Incontinence: Skin Care
Recommendations
| Identify and Treat the Cause | ||
|---|---|---|
| 1 | Take a careful history from the person identified to have urinary incontinence. | Level of Evidence Not Assessed |
| Address Patient-centered Concerns | ||
|---|---|---|
| 2 | Consider the potentially serious adverse effects that even mild urinary incontinence has on a patient’s quality of life. | Level of Evidence Not Assessed |
| 3 | Provide information and advice on treatment options available in both primary and secondary care. | Level of Evidence Not Assessed |
| 4 | Use a validated quality of life and incontinence severity questionnaire. | Level of Evidence Not Assessed |
| Provide Local Care | ||
|---|---|---|
| 5 | Recommend containment products and reassess their suitability. | Level of Evidence Not Assessed |
| 6 | Consider absorbent products as: - a coping strategy pending definitive treatment - an adjunct to other ongoing therapy - long term management of urinary incontinence only after other treatment options have been explored | Level of Evidence Not Assessed |
| 7 | Inspect genital-perineal area daily to identify signs of contact dermatitis and skin excoriation. | Level of Evidence Not Assessed |
| 8 | Develop individualized skin care plans for patients with incontinence and intact or irritated skin, based on regularly cleansing, moisturizing and protecting the perineal skin. | Level of Evidence Not Assessed |
| 9 | Prevent skin breakdown by providing immediate cleansing after an incontinent episode and utilizing appropriate skin and barrier creams. | Level of Evidence Not Assessed |
| 10 | Treat infected skin or other skin complications appropriately. | Level of Evidence Not Assessed |
| Provide Organizational Support | ||
|---|---|---|
| 11 | Facilitate healthcare professionals to gain relevant knowledge and skills to offer appropriate advice and information. | Level of Evidence Not Assessed |
Background
Skin care for people with incontinence is individualized, based on assessment and response to specific products. However, skin care is generally directed to the following goals:• Prompt removal of soil and irritants from the skin
• Reduction or prevention of exposure to irritants and organisms
• Restoration or maintenance of skin barrier function.
The main strategies to achieve these goals are cleansing, moisturizing and protecting the skin.
• Cleansing: Routine hygiene includes cleansing the skin after each episode of incontinence and cleansing the entire perineal area daily. A cleanser containing water and a surfactant, with a pH close to normal skin pH is recommended. Moisturizers or moisture barriers may be incorporated into some skin cleansers.
• Moisturizing: Use of humectants and/or emollients after each cleansing replaces lost skin oils, promotes skin barrier function, softens skin, and soothes irritation.
• Protecting: Applying skin protectants and/or sealants whenever the skin is cleansed can block exposure of irritated skin both to drainage from eroded skin and to irritants in urine or feces. Routine use of protectants promotes restoration or maintenance of the normal skin barrier.
In cases of skin infection, local or systemic treatment is also indicated. Candidiasis is usually treated with an antimycotic cream that will also prevent exposure to moisture, whereas bacterial skin infection may require treatment with systemic antibiotics.
Routine skin care plus use of a containment device to minimize or prevent exposure of perineal skin to incontinence can reverse or prevent skin irritation from incontinence until a definitive continence management plan is developed and implemented.
References
| Essential Publications |
|---|
| 1 | Topical skin care |
Quality Indicator
|
Type: Systematic review |
| Hodgkinson B, Nay R, Wilson J (2007) A systematic review of topical skin care in aged care facilities. Journal of Clinical Nursing 16, 129-136. | |||
| This systematic review of systematic reviews, RCTs, and non-randomized controlled studies was conducted to determine the effectiveness of topical skin care interventions for residents of aged care facilities by examining the incidence of adverse skin conditions such as rash, skin irritation, haematoma or tears, and by patient satisfaction. Since the interventions and outcomes measured in the studies varied, the results were not combined but one or more individual studies were reported. | |||
| 2 | Skin damage prevention |
Quality Indicator
|
Type: RCT |
| Bliss DZ, Zehrer C, Savik K, Smith G, Hedblom E. An economic evaluation of four skin damage prevention regimens in nursing home residents with incontinence: Economics of skin damage prevention. JWOCN 2007;34(2):143-52, discussion 152. | |||
| The clinical and cost effectiveness of different incontinence-associated dermatitis (IAD) prevention regimens for nursing home residents was evaluated in this study. Four regimens were analyzed: one regimen consisted of applying a polymer-based barrier film three times per week and the other three regimens consisted of applying various moisture barrier ointments or creams after each occurrence of incontinence. Nearly two thousand residents in sixteen nursing homes were evaluated, and it was determined that the barrier film regimen was effective at preventing IAD and was also associated with significantly lower costs than the three ointment regimens. | |||