Just the FAQs: Skin care, incontinence

ABOUT CLINICALLY SPEAKING

Clinically Speaking addresses clinical topics of interest to the long-term care community, such as skin care and incontinence; diagnostic advances; wound care; infection control; and medication management. Each month an expert in the area of clinical care or an expert representing a professional association with LTC clinical expertise will author an article. If you are interested in contributing to Clinically Speaking on behalf of yourself or your association, contact Editor-in-Chief Patricia Sheehan at psheehan@iadvanceseniorcare.com.

WHAT IS IAD?

Incontinence-associated dermatitis (IAD) is an acronym that is being used to describe incontinence-related skin problems. Common clinical conditions associated with urinary and fecal incontinence include skin maceration, erosion, or denuding of the skin and skin infections, such as candidiasis. These conditions are typically diffuse over the buttocks and genitals, distinguishing them from pressure ulcers that typically occur over a bony prominence such as the sacrum, coccyx, trochanter, or ischium. For more information, the reader is referred to

Urinary & Fecal Incontinence, Edition 3, edited by Dorothy B. Doughty, Elsevier Health Sciences, 2005.

WHAT’S NEW FOR THE CONTAINMENT OF URINARY INCONTINENCE?

New polymer-filled products for adults are improving the way urinary incontinence can be managed. These super-absorbent products come in a variety of shapes and sizes, including pads, pull-ups, briefs, and underpads in sizing small to bariatric. Many of the high-end products are capable of wicking hundreds of ccs of fluid away from the body and keeping the skin-device interface bone dry. It is common for people to wear a less absorbent product during the day (e.g., pull-up) and a more absorbent product overnight. Manufacturers have guidelines for sizing these products to the individual person, which is key to their successful use. For more information, refer to Continence Ostomy Source published by Kestrel Health Information (www.continenceostomysource.com).

WHAT’S NEW FOR THE CONTAINMENT OF FECAL INCONTINENCE?

A major breakthrough for the management of incontinence has been the introduction and widespread use of a fecal management system known as Flexi-Seal® FMS (ConvaTec, Skillman, New Jersey). This system enables critically ill patients and persons with loss of bowel control to be connected using an indwelling catheter to a containment pouch. Not only does the system prevent skin breakdown, but it also manages odors and reduces bacterial contamination of the environment. This system reduces the complications associated with rectal tubes and other old-fashioned containment devices. A product brochure, educational materials, clinical, and free products for trial are available from Bristol-Myers Squibb Professional Services by sending an e-mail to professional.services@bms.com. For more information on fecal incontinence, refer to Mary Arnold-Long’s feature on incontinence in the October 2010 issue of Long-Term Living titled “Fecal Incontinence,” p. 50.

WHAT’S ALL THE BUZZ ABOUT DIMETHICONE?

Dimethicone is a new ingredient in barrier products for managing light to moderate urinary or fecal incontinence. While petrolatum and zinc oxide barriers are still used for the management of heavy incontinence, the dimethicone barriers are effective without the sticky, gooey feel of zinc oxide and petrolatum products. A variety of manufacturers now offer incontinence barrier products with dimethicone. Go to www.incontinenceostomysource.com for more information.

Many of the high-end products are capable of wicking hundreds of ccs of fluid away from the body and keeping the skin-device interface bone dry.

Manufacturers have guidelines for sizing these products to the individual person, which is key to their successful use.

ARE THERE PRACTICE RECOMMENDATIONS FOR INCONTINENCE CARE?

The Wound Ostomy Continence Nurses Society publishes a number of resources related to incontinence. These can be purchased from the WOCN Web site (www.wocn.org). Of particular interest are the following four documents:

• Indwelling Urinary Catheters: Best Practice Document for Clinicians (2009)

• Bladder Diary: Best Practice Document for Clinicians (2007)

• Reversible Causes of Urinary Incontinence: A Guide for Clinicians (2007)

• Reversible Causes of Urinary Incontinence: A Guide for Patients (2007) LTL

Diane L. Krasner, PhD, RN, CWCN, CWS, MAPWCA, FAAN, is a wound and skin care consultant in York, Pennsylvania. She is the Wound, Ostomy, Continence/Special Projects Nurse at Rest Haven-York, Pennsylvania. Dr. Krasner is the lead co-editor of

Chronic Wound Care: A Clinical Source Book for Healthcare Professionals, 4

^th edition (

www.chronicwoundcarebook.com), the clinical editor of WoundSource (

www.woundsource.com), and serves as an expert witness in legal cases involving wound care. Long-Term Living 2011 January;60(1):24-25