Prevention and management of urinary incontinence-associated dermatitis: A systematic review.

BACKGROUND: To prevent incontinence-associated dermatitis (IAD) and manage the treatment, the cause of IAD must be determined correctly and distinguished from other skin problems. IAD can be prevented with professional care. AIM: This systematic review aims to systematically examine the methods used in the prevention and treatment of urinary incontinence-associated dermatitis. MATERIALS AND METHODS: The PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) criteria were taken as the basis for creating the systematic review protocol and writing the article. In this systematic review, the scans are combinations of words and word groups determined by the MeSH (Medical Subject Headings) terms "incontinence", "incontinence-associated dermatitis", "prevention of urinary incontinence", "treatment of urinary incontinence" and "randomized controlled". Studies conducted in the last eight years were examined in the PubMed, Cochrane Library, Web of Science, and Scopus databases between January and March 2024. Studies were selected by determining inclusion and exclusion criteria according to the PICOS method and these studies included in the review were evaluated according to the Joanna Briggs Institute (JBI) critical evaluation lists according to their types. RESULTS: Five randomized controlled trials with a total of 644 participants were included in this systematic review. In all five studies included in the review, it was determined that pharmacological and non-pharmacological methods significantly reduced dermatitis associated with urinary incontinence. CONCLUSION: In the reviewed studies, it was observed that pharmacological and non-pharmacological methods had a positive effect on dermatitis in individuals with IAD. It is recommended to conduct more studies of high methodological quality, using larger sample groups, with different interventions and randomization and blinding methods, and examining the effectiveness of pharmacological and non-pharmacological methods in individuals with urinary incontinence-associated dermatitis.

Patients' experience of incontinence and incontinence-associated dermatitis in hospital settings: a qualitative study.

OBJECTIVE: To explore the experience of patients with incontinence and incontinence-associated dermatitis (IAD) in acute care hospitals and their family caregivers, including their perceptions and management, as well as the impact on their wellbeing. METHOD: A qualitative exploratory study design was employed in 18 wards across six acute/subacute hospitals in New South Wales, Australia. Patients with incontinence (with or without IAD) were invited to participate. Where interviews were not possible with the patient, their family caregiver was invited to participate. Semi-structured interviews were conducted. RESULTS: There were 45 interviewees in the study; 41 were patients with incontinence (11 of whom had IAD) and four were family caregivers. The experience of incontinence was captured by three themes: 'incontinence interrupts every aspect of my life'; 'actively concealing and cloaking'; and 'perceived as irreversible'. Incontinence was expected by the patients at their age and did not come as a surprise. It was normalised and approached with stoicism. As such, patients self-managed their incontinence by developing strategies to ensure they avoided episodes of incontinence during their stay. Incontinence left patients feeling anxious, embarrassed and with a sense of shame, and they did not communicate these feelings, or engage with health professionals about their incontinence, nor did health professionals discuss their incontinence with them. There was a strong sense of resignation that incontinence was irreversible and nothing could be done to improve it. All participants displayed little knowledge of IAD. The experience of having IAD was characterised by the theme 'debilitating and desperate for relief' and was experienced as a particularly painful, itching and burning condition that left patients distressed and irritable. CONCLUSION: Patients with incontinence in acute settings required further education from health professionals to reduce the stigma of incontinence, and provide further support to manage their incontinence. Health professionals can also play a key role in educating patients about the risks of developing IAD and how it can be prevented.

Silicone dressing combined with topical oxygen therapy alleviates incontinence-associated dermatitis via NF-κB p65/STAT1 signaling pathway.

