Every nurse will encounter patients experiencing incontinence, so every nurse must be aware of incontinence-associated dermatitis – and how it can be addressed
When a patient experiences an episode of urinary or faecal incontinence, the traditional course of nursing action is to reach for a bowl, soap, towel and barrier cream. The aim is, of course, to ensure patient wellbeing. After all, prolonged contact with urine or faeces can lead to skin breakdown, resulting in what may be referred to as moisture lesions.
Incontinence-associated dermatitis (IAD) can significantly impact on patients’ physical and psychological wellbeing. Research suggests it is fairly common, with an estimated prevalence of 20-27%, and it is a known predisposing risk factor for pressure sores. But, ironically, the common way to try to reduce the risk of skin breakdown and infection for patients experiencing incontinence can actually increase it.
Soap can affect the pH level of the skin, thereby increasing the risk of bacterial and fungal colonisation. Friction from cleaning skin then rubbing it dry can be harmful too. And a 2012 study in the American Journal of Infection Control showed that 62.2% of bath basins in 88 US hospitals were contaminated with commonly encountered hospital-acquired pathogens.
The other challenge of using soap and water: time. For nurses and healthcare assistants on a busy ward, ensuring speedy and effective cleansing for a patient who has experienced an episode of incontinence can be challenging – more so if there are multiple patients experiencing multiple episodes. It can also be challenging to retain patients’ dignity. And even once soap and water has been prepared, dry wipes used and barrier cream applied, there is often a bowl to take to the sluice.
More and more organisations are therefore investigating a different approach: an all-in-one wipe. GAMA Healthcare’s Contiplan product contains 4% dimethicone and 6% liquid paraffin so, as well as cleansing the patient’s skin, the wipes leave a protective barrier. The formula is patented, and also contains witch hazel and camomile to help soothe the skin and aid healing.
Instead of preparing soap and water, washing and drying a patient, then applying a barrier cream, nurses can simply use one wipe and leave skin to air dry. As it’s a single-use product and a packet of wipes is allocated per patient, the danger of cross-contamination is eliminated. Wipes can be disposed of as standard clinical waste.
At Kettering General Hospital Foundation Trust, staff found the wipes cost less than traditional methods of skin care for patients with incontinence, saved nursing time and were just as effective as barrier creams for preventing IAD. Similarly, Luton and Dunstable University Hospital Foundation Trust found 90% of patients with existing IAD experienced improved skin integrity during a trial of the wipes. All patients who started the trial without IAD concluded it with no IAD, indicating the wipes provided effective barrier protection. Notably, 93% of staff said using the wipes was better than the previous cleaning method. The mean time to use the wipe method was less than nine minutes.
These benefits are echoed by Amy Cartwright, continence team lead at Nottingham University Hospitals Trust. “The wipes are great and we get really good patient feedback on them,” she says. “They are a lot kinder to patients’ skin and staff find them so much easier to use. The whole process is a lot quicker and more dignified.”
The risk of incontinence increases with age and our society is ageing, so it is likely that more acute and community nurses will care for more patients with loss of bladder and bowel control. It follows, then, that exploring the best ways to prevent IAD will be worthwhile for NHS organisations.
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