Archive for the ‘Incontinence Associated Dermatitis’ Category

Wound Care Minute: What’s the Difference Between Excoriation and Denuded Skin?

Saturday, December 24th, 2016

Excoriation vs. Denuded: WCEI co-founder Nancy Morgan discusses these often-confused wound care terms

 

 

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Will the Real Pressure Ulcer Please Stand Up?

Wednesday, October 28th, 2015

How to know the difference between Incontinence Associated Dermatitis (IAD) and pressure ulcers.

Incontinence Associated Dermatitis (IAD) vs Pressure Ulcer

As wound care clinicians, we treat our patients to the best of our ability and heal wounds – that’s what we do. But unfortunately, even under the best of circumstances, facility-acquired pressure ulcers happen. And we have to document them … because again, that’s what we do.

So then it would stand to reason that no one would ever purposely document this type of pressure ulcer without cause, right? So here is the big question of the day: why is it that Incontinence Associated Dermatitis (IAD), rather than a pressure ulcer, is often documented as a Stage II? We’ve got your answer.

The truth about pressure ulcers and staging

We know that any staged skin lesion, by definition, is an area of skin disturbance caused by pressure, and according to the National Pressure Ulcer Advisory Panel, only pressure ulcers should be staged. We also know that once any skin lesion is staged, you might find yourself sitting on the “hot seat” – having to defend how this new wound developed. And since part of our job is to prevent pressure ulcers, staging areas like this puts us on the defensive when we don’t have to be.  The truth: unnecessary staging could lead to charges of inadequate assessment, since that is exactly what it is.

Let’s take a closer look

So how do we keep from putting ourselves in such an uncomfortable situation? First, let’s review the difference between these two types of lesions.

Incontinence Associated Dermatitis (IAD)

  • IAD is a form of Moisture Associated Skin Damage, and is defined as inflammation of the skin from prolonged exposure to urine and stool.
  • This is usually seen in conjunction with friction and/or chemical and/or bacterial factors – they work together to cause IAD.
  • The skin injury that results is always partial thickness in nature.
  • You may see some loss of epidermis and superficial dermis leading to a partial thickness wound, but these are not pressure ulcers.
  • These are moisture related injuries, and should never be staged.

Pressure ulcers

  • Pressure ulcers are caused by unrelieved pressure or shearing forces (which is not what happens in the case of IAD).

Where it gets complicated

Even though we are talking about two different lesions, there are times when IAD converts to a pressure ulcer. Here’s what you need to know:

  • A previously identified IAD must be considered a pressure ulcer when you see new evidence of full thickness and damage below the dermis (slough, eschar, and granulation tissue are good examples).
  • This indicates that the deeper acting forces of pressure and shearing are present (read more about friction vs. shearing here).
  • You cannot damage the subcutaneous layer and below by moisture alone.
  • Remember – moisture damage to the skin can only be partial thickness.
  • Evidence of full thickness injury means it is no longer considered IAD and there was ischemic damage that took place, which means it is now considered a pressure ulcer. So it’s time to stage it and get to work healing it.

The importance of assessment

Under such circumstances, this would be considered a facility acquired pressure ulcer.  Hopefully, your patient was previously identified as being at risk for pressure ulcer development, and prevention interventions are already in place.

Once staging happens, it’s time to go back and do another full assessment of your patient and the wound, and put in place both the proper treatment plan and more advanced prevention interventions. Moving forward, all incontinent patients should be considered at risk for skin breakdown, and a care plan to prevent IAD and pressure injury should be implemented from the get-go.

What do you think?

We’d appreciate hearing about your own experiences with staging IADs, versus true pressure ulcers. Do all clinicians in your setting who document wound assessments know how to tell the difference between these two types of lesions?  Do you feel you have adequate interventions in place for IAD patients?  And what are your biggest challenges in treating these patients and assuring proper identification of these wounds? Please leave your comments below.

 

What’s Up Down There? Identifying and Treating IAD

Monday, November 24th, 2014

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.