Hospitals Efforts to Reduce Skin Injury in Patients Must Improve

CARY, Ill. -- In a recent opinion poll conducted by Sage Products Inc., 57 percent of the 200 wound ostomy continence nurses who responded said their hospital has a specific protocol in place for prevention of incontinence-associated dermatitis (IAD). Forty-three percent do not have any protocols in place. The poll was conducted at the Wound Ostomy & Continence Nurses (WOCN) Societys annual conference, June 9-13, 2007.

IAD is an inflammation of the skin that occurs when urine or stool comes into contact with perineal or perigenital skin. The condition is under-reported and research shows that 20 percent of acute patients are incontinent. In addition, new research in the Journal of Wound, Ostomy and Continence Nursing (May/June 2007)1, shows that 42.5 percent of incontinent patients suffer from some type of skin injury.

The prevalence of skin injury in incontinent patients is alarming because it is preventable and is associated with an increased risk of pressure ulcers, said Joan Junkin, CWOCN, clinical nurse specialist at BryanLGH Medical Center in Lincoln, NE. Hospitals need to investigate their prevalence and implement measures to address IAD and improve outcomes. Weve implemented new protocols and methods and have realized a 37.7 percent decrease in skin damage incidence.

IAD costs are grouped with costs for other skin injuries, such as pressure ulcers (PUs). A study in Ostomy/Wound Management found that the average hospital spends $400,000 to $700,000 annually treating pressure ulcersand most of this cost cannot be reimbursed. In addition, national quality initiatives, such as the Institute for Healthcare Improvements (IHI) Protecting 5 Million Lives from Harm Campaign, are raising awareness of patient care and hospital-acquired events. Preventing PUs is one of the IHIs campaign interventions.

IAD can develop within a short time-frame and speed of development is driven by:

-- Urine Skin exhibiting symptoms of dermatitis (red, sore, cracked) when exposed to urine can develop IAD within 72-hours.

-- Stool Fecal matter contains digestive enzymes that erode or eat away at skin upon contact. IAD can begin to develop within eight hours, sooner if liquid stool is present.2

-- Containment devices Disposable briefs/pads keep urine and fecal matter close to skin and raise temperature in the area, which causes perspiration. This sequence further prompts development of IAD.

IAD prevention requires continuous monitoring and care. Ninety-two percent of poll respondents said that they use barrier paste or creams to prevent IAD. Use of pastes and creams does not encourage compliance because nurses have to take time to collect materials and bring those items to the patients bedside for treatment. Having materials at bedside makes prevention and treatment of skin injury easier, and is recommended in the IHIs Getting Started Kit: Prevent Pressure Ulcers How-to Guide. Fifty percent of nurses said they use pre-moistened cloths while others reported using wipes (30 percent) and basin/water/cloth combinations (29 percent). Pre-moistened barrier cloths optimize IAD prevention and treatment because they are designed to be skin-friendly and have built-in protection so they are included in the IHIs pressure ulcer prevention initiative recommendations. The barrier cloths gently cleanse the skin, moisturize, deodorize and protect skin. In addition, the barrier cloths are easily stored at the patients bedside for ease of use. Bedside barrier stations promote barrier compliance because cloths are stored at patients beside.

WOC nurses are highly skilled and focused on treating complicated wounds such as pressure ulcers. The poll revealed information about how WOC nurses are spending their time. Of the nurses that responded, 25 percent said that they are spending 21 percent or more of their time performing IAD consults. Improved efforts and protocols focused on IAD prevention can help specialty nurses and bedside clinicians better manage their time and help hospitals better manage resources.

IAD prevention is planned by our Skin Team and conducted by nursing staff at our facility as part of our overall skin program, said Junkin. We are a mentor hospital for the IHIs 5 Million Lives campaign to prevent pressure ulcers. We work diligently to ensure patients are receiving optimal care and skin injury issues are addressed before they become serious and more costly.


1. Junkin J, et al., J Wound Ostomy Continence Nurs. 2007 May-June;34(3):260-269.

2. Gray M, et al., J Wound Ostomy Continence Nurs. 2007 Jan-Feb;34(1):45-54.

Source: Sage Products, Inc.