Clinicians and caregivers face the challenge of protecting their patients against skin breakdown that can lead to perineal dermatitis and pressure ulcer development. Between 1.5 and 3 million adults suffer from pressure ulcers in the US at a cost to healthcare of close to $1.6 billion annually.1,2 Often, these wounds are related to the effects of incontinence.
An incontinence care opinion poll was conducted at the 37th Annual Wound, Ostomy and Continence Nurses Society conference, held June 12–16, 2005, in Las Vegas, Nev. Of the 1,318 registered attendees, 230 participated in a five-question incontinence survey conducted by Sage Products, Inc. (Cary, Ill.) (see Table 1). The survey tool included questions regarding protectant products for urinary and fecal incontinence (occurring independently and in combination); products containing either dimethicone or zinc oxide were the most frequently used (compared to products containing petroleum or a combination of products) for either type of incontinence, as well as when both types were present.
The survey answers also reveal that despite escalating healthcare costs and professional and regulatory guideline mandates, wound, ostomy, and continence care nurses struggle with educating staff and creating an environment where skin health is understood, valued, and routinely monitored. Of the wound, ostomy and continence nurses participating in the survey, 18% said little or no time is spent educating staff nurses and certified nursing assistants about incontinence care, 52% spend “some” time, and 26% spend “a lot” of time. Respondents also reported that healthcare facilities need to improve communication of skin problems between different levels of caregivers (67%), frequency and/or consistency of skin assessment/monitoring (60%), and method of skin assessment/monitoring (43%).
Even though 62% of respondents said patients at their facility who are at risk for skin breakdown receive a full skin assessment daily, 20% indicated that their facility’s incontinence care protocol does not include adequate prevention strategies. One-fifth of the respondents said their facility had no protocol in place for continence care.
Nurses can be a formidable factor in driving skin care assessment at their facilities. This has the potential to decrease the effects of incontinence episodes, pressure ulcer incidence, and patient discomfort (see “My Scope of Practice,” page 18). Personal and professional determination, improved communication across the care continuum, new guidance from the Centers for Medicare and Medicaid Services, and increased awareness of preventive measures, including appropriate use of protectant products, collectively can combine to reduce the effects of incontinence on the skin.