence-associated dermatitis: a cross-sectional prevalence study in the Australian acute care hospital setting. Int Wound J 2014 doi:10.1111/iwj.12322
8Bliss DZ, Zehrer C, Savik K, et al. An economic evaluation of four skin damage prevention regimens in nursing home residents with incontinence. J WOCN 2007; 34(2): 143-52
9Long M, Reed L, Dunning K, Ying J. Incontinence-associated dermatitis in a long-term acute care facility. J WOCN 2012 39(3): 318-27
10Borchert K, Bliss DZ, Savik K, et al. The incontinence-associated dermatitis and its severity instrument: development and validation. J WOCN 2010; 37(5): 527–35