BACKGROUND: Incontinence-associated dermatitis (IAD) is a tough problem in clinical settings, not only increasing the risk of complications like catheter-related urinary tract infections and pressure ulcers in elderly and critically ill patients, but also prolonging hospital stays, raising hospital costs, and possibly leading to medical disputes. This study is aimed to evaluate the therapeutic effect of silicone dressing combined with topical oxygen therapy on IAD in a rat model. METHODS: An IAD rat model induced by synthetic urine with trypsin was established. Hematoxylin & eosin staining was carried out to examine skin histology. Using immunofluorescence, the microvessel density in the affected skin tissues was determined. ELISA was performed to measure the concentrations of inflammatory cytokines and angiogenic factors in serum. The mRNA expression of EGF, PDGF, and VEGF was detected via qRT-PCR. Western blotting was employed to determine NF-κB p65/STAT1 pathway-related protein levels. RESULTS: Compared to single therapy, silicone dressing combined with topical oxygen therapy could significantly reduce the severity of IAD, improve skin histology, inhibit inflammation, and promote angiogenesis in IAD rat models. Additionally, the results showed that relatively speaking, the combined therapy suppressed the NF-κB p65/STAT1 signaling pathway more effectively. CONCLUSION: These findings indicated that silicone dressing combined with topical oxygen therapy can alleviate IAD through promoting wound healing and inhibiting inflammation via NF-κB p65/STAT1 signaling pathway in a rat model, which provided a theoretical basis for the prevention and treatment of IAD in clinic.

Implementation of an external female urinary catheter strategy on prevention of skin breakdown in acute care: A quality improvement study.

AIM(S): To evaluate the incidence of skin-related complications attributable to incontinence-associated dermatitis (IAD) using an external female urinary catheter device strategy for urinary incontinent (UI) patients in acute care. DESIGN: Multicenter quality improvement study. METHODS: Randomized allocation of two commercially available external female urinary catheter devices was used in hospitalized UI female patients. Daily nursing skin assessments were documented in the electronic health record before, during and after external catheter device application. Methods and results were reported following SQUIRE guidelines. RESULTS: Three hundred and eighty-one patients from 57 inpatient care units were included in the analysis. Both catheter devices were associated with an overall low risk (5 %) of new or worsening skin breakdown. CONCLUSION: The overall benefit of external catheters is most persuasive for skin integrity, rather than infection prevention. IMPACT: Significant negative outcomes are associated with UI patients. External female urinary catheters are a non-invasive alternative strategy to reduce exposure of regional skin to urine contamination and IAD-related skin complications. Use of external female urinary catheters in hospitalized UI female patients offers low risk (5%) of new or worsening overall skin breakdown. PATIENT CONTRIBUTION: Hospitalized UI female patients were screened for external catheter device eligibility by the bedside nurse. The quality improvement review committee waved consent because the intervention was considered standard care.

Effects of Nursing Program in Preventing Incontinence-Associated Dermatitis by Applying Zinc Oxide and Petroleum Jelly Skin Protection Products Among Older Patients in Semi-Intensive Medical Care Units: A Pilot Study.

Aim: Incontinence-associated dermatitis is a common health problem among older clinical patients, causing related severe skin damage such as pressure ulcers, secondary infection, and long length of hospital stay. This pilot study aimed to develop and examine the effects of nursing programs in preventing incontinence-associated dermatitis (IAD) among older patients. Ten older patients at high risk of incontinence-associated dermatitis were included in this study: five patients received a nursing program combined with mixed products, and another five received a nursing program combined with separate use of products. The program was evaluated using a perianal assessment tool (PAT-T) for risk assessment, the incontinence-associated dermatitis invention tool (IADIT-T) for severity assessment, the skin surface pH, and skin surface moisture. The results revealed that the nursing program and skin products are usable and acceptable, provide step-by-step details, and are simple and easy to follow. The nursing program combined with using zinc oxide products followed by petroleum jelly can prevent and decrease the severity of incontinence-associated dermatitis in older patients. Moreover, it can also improve the skin surface pH to a mild acidity appropriate for the skin condition and increase the skin's moisture better the nursing program with mixed skin products. This pilot study confirmed that the developed program can be applied in practice. Moreover, the program could be used to decrease the incidence of IAD and skin surface pH but increase skin moisture. However, future study with a larger sample size and applying a more substantial research design for more accuracy and generalization is needed. Clinical Trial Registration Number: OSF https://osf.io/8gj3d.

Prevention and care for moisture-associated skin damage: A scoping review.

