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Perineal Dermatitis
Perineal dermatitis is an inflammation of the skin in the genital, buttock, or upper leg areas that is often associated with changes in the skin barrier, redness, a rash or vesiculation, and adverse symptoms such as pain or itching.
The Effect of Different Formulations of Equivalent Active Ingredients on the Performance of Two Topical Wound Treatment Products
Product selection for the management of pressure ulcers or perineal dermatitis is typically based on consideration of active ingredients, but a growing body of evidence suggests that delivery vehicles also may influence product safety and efficacy. A 10-day, randomized, controlled experimental study was conducted to compare the safety and efficacy of two prescription products used for the treatment of pressure ulcers and perineal dermatitis. Both products contain equivalent active ingredients (balsam of Peru, castor oil, and trypsin), but one product delivers these ingredients in an ointment base while the other uses an aerosol spray. Sixty healthy volunteers (> 65 years of age) underwent intentional creation of two equivalent skin wounds (approximately 6 mm in diameter) using an Erbium-YAG laser. Volunteers served as their own control. Wounds were randomized to treatment with one of the balsam of Peru products or saline. Wounds were evaluated every other day. Significant differences between treatments were observed for most outcome variables (edema, scabbing, erythema, epithelialization). Wounds managed with the ointment-based product had lower edema, scabbing, and erythema scores and higher epithelialization scores than the spray or saline managed wounds. The results of this study confirm that formulation of the vehicle base can have a significant effect on product safety and effectiveness.
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Clinical and Cost Effectiveness of a Cleanser Protectant Lotion for Treatment of Perineal Skin Breakdown in Low-Risk Patients with Incontinence
Perineal dermatitis due to urinary and/or fecal incontinence is a common problem. A multicenter, open label, phase II product evaluation was conducted to determine the effectiveness of a new cleanser protectant lotion in reducing perineal erythema and pain in patients at low-risk for perineal dermatitis and to compare the cost of this product to standard protocols of care. Nineteen elderly patients (14 male, 5 female, mean age 73.1 years) participated in the study. Average baseline scores for erythema and pain were 2.3 (+/- 0.5) and 1.5 (+/- 1.0), respectively (scale 0 to 4). After 7 days, both scores were significantly lower (mean scores 0.6 +/- 0.8 and 0.3 +/- 0.8, respectively; P < 0.01). Based on an average of 2.6 perineal episodes per day, the one-step product evaluated would cost $136 per patient/year less than standard protocols of care while reducing caregiver time (average 23 seconds per episode of care). Optimal perineal care may reduce the incidence of complications; studies to ascertain the safety and effectiveness of commonly used products and procedures are needed.
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A Review of Perineal Skin Care Protocols and Skin Barrier Product Use
Perineal skin damage secondary to incontinence is painful, prevalent, and preventable. Skin care professionals consider regular application of skin protectants for patients with incontinence the standard of care for preventing perineal skin injury secondary to incontinence. Although protocols to improve care exist, the extent to which they are implemented and followed has not been documented. A study was conducted to ascertain the extent to which perineal skin care protocols are consistent with Wound, Ostomy and Continence Nurses Society Clinical Practice Guidelines and to estimate the level of compliance related to the use of protective perineal skin barriers. A convenience sample of 76 perineal skin care protocols was obtained from acute care (n = 55), long-term care (n = 9), and nondisclosed types of extended care facilities (n = 12). All protocol interventions were compared to the Wound, Ostomy and Continence Nurses guidelines. Healthcare Products Information Services data were used to obtain the total amount of skin protectants sold to US healthcare facilities in 2002. Skin protectant use was compared to previously published urinary and fecal (urofecal) incontinence prevalence data. All 76 protocols lacked one or more of the interventions considered important in perineal skin care. Although 75% of the protocols included the use of skin protectants, Healthcare Products Information Services data and urofecal prevalence data suggest underutilization of skin protectants; an estimated 10 cents per day versus an anticipated average cost of 23.5 cents per application is being spent. Further study is warranted and necessary to ensure the application of evidence-based protocols of care in practice. KEYWORDS: perineal, skin, wounds, incontinence, dermatitis
