Incontinence-Associated Skin Damage in Nursing Home Residents: A Secondary Analysis of a Prospective, Multicenter Study
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With regard to incontinence, 10% of the residents had urinary incontinence only, 15% had fecal incontinence only, and 48% had both urinary and fecal incontinence. Of the 35,504 residents who were incontinent, dermatitis was present in 2,472 (7%).
Zehrer et al3 screened 398 of 521 nursing home residents in three upper Midwestern nursing homes for IAD during a cost comparison of three skin damage prevention regimens. At least 50% of residents in each of the homes were incontinent. Perineal skin damage was present in 16 (4%) at the baseline assessment. Although the characteristics of all screened residents were not reported, knowledge of the sample can be inferred from the enrolled residents. The 250 enrolled residents were predominantly female (76%) and Caucasian (98%) and the median age was between 81 and 90 years. About half (54%) of the residents had dementia. All participants were on a skin damage prevention regimen that included use of a pH-balanced cleanser and moisture barrier. During a 3-month surveillance period, six out of 183 (3.3%) new cases of IAD developed.
Bale et al2 compared the skin condition of residents in two nursing homes before (n = 79) and after (n = 85) implementation of a new skin care regimen that used a skin cleanser and a durable barrier cream for mild incontinence or intact skin or a skin cleanser and a barrier film for severe incontinence or damaged skin. The majority of residents were female (70%) and >80 years of age (72%). At the start of the study, most (51, 65%) of the residents were incontinent of both urine and stool; 29% had urinary incontinence only. Before the intervention, 20 out of 79 (25%) of residents had IAD. Incontinence-associated dermatitis severity was mild in approximately 5%, moderate in 12%, and severe in 3% of residents.
Lewis-Byers et al4 compared the skin effects of a skin care regimen using soap and water and a moisturizing lotion after each episode of incontinence (control) versus using a no-rinse cleanser and a durable moisture barrier cream once per day (intervention) in 31 nursing home residents. Most of the sample (24 out of 31, 77%) had both urinary and fecal incontinence, four out of 31 (13%) had fecal incontinence only, and three out of 31 (9.6%) had urinary incontinence only. The incidence of skin damage during the baseline period was not reported. A skin condition score that ranged from 0 (intact skin) to 4 (eroded/ulcerated skin) was developed. At the start of the study, skin condition score (mean, SD) of the control and intervention groups was 0.54 (0.8) and 0.56 (1.15), respectively, indicating some residents had skin damage. During the 3-week study period, the skin condition of three of the 13 control group participants (23%) and two out of 18 (11%) intervention group members worsened or did not improve from an abnormal baseline. Larger studies of IAD in nursing home residents using prospective observational methods are lacking.
Study design and regimens. A secondary analysis was conducted of a multisite, open-label, quasi-experimental study of the cost and efficacy of four regimens for preventing IAD in nursing home residents. The methods of the parent study have been reported and are summarized here.9 The four regimens each used a moisture barrier of different composition and a skin cleanser of the same manufacturer (see Table 1). Regimen W used an acrylate terpolymer-based barrier film, regimen X used an ointment with 43% petrolatum, regimen Y used an ointment with 98% petrolatum, and regimen Z used a cream with 12% zinc oxide + 1% dimethicone. The moisture barrier was applied three times per week in regimen W and after each episode of incontinence in regimens X, Y, and Z per manufacturer recommendations.