OBJECTIVE: Moisture-associated skin damage (MASD) is an inflammatory skin condition caused by long-term exposure to a moist environment, which can compromise the integrity of the barrier and increase pain. This scoping review aimed to systematically analyze the research status of prevention and care for MASD. METHODS: We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. PubMed, MEDLINE, Scopus, Web of Science, CINAHL, and the Cochrane Database of Systematic Reviews were searched for relevant articles until March 2023. RESULTS: Based on eligibility criteria, 34 research studies and review articles were included. The prevalence of MASD varies greatly in different medical environments and patient groups. The high-risk factors included prolonged exposure to excessive water, chemical irritation such as urine or feces, mechanical factors such as friction or improper removal of medical adhesives and local bacterial colonization. Prevention measures mainly include avoiding skin exposure to moisture, skin cleansing, moisturizing and the treatment of secondary bacterial infection. CONCLUSION: A variety of factors have an impact on MASD. Nurses should select suitable tools to screen high-risk patients and take targeted preventive measures according to the related types of skin injury to reduce the incidence of MASD.

Incontinence-associated dermatitis in older adults in residential care settings: a point prevalence study.

Incontinence-associated dermatitis (IAD) is a skin inflammation caused by contact with urine or faeces or both. It has a negative effect on the patient's quality of life and is indicative of the care provided. However, globally there is a lack of empirical data on the prevalence of IAD. AIM: To identify, for the first time, the proportion of older adults in extended care settings in Ireland affected by IAD. DESIGN: Cross-sectional, multisite, point prevalence survey, across three community extended care settings for older people in Ireland. METHODS: Two clinical nurse specialists, using the Scottish Excoriation and Moisture Related Skin Damage Tool, identified the presence of IAD through clinical observation and visual skin inspection. IAD prevalence was calculated for the total population and incontinent population sets using percentages and confidence intervals (CI). RESULTS: The prevalence of incontinence was 86.4% (n=165), a significantly higher proportion were female (P=0.003). The point prevalence of IAD across the total population and incontinent population was 11.5% (22/191; 95% CI, 7.4-19.9%) and 13.3% (22/164; 95% CI, 8.5-19.5%), respectively. Being incontinent was associated with being female, more dependent (Barthel), having possible cognitive impairment, poorer mobility (Braden and Waterlow) and a high risk of pressure ulcers (Waterlow). A logistic regression analysis found no predictor variables for IAD among the variables that met the cut-off point for this analysis. CONCLUSIONS: The study provides the first point prevalence empirical data on the occurrence of IAD in Ireland. It can inform decision-making on future planning and budgeting of new quality improvement projects and act as a benchmark for ongoing auditing of IAD.

Managing incontinence-associated dermatitis in the community: an overview.

Incontinence-associated dermatitis (IAD) is often treated a hygienic challenge, rather than a serious condition with potentially life-threatening consequences. More appropriate education on the management strategies specific to IAD is required, in order for personalised and effective care that reflects the critical nature of this condition to be provided. Francesca Ramadan provides an overview of the key elements of best practice in IAD management and treatment.

Knowledge and Visual Differentiation Ability of the Pressure Injury Classification System and Incontinence-Associated Dermatitis among Hospital Nurses: A Descriptive Study.

This study investigated clinical nurses' knowledge and visual differentiation ability of the pressure injury classification system (PICS) and incontinence-associated dermatitis (IAD), additionally analyzing possible influencing factors. A convenience sample of 248 nurses took the PICS and IAD knowledge test (KT) and completed the visual differentiation ability test (VDAT), consisting of 21 photographs with clinical information. The overall mean score for correct answers was 12.65 ± 2.90 points in PICS and IAD KT and 11.43 ± 4.57 points in VDAT. Incorrect responses were most common for statements related to stage II, III, IAD for PICS and IAD KT, and deep tissue pressure injury (DTPI), unstageable, and stage III for VDAT. Significant correlations were found between PICS and IAD KT and VDAT (r = 0.252, p < 0.001). Factors affecting scores for VDAT were the scores of PICS and IAD KT, debridement experience in nursing patients with PI, and the management frequency of PI and IAD. Results indicate that nurses have an overall understanding of PICS and IAD, but low visual differentiation ability regarding stage III, DTPI, and unstageable PI. Continuing education is needed to further improve knowledge and visual differentiation ability for PICS and IAD.