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Incontinence-Associated Skin Damage in Nursing Home Residents: A Secondary Analysis of a Prospective, Multicenter Study
More than half of the nursing home population is incontinent of urine or feces, presenting challenges to perineal skin health. To determine the occurrence and severity of skin damage in nursing home residents with incontinence, a secondary analysis of data collected from a multisite, open-label, quasi-experimental study of cost and efficacy of four regimens for preventing incontinence-associated dermatitis in nursing home residents was performed. Sixteen randomly selected nursing homes from across the US were included in the study. Participating nursing home residents were incontinent of urine and/or feces and free of skin damage. Of the 1,918 persons screened, 51% (n = 981) qualified for prospective surveillance. Perineal skin was assessed over a 6-week period; frequency, type, and severity of skin damage were observed. Skin damage developed after a median of 13 (range 6 to 42) days in 45 out of 981 residents (4.6%), of which 3.4% was determined to be incontinence-associated dermatitis. Some residents (14 out of 45, 31%) had incontinence-associated dermatitis or other skin damage in more than one area. This study is one of the first to report the characteristics of incontinence-associated dermatitis in a large sample of nursing home residents. The sample size and random selection of nursing homes impart generalizability to the findings. Incontinence-associated dermatitis is a risk in nursing home residents, especially those with fecal incontinence. These findings suggest that the rate and severity of incontinence-associated dermatitis are low with close monitoring and use of a defined skin care regimen that includes a pH-balanced cleanser and moisture barrier. KEYWORDS: skin damage, dermatitis, incontinence, pressure ulcer, skin treatment, moisture barrier, nursing home
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Evaluating the Efficacy of a Uniquely Delivered Skin Protectant and Its Effect on the Formation of Sacral/Buttock Pressure Ulcers
Skin breakdown is a common adverse occurrence in healthcare facilities; effective management of related risk factors is critical for prevention. Measures focusing on the skin care of patients with incontinence are recommended to reduce the incidence of pressure ulcers on the sacrum and ischium. However, little research exists to support these recommendations. A retrospective study was conducted to determine if the use of a skin cleansing/protectant product on residents with incontinence decreased the incidence of nosocomial pressure ulcers in the sacral/buttock area. Chart data from all residents with incontinence of a 57-bed, long-term care, skilled nursing home that employs a comprehensive approach to pressure ulcer prevention were collected for a period of 3 months before use of the new product and for 3 months following introduction of the new product. During the first 3 months, five (14.7%) of the 34 incontinent residents developed superficial pressure ulcers (20% were Stage I, 80% were Stage II). Following the change in skin care, no pressure ulcers occurred in the 30 residents with incontinence. The observed decrease (McNemar's chi-square = 4.786, df = 1, Phi = -.273, P = .015) suggests a significant association between the consistent application of a skin protectant and the prevention of skin breakdown. The results of this study demonstrate that, in this population, and in the presence of a comprehensive pressure ulcer prevention program, use of this skin protectant can significantly reduce the incidence of nosocomial sacral/buttocks pressure ulcers.
