What’s Up Down There? Identifying and Treating IAD

Identifying Incontinence Associated Dermatitis or IAD can be a challenge for wound care clinicians as often it is confused and mislabeled as a pressure ulcer. We need A Questionto get good at identifying the true root cause of what has caused the skin breakdown. This IAD skin damage is damage that occurs from the top layers of the skin down where the pressure ulcer damage starts down deep when vessels are occluded from pressure. IAD is an inflammation of the perineal skin that has come into contact with urine or stool for an extended period of time and this has lead to skin damage.

IAD may present as an area of erythema, blistered, edematous and or a denuded area, but it will be free of necrosis. There may be epidermal loss and the skin damage will always remain partial thickness in nature. The patient may experience pain and complain of itching or burning as well.

Contributing factors for developing IAD include the patients generalized tissue tolerance of the skin, the tissue perfusion and oxygenation. The patient’s perineal environment is another risk factor, how much is moisture present on the skin. The toileting ability of the patient can also increase the risk for developing IAD and any mechanical trauma the skin must endure must also be considered a risk factor as well.

When our patient is at risk for IAD or develops IAD we must put appropriate interventions in place. These include a good skin care regimen with a gentle cleansing of the skin using a mild soap or no rinse soap. We need to use products that will maintain the PH of the skin.  Institute interventions such as patting the skin dry, no rubbing. Moisturize the skin with a product that contains humectant like glycerin, lanolin or mineral oil and use emollients to restore the lipids that have
been lost and apply to the skin when damp. Protect the skin from urine and stool with a moisture barrier ointment that contains zinc oxide, dimethicone or petrolatum or a combination of them.

Institute patient specific interventions for those risk factors that have been identified.  Interventions such as toileting schedules, open systems at night to avoid use of briefs, fecal collection devices, urinary catheters, and low air loss support surfaces may be needed and appropriate. If the IAD is severe topical wound therapy with dressings may be necessary. If candidiasis were suspected further fungal treatment and medical evaluation would be warranted as well.  A good preventive plan of care for the incontinent patient is a must!  For further information Click Here.

 

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