30
SKIN CARE TODAY
2015,Vol 1, No1
FOCUS ON INCONTINENCE-RELATED SKIN DAMAGE
i
National Association of TissueViability
Nurses Scotland (NATVNS) (2009)
Skin Excoriation tool for incontinent
patients
. Available online at: www.
healthcareimprovementscotland.
org/our_work/patient_safety/tissue_
viability_resources/excoriation_tool.aspx
National Institute for Health and Care
Excellence (2007) CG49.
Faecal
incontinence; the management of faecal
incontinence in adults
. NICE, London.
Available online at: www.nice.org.uk/
guidance/cg49 (accessed 28 January,
2015)
National Institute for Health and Care
Excellence (2010) CG97.
Lower urinary
tract symptoms: the management of lower
urinary tract symptoms in men
. NICE
London. Available online at: www.nice.
org.uk/guidance/cg97 (accessed 28
January, 2015)
National Institute for Health and Care
Excellence (2012) CG148.
Urinary
incontinence in neurological disease:
management of lower urinary tract
dysfunction in neurological disease
. NICE,
London. Available online at: www.nice.
org.uk/guidance/cg148 (accessed 28
January, 2015)
National Institute for Health and Care
Excellence (2013) CG171.
Urinary
incontinence: the management of urinary
incontinence in women
. NICE, London.
Available online at: www.nice.org.uk/
guidance/cg171 (accessed 28 January,
2015)
National Institute for Health and Care
Excellence (2014) IPG483.
Insertion of a
magnetic bead band for faecal incontinence
.
NICE, London. Available online at:
www.nice.org.uk/guidance/ipg483
(accessed 28 January, 2015)
Nursing Midwifery Council (2008)
The code:
standards of conduct, performance and ethics
for nurses and midwives
. NMC, London
Penzer R (2008)
Continence Essentials
28–32
Timby BK (1996)
Hygiene. Fundamental
skills and concepts in patient care.
6th edn.
Lippincott Raven, London
Tonna I, Welsby PD (2005)
Postgrad Med J
367–9
Voegli D (2010)
Nurs Residential Care
422–9
Warshaw E, Nix D, Kula J Markon C (2002)
Ostomy Wound Management
44–51
Wiesen, P,Van Gossum A, Preiser JC
(2006)
Curr Opin Crit Care
149–54
such as zinc and castor oil, which had
a tendency to clog continence pads
and interfere with absorption (Penzer,
2008). Some examples of modern
barrier creams are described in
Table 2
.
TREATMENT OF IAD
Incontinence-associated dermatitis
is painful and debilitating.
Consequently, prompt action should
be taken to alleviate symptoms and
calm the resultant inflamed skin. The
skin excoriation tool for incontinent
patients is used by the National
Association of TissueViability Nurses
(Scotland) (2009) to help healthcare
professionals assess the skin and
determine appropriate treatment.
Minor irritation may subside
spontaneously once the individual’s
skin is protected using an appropriate
barrier cream or film, as discussed
above. However, if the condition has
progressed unchecked, the individual
may suffer a severe dermatitis
which will necessitate the use of
an antifungal cream to both calm
the skin and treat any secondary
infection, e.g. Clotrimazole 1% found
in Canestan
™
or Daktacort
™
cream.
Particularly severe cases
may require the addition of a
steroid within a cream to reduce
inflammation, e.g. Canestan
hydrocortisone or Daktacort
hydrocortisone (Grey et al, 2012).
When a severe case of IAD occurs
or fails to respond to treatment, it
is vital that healthcare professionals
recognise the limitations of their
knowledge and make appropriate
referrals to continence specialists.
CONCLUSION
An individual suffering from
incontinence is entitled to a
comprehensive assessment by
a healthcare professional with
appropriate skills. It should not be
assumed that their incontinence is
the result of ageing, as incontinence
may be due to an underlying medical
problem which requires intervention.
In addition, an appropriate
continence management regimen
should be implemented, involving
use of appropriate appliances/
continence pads and skin care to
protect the individual’s skin from
potential harm.
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SCT
