Incontinence Associated Dermatitis in care facilities
IAD- causes, symptoms and prevention in health care
All people with incontinence are at risk of developing IAD (Incontinence Associated Dermatitis). Incontinence Associated Dermatitis is a health care challenge worldwide, reducing comfort and quality of life for those affected.
The good news is that when treated early and with the right products, IAD can be reduced and cured – and in most cases even prevented. A lot can be done to prevent IAD by applying a structured skin care program and using appropriate products that protect the skin in exposed areas.
It is estimated that 25% of nursing home residents are at risk of developing IAD due to fecal, urine or double incontinence. Because of its widespread prevalence, continence management is an important task in all types of health care settings.
What is IAD (Incontinence Associated Dermatitis)?
Incontinence Associated Dermatitis (IAD ) is a condition that occurs when the skin is damaged as a result of exposure to urine and/or feces. A number of factors may contribute to the development of IAD, including infrequent change of diapers (causing a moist environment), poor hygiene, use of products that are not breathable, incorrect use of skin care products, or frequent use of soap, water, and rough washcloths and towels (causing excess friction).
The skin becomes more alkaline when exposed to urine and/or feces, allowing microorganisms to thrive and increasing the risk of skin problems.
IAD is a moisture-associated skin damage. Other types of MASD include intertriginous Dermatitis, Periwound Moisture-associated skin damage, and Peristomal Moisture Associated Skin damage
What are the symptoms of IAD?
IAD typically appears as erythema (redness of the skin) ranging in color from pink to red.
The affected area usually has frayed edges and the skin may feel warmer and firmer due to the underlying inflammation. Patients with urinary and/or fecal incontinence should have their skin checked regularly, preferably daily, for any signs of IAD or for changes in symptom.
Differentiating IAD from pressure ulcer
Although IAD and pressure ulcers are clinically and pathologically different, differentiating them from each other remains a major challenge for nurses and caregivers.
If a wrong diagnosis is made, it can lead to suboptimal or wrong care and unnecessary costs. In addition, the preventive measures and treatments differ for the two conditions.
Main differences between IAD and pressure ulcers:
|
|
IAD |
Pressure Ulcer |
|---|---|---|
|
Location |
Skin folds, buttocks, inner thighs, groin |
Usually over a bony prominence, as a results of pressure |
|
Color |
Pink or bright red |
Red to bluish/purple |
|
Depth |
Partial thickness, blistering |
Partial or full thickness, injuring |
|
Cause |
Top-down damage caused by moisture and pH change |
Bottom-up damage causes by pressure and poor blood circulation |
|
Skin Necrosis |
No |
Yes/No |
|
Pain and itching |
Yes |
Yes/no |
Preventing IAD
With the right skin care regimen and incontinence care routines, IAD can be prevented. Or, if identified early and accurately, IAD can be reduced and cured.
Following a structured skin care regimen should be a part of the daily routine for all patients and residents with incontinence.
Preventive measures for IAD
In addition to following a structured skin care regimen, there a number of preventive measure to apply:
- Daily examination of the skin during everyday care. If changes in the skin condition are noticeable (such as moist skin, redness, cracks and surface damage, elevated temperature, eczema or skin rash), measures should be taken immediately
- Turning or changing the position of the patient every two hours if the patient is bedridden
- Using high quality, breathable incontinence products
- Using customized mattresses, pressure relief aids and position pads to prevent irritation
- Avoid bedding, towels or clothes that irritate the skin
- Wash gently and apply the right skin care products
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