FOURTEENTH ANNUAL EUROPEAN PRESSURE ULCER ...
FOURTEENTH ANNUAL EUROPEAN PRESSURE ULCER ...
FOURTEENTH ANNUAL EUROPEAN PRESSURE ULCER ...
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Thursday September 1st<br />
Proceedings of the 14th Annual European Pressure Ulcer Meeting<br />
Oporto, Portugal<br />
A 3-in-1 perineal care washcloth impregnated with dimethicone 3% vs. water and pH<br />
neutral soap to prevent and treat incontinence-associated dermatitis: a randomized<br />
controlled clinical trial<br />
Dimitri BEECKMAN 1*, 2, 3 , Tom DEFLOOR † 2 , Lisette SCHOONHOVEN 4 , Katrien VANDERWEE 2<br />
1* King’s College London, United Kingdom, dimitri.beeckman@kcl.ac.uk, 2 Ghent University, Belgium,<br />
3 Artevelde University College, Belgium, 4 Radboud University Medical Center, The Netherlands<br />
Introduction<br />
Incontinence- associated dermatitis (IAD) is an<br />
inflammation of the skin in the genital, buttock or upper<br />
leg areas that occurs when urine and/or feces comes<br />
into contact with the skin [1]. The past decade has<br />
seen a huge growth in publications focusing on the<br />
clinical observation of IAD and the differentiation<br />
between IAD and pressure ulcers. Differentiation is<br />
particularly important since prevention and treatment<br />
are different. The clinical observation of IAD ranges<br />
from erythema (with or without loss of skin integrity) to<br />
cutaneous infections (such as candidiasis) [2]. IAD is<br />
often associated with redness, rash, or vesiculation [2].<br />
The lesions are superficial, but are likely to become<br />
slightly deeper if an infection occurs [2].<br />
An increasing amount of evidence draws attention to<br />
the importance of a consistent, defined skin care<br />
regimen to prevent and treat IAD. Although studies on<br />
the effectiveness of different regimens show extensive<br />
variation in their components, all of them include (1)<br />
gentle perineal cleansing, (2) the application of a<br />
moisturizer, and (3) the application of a skin<br />
protectant.<br />
Multiple studies showed that a single-step intervention<br />
has the potential to maximize time efficiency and to<br />
encourage adherence to the skin care regimen. These<br />
single-step products include disposable washcloths<br />
that incorporate cleansers, moisturizers, and skin<br />
protectants into a single product.<br />
The aim of this study was to compare the<br />
effectiveness of a 3-in-1 perineal care washcloth<br />
versus the standard-of-care (water and pH neutral<br />
soap) to prevent and treat IAD.<br />
Methods<br />
A randomized controlled clinical trial was designed.<br />
The setting included a random sample of 11 nursing<br />
home wards (6 experimental; 5 control) in a<br />
convenience sample of 4 nursing homes Belgium. The<br />
sample included nursing home residents at risk for<br />
and/or affected by IAD (defined as permanently<br />
incontinent for urine, feces, urine/feces, and/or having<br />
discoloration of the perineal skin (not caused by<br />
pressure/shear), and/or having an edematous skin in<br />
the genital area. Participants in the experimental group<br />
were treated according to a standardized protocol,<br />
including the use of a 3-in-1 perineal care washcloth<br />
impregnated with dimethicone 3%. Participants in the<br />
72<br />
control group received perineal skin care with water<br />
and pH neutral soap. The study period was 120 days.<br />
Data were collected between February and May 2010.<br />
IAD prevalence and severity were assessed using the<br />
IAD Skin Condition Assessment Tool. The surface<br />
(cm 2 ), redness, and depth of the perineal lesion were<br />
assessed daily by the nurses. This tool generates a<br />
cumulative severity score (Maximum score = 10)<br />
based on area of skin affected, degree of redness, and<br />
depth of erosion.<br />
Results<br />
In total, 464 nursing home residents were assessed<br />
and 32.9% (n=141) met the criteria for inclusion (exp.<br />
= 73, contr. = 68). Baseline IAD prevalence was<br />
comparable in both groups (exp.: 22.3% vs. contr.:<br />
22.8%, p=0.76). Baseline IAD severity was 6.9/10 in<br />
the experimental and 7.3/10 in the control group. A<br />
significant intervention effect on IAD prevalence was<br />
found (exp.: 8.1% vs. contr.: 27.1%, F= 3.1, p=<br />
0.003). A non- significant effect on IAD severity could<br />
be determined (exp.: 3.8/10 vs. contr.: 6.9/10, F= 0.8,<br />
p=0.06). (See figure 1)<br />
Figure 1. Evolution IAD prevalence and severity over time.<br />
Experimental<br />
Control<br />
Time 1 = day 1, 2= day 21, 3= day 42, 4= day 63, 5= day 91, 6= day<br />
119<br />
Clinical relevance<br />
A defined standardized skin care regimen, including<br />
the use of a soft pre- moistened washcloth (3%<br />
dimethicone) resulted in a significantly reduced<br />
prevalence. The introduction of a 1- step skin care<br />
product needs to receive full attention.<br />
Conflict of Interest<br />
None<br />
References<br />
[1] Nix D. et al. Ostomy Wound Manag. 50: 59-62,<br />
2004<br />
[2] Gray M. et al. Am J Clin Dermatol. 11:201-10, 2010<br />
Copyright © 2011 by EPUAP