Progress in Practice: Maintaining Skin Integrity in Patients with Incontinent Episodes

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Catherine T. Milne, MSN, APRN, BC-ANP/CNS, CWOCN, Advanced Practice Nurse – Wound, Ostomy, Continence, Connecticut Clinical Nursing Associates, Bristol, CT

  Foam dressings are a mainstay in managing wounds. Traditionally used for exudate management, foam dressings can have a wide performance range depending on the composition of the biomaterials used. Factors that can affect dressing performance include but are not limited to wound characteristics, clinician experience, systemic patient factors, and the clinical setting.

  Maintaining dressing integrity in patients with incontinence is a frequently encountered clinical challenge. Inability to achieve dressing adherence on moist, compromised skin adversely affects patient confidence in healthcare providers, introduces bacteria into the wound, and increases cost. Dressing construction impacts these factors.1

  A new product in the ConvaTec, Inc (Skillman, NJ) AQUACEL® family of dressings — AQUACEL® Foam dressing — features sodium carbomethylcellulose Hydrofiber® technology. This technology utilizes an AQUACEL® wound contact interface to lock in wound exudate and prevent lateral spread of fluid, reducing the risk for maceration of the periwound skin. The dressing has a soft, absorbent foam pad and is available as a nonadhesive and with a gentle, skin-friendly silicone adhesive border. The water- and bacteria-proof outer barrier can be applied to a variety of wounds in a variety of clinical settings.

  Patients with incontinence and wounds can benefit from this new foam dressing technology. A prospective convenience sample2 of seven patients with repeated loss of dressing adhesion from mechanical forces or chemical (urine/stool) insults were selected. Participants were evaluated for length of dressing integrity, dressing change discomfort, and exudate management with AQUACEL® foam dressing.

  In five of the seven patients, the dressing adhered for 7 days. The two additional patients required dressing changes twice a week: one for exudate management and one to ensure adhesion. All dressings adhered on the first attempt without use of a barrier film. Fecal effluent on the external dressing was easily removed with a cloth wipe; no effluent was observed under the dressing border. Two patients reported minimal and five reported no discomfort during dressing changes. No adhesive denudations were noted. Both sides of this dressing appeared to perform as designed. The contact layer provided effective exudate management and a skin-friendly adhesive, and the external side provided an easy-to-clean waterproof viral and bacterial barrier. These characteristics appear to increase dressing adhesion and adherence to protocols of care in patients with incontinence.

  A case report also supports use of the dressing. A 76-year-old woman with a history of fecal and urinary incontinence, morbid obesity, hyperlipidemia, hypertension, insulin dependent diabetes, osteoarthritis, and obstructive sleep apnea had incontinence-associated dermatitis on her medial upper thigh. Previous dressings did not stay in place and, due to constant friction, caused bleeding and irritation. Creams and ointments were not effective in this location. Her skin issues prevented discharge from long-term care to her home setting.

  AQUACEL® foam dressing was applied and stayed in place even with five to eight incontinent episodes per day. Five days after wound management with AQUACEL® foam dressing began, the patient’s skin showed improvement and healed within 3 weeks (see photographs).

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