The effectiveness of faecal collection devices in preventing moderate to severe incontinence-associated dermatitis: A systematic review and network meta-analysis.

BACKGROUND: Incontinence-associated dermatitis (IAD) is a common problem among critically ill patients with faecal incontinence (FI). However, there are few studies comparing the effects of different faecal collection devices impact the prevention of moderate to severe IAD in this patient population. AIM: This review aims to compare the effectiveness of various devices for collecting faecal matter in preventing moderate to severe IAD in critically ill patients suffering from FI through a network meta-analysis. STUDY DESIGN: We conducted a systematic search of PubMed, Embase, ProQuest, CENTRAL, CINAHL Plus with Full Text, China National Knowledge Infrastructure (CNKI), Wan fang, Wei Pu, and China Biomedicine (CBM) from their inception until May 4, 2023. The selected studies were randomized controlled trials (RCTs). Two researchers independently performed study selection and data extraction. We assessed the risk of bias using the Cochrane risk of bias tool Version 2.0. RevMan 5.4 was utilized for conventional pairwise meta-analysis of direct comparisons, while Stata16.0 was employed for network meta-analysis. RESULTS: A total of 14 studies, involving 1345 patients, were included in the analysis. Pairwise meta-analysis showed that an anal bag[odds ratio(OR): 0.07(0.03, 0.20)], a balloon catheter[(OR:0.30(0.15, 0.62)], and an anal bag connected to negative pressure and flushing [(OR: 0.09(0.01,0.68)] all reduced the incidence of moderate to severe IAD in critically ill patients compared with usual care measures, respectively. The cumulative rank probabilities indicated that moderate to severe IAD prevention was more effective when employing balloon catheters connected to negative pressure [surface under the cumulative ranking curve(SUCRA): 20.8%] and anal bags connected to negative pressure (SUCRA: 27.0%) among critically ill patients with FI. CONCLUSION: FI is a common problem among severely ill patients, and the reduction of moderate and severe IAD incidence is deemed essential. In this review, it is suggested that both balloon catheters connected to negative pressure and anal bags connected to negative pressure are associated with a higher effectiveness in preventing moderate and severe IAD. RELEVANCE TO CLINICAL PRACTICE: The findings of this review can assist healthcare professionals in the selection of suitable stool management devices for the prevention of moderate to severe IAD in critically ill patients with FI.

Clinical and Health Economic Evaluation of a Novel Device for Fecal Management in Bedridden Patients.

Purpose: To evaluate the clinical effectiveness and health economic benefits of a novel indwelling lattice-based device for fecal management in bedridden patients. Materials and methods: This nonrandomized, two-arm study included 70 bedridden patients (≥18 years exhibiting liquid stool) referred from the ICU of surgery and medicine units of a 2000-bed tertiary care referral hospital, assigned to the intervention and control groups. About 35 patients were eligible to be included in the intervention group while 35 patients with contraindications to the intervention device were included in the usual care control group. Assessments were made before and every 24 hours during the study, and all patients were closely monitored for development of incontinence-associated dermatitis (IAD) and hospital-acquired pressure injury. Results: The test device was successfully deployed on the first attempt and effectively diverted fecal matter in all 35 patients, with no adverse events. In the control group, 83% of the patients developed IAD, which resulted in prolonged hospitalization and increased expenses. Overall, the control group (with adult diapers) required greater time, resources, and efforts for fecal management and resulted in increased patient morbidity. Conclusion: The patient management time, resource consumption, overall cost of hospital admission, and the complication rates are significantly lower with the use of the novel lattice-based device than with the use of adult diapers for fecal management. How to cite this article: Sheth H, Rao S, Karthik V. Clinical and Health Economic Evaluation of a Novel Device for Fecal Management in Bedridden Patients. Indian J Crit Care Med 2023;27(10):759-765.

Incontinence-Associated Dermatitis in Older Intensive Care Patients: A Review and Case Report.