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Fecal Incontinence in Acutely and Critically Ill Patients: Options in Management
Fecal incontinence presents a major challenge in the comprehensive nursing care of acutely and critically ill patients. When manifested as diarrhea, the effects of fecal incontinence can range from mild (superficial skin irritation) to profound (severe perineal dermatitis, dehydration, electrolyte imbalance, and sepsis). Fecal incontinence has many etiologies and risk factors. These include damage to the anal sphincter or pelvic floor, liquid stool consistency, abnormal colonic transport, and decreased intestinal capacity. To avoid or minimize complications, the cause of diarrhea should be addressed, fecal leakage prevented, stool contained, and skin integrity preserved. Management options addressing these goals include diet, pharmacological therapy, and the use of containment products. Management options and their respective advantages and disadvantages are presented with a special focus on safety issues. Diverse approaches are safe only if they are knowledgeably selected, carefully instituted, and constantly monitored for their effects on patient outcomes. Research to identify which options work best in selected clinical situations and which combinations of therapies are most effective is needed. KEYWORDS: fecal incontinence, diarrhea, critical illness
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A Three-Year Multiphase Pressure Ulcer Prevalence/Incidence Study in a Regional Referral Hospital
Pressure ulcers can have a devastating impact on health and care provision, ranging from patient discomfort and increased healthcare costs to a potential reflection on the quality of care. To evaluate the outcomes of prevention education and skin integrity interventions on the incidence of pressure ulcers, a multiphase project was initiated in an urban 154-bed regional referral community hospital in Ontario, Canada that provides care to an urban and rural population. The prevalence study included 84 adult subjects at baseline, 77 after one year (Phase 1), and 100 after 3 years (Phase 2). The Braden Scale for Predicting Pressure Sore Risk and a data collection form were used to record prevalence, incidence, stage, and location of pressure ulcers, and related documented interventions. Incidence data were obtained from patient charts and defined as ulcers that developed >24 hours following admission. Phase 1 interventions involved staff education and replacement of existing skin care products. Phase 2 interventions included adoption of pressure ulcer prevention protocols, advanced wound care products, improved support surface usage, modification of documentation methods, and staff education. Of the 84 patients assessed at baseline, 15 (17.9 %) developed 22 pressure ulcers compared to four of 77 (5.2%) during Phase 1 and two out of 100 (2.0%) during Phase 2. The difference between baseline and both subsequent time points was statistically significant (P < 0.05). These results suggest that education and the implementation of appropriate skin care products and procedures and pressure ulcer prevention protocols may reduce the incidence of hospital-acquired pressure ulcers. Keywords: pressure ulcers, nosocomial, prevention, skin care, acute care
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Validity and Reliability of the Perineal Assessment Tool
This study was conducted to evaluate the validity and reliability of an instrument designed to measure risk of perineal skin injury in hospitalized individuals. Interrater reliability of the Perineal Assessment Tool was examined by correlating the scores calculated by a wound, ostomy and continence nurse compared to those calculated by staff RNs and LPNs using the same tool with the same patient. Content validity was assessed by obtaining level of agreement ratings from 102 wound, ostomy, and continence nurses. Good correlation between the expert and staff nurse scores was found (r = .970, confidence intervals = 95%, P = .923 to .988 or P < .0001). Average perineal assessment tool subscale level of agreement scores ranged from 7.66 to 8.4 (range 1 = strongly disagree to 10 = strongly agree) and the median score for all subscales was 9. The results obtained are encouraging and justify additional reliability and validity studies.
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Prevention and Treatment of Perineal Skin Breakdown Due to Incontinence
For example, F-314 identifies moisture from incontinence as one of the risk factors that must be minimized to prevent pressure ulcers.14 F-315 guides surveyor evaluation of efforts regarding appropriate cleansing, rinsing, drying, and protective moisture barrier application to prevent skin breakdown from incontinence.15 Plan of Care The plan of care must be individualized for the patient with incontinence and should include the following components:&...
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From NPUAP Pressure Ulcer Stages Revised by the National Pressure Ulcer Advisory Panel
From NPUAP Pressure Ulcer Stages Revised by the National Pressure Ulcer Advisory Panel Special Report: From NPUAP Pressure Ulcer Stages Revised by the National Pressure Ulcer Advisory Panel - The National Pressure Ulcer Advisory Panel (NPUAP) has redefined pressure ulcer and revised the stages of pressure ulcers. Pressure Ulcer Stages Suspected Deep Tissue Injury. ...
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