Preventing Incontinence-Associated Dermatitis (IAD)

Incontinence is a leading risk factor for skin breakdown, known as Incontinence-Associated Dermatitis (IAD).¹ IAD is defined as “an inflammation of the skin that occurs when urine or stool comes into contact with perineal or perigenital skin.”²

Not only does IAD cause skin irritation and discomfort, but it also is a major risk factor for pressure ulcers.¹ IAD is often grouped with pressure ulcers, but they are not one and the same—IAD works from the outside in, while pressure ulcers work from the inside out. Since they are different conditions, they should be treated differently.

Applying a barrier after incontinence episodes has been proven effective versus using soap and water in a randomized control trial. A 4-month study of 464 nursing home residents using a barrier cream cloth saw a reduction in the prevalence of IAD from 22% to 8%, while residents using soap and water saw IAD prevalence increase from 23% to 27%. The study also found a decrease in IAD severity in residents using the barrier cream cloth, while no improvement was seen with soap and water.³

Using the basin to clean patients after an incontinence episode puts them at risk for nosocomial infection. Basin sampling has proven that the basin is a reservoir for bacteria, including S. aureus and the multi-drug resistant organisms (MDROs) methicillin-resistant S. aureus (MRSA) and vancomycin-resistant enterococci (VRE).^4,5

This education section will help you bolster your IAD prevention program with evidence-based incontinence care. The IAD Assessment will help your facility track outcomes from your incontinence care protocol.

These unique tools will help you assess current clinical practice, educate staff, customize and implement evidence-based protocols, complete a performance improvement plan, and track progress, from pressure ulcer rates, to staff compliance, to costs.

REFERENCES: 1. Maklebust J, Magnan MA, Adv Wound Care. Nov 1994;7(6):25,27-8,31-4 passim. 2. Gray M, et al., J Wound Ostomy Continence Nurse. 2007 Jan-Feb;34(1):45-54. 3. Beekman D, et al., A 3-in-1 perineal care washcloth impregnated with dimethicone 3% versus water and pH neutral soap to prevent and treat incontinence-associated dermatitis. Journal of Woun, Ostomy and Continence Nursing, Nov/Dec 2011; 38(6). 4. Marchaim D, et al., Hospital bath basins are frequently contaminated with multi-drug resistant human pathogens. Poster presented at SHEA 21st Annual Scientific Meeting, April 2011. 5. Johnson D, Lineweaver, Maze L, Patients’ bath basins as potential sources of infection: a multicenter sampling study, AJCC, Vol 18, No 1, Jan 2009.