Background: Incontinence-Associated Dermatitis is a serious skin injury causing suffering, secondary infection, and inducing almost six times more pressure sore than normal skin patients. This moisture and chemical skin irritation is a concern, especially for intensive care unit nurses. This study aimed to review the effective nursing strategy for preventing and caring for incontinence-associated dermatitis in older intensive care unit patients and pilot its feasibility. Methods: The five databases, including PubMed, Google Scholar, CINAHL Complete, WanFang, and CNKI, were searched, and articles were screened and extracted. The strategies and details of prevention and care for incontinence-associated dermatitis were reviewed and summarized. Finally, selected strategies were applied to five intensive care unit patients with various health conditions and levels of Incontinence-Associated Dermatitis severity. Results: The literature review found that there is a standardized nursing process for incontinence-associated dermatitis. The prevention and care strategies for incontinence-associated dermatitis include assessment, risk factor management, skin cleaning, skin protection, and health education and training. In actual clinical application, personalized nursing measures can positively impact patients. Five case studies from our pilot confirmed this finding. Conclusion: Personalized nursing measures can positively impact patients in actual clinical applications. Our five case studies implementing the strategies from the review confirmed this finding. In clinical work, it is recommended to develop personalized nursing programs for specific risk factors of older intensive care unit patients. Protocol Registration: TCTR20230808004.

Development of prone positioning and skin damage prevention digital education: the PRONEtect project.

OBJECTIVE: The incidence of skin/tissue damage, such as pressure ulcers, remains high in mechanically ventilated patients in the prone position. According to guidelines, critically ill patients with acute respiratory distress syndrome (ARDS) should be prone for at least 12-16 hours to improve oxygenation and decrease mortality. Therefore, educating clinicians on how to reposition and manage the patient safely in a prone position plays a vital role in preventing adverse events. This project aimed to develop accessible online educational content to assist clinicians in safely executing the prone manoeuvre and minimise skin/tissue damage. METHOD: The development of the educational content was based on: a gap analysis and comprehensive review of available educational resources; evidence-based scientific literature; advice from international experts; and a qualitative study exploring the learning needs of 20 clinicians in Belgium and Sweden between February-August 2022. RESULTS: Volunteer clinicians assisted with the creation of eight simulation videos which were professionally filmed and edited. The interactive videos included the supine-to-prone and prone-to-supine manoeuvres, endotracheal and nasogastric tube securement, eye care, stoma care, protecting high-risk areas from pressure damage, and incontinence-associated dermatitis prevention. A prone positioning protocol, a checklist summarising the key aspects of the protocol, and teaching aids (slide deck for didactic lecturing) were developed and validated by a review of the relevant evidence-based literature and the international expert panel. A website was designed to host the content, with free user access, at www.pronetection.com. CONCLUSION: Education is one strategy towards prevention of complications of prone positioning. Accessible education could assist clinicians unfamiliar with prone positioning or current clinicians requiring refresher training to safely manage patients in this position.

Humidity-Sensing Mattress for Long-Term Bedridden Patients with Incontinence-Associated Dermatitis.

Designing new medical devices with advanced humidity sensors is of great significance for patients with incontinence-associated dermatitis (IAD). The primary goal of this study is to test the humidity-sensing mattress system for patients with IAD in clinical settings. The design of the mattress is set at 203 cm, with 10 × 3 sensors, dimensions of 19 × 32 cm, and a weighted bearing of 200 kg. The main sensors consist of a humidity-sensing film, a thin-film electrode (6 × 0.1 mm), and a glass substrate (500 nm). The sensitivity of the test mattress system showed that the resistance-humidity sensor was at a temperature of 35 °C (V0 = 30 V, V0 = 350 mV), with slope at 1.13 V/fF, f = 1 MHz, 20-90% RH, and a response time of 20 s at 2 µm. In addition, the humidity sensor reached 90% RH, with a response time of less than 10 s, a magnitude of 107-104 Ω, 1 mol%, CrO1.5, and FO1.5, respectively. This design is not only a simple, low-cost medical sensing device, but also opens a new pathway for developing humidity-sensing mattresses in the field of flexible sensors, wearable medical diagnostic devices, and health detection.

Friction between human skin and incontinence pads in the presence of barrier protection products.

