Preventing and treating incontinence-associated dermatitis in adults

Incontinence, a condition common among older people, has a significant impact on wellbeing and quality of life. Although the prevalence of incontinence varies by the study population, the estimates for faecal incontinence range from 0.8% to 15% (Lazarescu et al, 2009) while those for urinary incontinence may be as high as 45% in populations of older adults in protected care (Du Moulin, 2008). A prevalent complication of both faecal and urinary incontinence is the associated breakdown of perineal skin (Gray, 2010) and ensuing dermatitis (Beeckman et al, 2016).

Incontinence-associated dermatitis (IAD) arises from chemical and physical irritation of the skin due to persistent exposure to moisture (Beeckman et al, 2010). Subsequent inflammation exacerbates injury to the skin. As nurses are regularly involved in care for people with incontinence, an important goal of nursing care is to prevent and manage IAD in many settings, from aged care to critical care (Van den Bussche et al, 2017). When IAD does occur, the symptoms include skin erythema, bullae, other lesions and infection (Beeckman et al, 2018). At present, innumerable products are available for both the prevention and treatment of IAD. These include cleaning agents and leave-on products, which may be used on their own or in combination (Beeckman et al, 2016).