This novel experimental work aims to bring further knowledge of frictional performance of common barrier products used in the treatment of incontinence-associated dermatitis and determine how the skin-pad interface changes when a treatment is applied to the skin. Key data is reported and there is an in-depth analysis into friction profiles which reveals great differences between how different skin-pad tribosystems operate when exposed to commercially available barrier treatments. In a wet-pad state Barrier cream A (3M™ Cavilon™ Barrier cream) reduced friction and had much lower dynamic and static coefficients of friction than the other barrier treatments (Barrier cream B (Sorbaderm Barrier cream) and the Barrier spray C (Sorbaderm Barrier spray)). Barrier cream A provided stable friction coefficients in reciprocating sliding, whereas the other treatments, and untreated skin, did not display this unique characteristic. The barrier spray gave rise to high static friction coefficients and exhibited the most stick-slip. All three candidate barrier protection products were found to reduce directional differences in the static coefficient of friction: indicative of reduced shear loading. Knowledge of the desirable frictional properties would drive innovation in product development, and benefit companies, clinicians and users.

Measurement instruments to evaluate diaper dermatitis in children: Systematic review of measurement properties.

AIM: The aim of this study was to summarize and evaluate the empirical evidence on the measurement properties of diaper dermatitis (DD) measurement instruments in children. DESIGN: Systematic review. METHODS: MEDLINE, CINAHL and EMBASE were systematically searched until 14 June 2021. Citation searching was conducted in Scopus. The risk of bias, the reported measurement properties and the quality of evidence were evaluated using the COSMIN framework. The reporting follows the PRISMA 2020 statement. RESULTS: We identified 1200 records in the databases and 108 records during citation searching and included four studies describing three measurement instruments for DD in children and their measurement properties. We considered the content validity inconsistent for all three instruments. The study authors reported internal consistency, reliability and construct validity for one instrument. We rated the quality of evidence from very low to moderate.

Risk factors of incontinence-associated dermatitis among critically ill patients: A systematic review and meta-analysis.

Objectives: Incontinence-associated dermatitis (IAD) is increasingly found among critically ill patients, but the risk factors for IAD in these patients are currently unclear. The purpose of this meta-analysis was to identify the risk factors of IAD in critically ill patients. Methods: Web of Science, PubMed, EMBASE, and Cochrane Library were systemically searched until July 2022. The studies were selected based on inclusion criteria, and data were independently extracted by two researchers. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. Odds ratios (ORs) and their associated 95% confidence intervals (CIs) were used to identify significant differences in the risk factors. The I 2 test was used to estimate the heterogeneity of studies, and Egger's test was used to assess the potential publication bias. Results: A total of 7 studies enrolling 1,238 recipients were included in the meta-analysis. Age ≥ 60 (OR = 2.18, 95% CI: 1.38~3.42), female sex (OR = 1.76, 95% CI: 1.32~2.34), dialysis (OR = 2.67, 95% CI: 1.51~4.73), fever (OR = 1.55, 95% CI: 1.03~2.33), vasoactive agent (OR = 2.35, 95% CI: 1.45~3.80), PAT score ≥ 7 (OR = 5.23, 95% CI: 3.15~8.99), frequency of bowel movement > 3times/d (OR = 5.33, 95% CI: 3.19~8.93), and liquid stool (OR = 2.61, 95% CI: 1.56~4.38) were the risk factors of IAD among critically ill patients. Conclusions: Many risk factors are related to IAD among critically ill patients. Nursing staff should pay more attention to evaluating the risk of IAD and enhance the care of high-risk groups.

Skin assessments and interventions for maintaining skin integrity in nursing practice: An umbrella review.

BACKGROUND: Daily skin care routines are fundamental aspects of clinical nursing practice. Providing skin care, including skin cleansing and application of leave-on products have substantial impact on the prevention and treatment of a number of skin conditions. There are hundreds of individual studies about skin risks, classifications, skin conditions, prevention and treatment. OBJECTIVE: To summarise the overall evidence regarding 1) risk factors associated with xerosis cutis, incontinence-associated dermatitis/diaper dermatitis, intertrigo, skin tears, 2) the performance of diagnostic tests and/or classifications addressing the severity and/or signs and symptoms of xerosis cutis, incontinence-associated dermatitis/diaper dermatitis, intertrigo, skin tears, 3) the effects of skin cleansing/care interventions for the maintenance and promotion of skin integrity in all age groups, 4) effects of skin cleansing/care interventions for the prevention of xerosis cutis, incontinence-associated dermatitis/diaper dermatitis, intertrigo, skin tears in all age groups. DESIGN: Umbrella review. DATA SOURCES: A systematic search in MEDLINE and Embase (via OvidSP), Cochrane and Epistemonikos was conducted. Reference lists and experts were consulted for potentially missed reviews. REVIEW METHODS: Two reviewers screened titles/abstracts and full-texts independently. After rating the risk of bias only low to high overall confidence (AMSTAR 2) and low risk of bias (ROBIS) reviews were included. RESULTS: Twelve systematic reviews were included. Due to substantial heterogeneity regarding study designs, methods, and outcomes all authors presented findings in a narrative synthesis. The validity and reliability of the International Skin Tear Advisory Panel classification is supported by moderate quality evidence, and the reliability and criterion validity for Skin Tear Audit Research were rated insufficient. Overall, review results indicate that structured skin care programs are preferable to unstructured skin care with classic soap and water for maintaining skin integrity in general, preventing skin tears, and to prevent and treat xerosis cutis and incontinence-associated dermatitis. All reviews focusing on leave-on products for the prevention and treatment of incontinence-associated dermatitis and diaper dermatitis indicate the effectiveness of barrier films or lipophilic leave-on products in adults, elderly people and paediatric care, but could not establish the superiority of any product. CONCLUSIONS: The majority of systematic reviews in the field of skin care is at high risk of bias and should not be used for evidence-based practice. Overall, evidence indicates, that structured skin care programs containing low-irritating cleansers and application of leave-on products are beneficial to maintain skin integrity and prevent skin damage across a wide range of different skin conditions across the life span.

Efficacy of modified isolation in incontinence associated dermatitis.

OBJECTIVE: To analyze the value of modified isolation in preventing the occurrence of incontinence associated dermatitis (IAD) in patients with incontinence, and to provide high value skin care intervention for the patients. METHODS: Clinical data of 204 patients were collected for retrospective analysis. The patients were divided into a conventional group (conventional skin care protocol, n=102) and a modified group (modified isolation care protocol, n=102) according to the different treatment regimens. The differences in the incidence of IAD, time to IAD, required weekly care, cost of nursing supplies, perineal skin status and nursing satisfaction were compared between the two groups. RESULTS: Compared with the conventional group, the modified group had a greatly lower incidence of IAD (42.16% vs. 2.94%), longer time to IAD occurrence (5.75±1.25 vs. 12.50±1.50), less required weekly care (43.05±8.41 vs. 13.54±2.57), lower cost of nursing supplies (330.16±98.44 vs. 115.53±32.58), and a better correlation between perineal skin status and nursing satisfaction (all P<0.05). CONCLUSION: Modified isolation can greatly reduce the incidence of IAD in incontinent patients, improve their status of the perineal skin, increase patient satisfaction with care, and reduce the cost of required nursing supplies. So, modified isolation may serve as the preferred care protocol for incontinent patients.

Detecting and monitoring incontinence associated dermatitis: Does impedance spectroscopy have a part to play?

In this review, current understanding of the prevention and treatment of Incontinence Associated Dermatitis (IAD) is discussed. The need for preventative measures which target specific faecal/urinary irritants is highlighted, including the role of urease inhibitors. There is no existing internationally and clinically accepted method to diagnose and categorise the severity of IAD. Diagnosis currently relies on visual inspection; non-invasive techniques to assess skin barrier function could remove subjectiveness, particularly in darker skin tones. Impedance spectroscopy is a non-invasive technique which can be used to monitor skin barrier function, supporting visual assessments. Six studies (2003-2021) which used impedance to assess dermatitis were reviewed; inflamed skin was distinguishable from healthy skin in each case. This suggests that impedance spectroscopy could be useful in diagnosis early-stage IAD, potentially enabling earlier intervention. Finally, the authors present their initial findings on the role of urease in skin breakdown in an in vivo IAD model, using impedance spectroscopy.