Prevention of Incontinence-Related Skin Breakdown
Prevention of Incontinence-Related Skin Breakdown
Perineal protection products were compared for their efficacy in preventing skin breakdown in the hospitalized patient with urinary and/or fecal incontinence. Each product was used for the duration of the hospital stay with daily observations for perineal skin condition. Results indicated the spray product and wipe product were comparable in rate of skin breakdown prevention. Findings suggest the wipe product is more cost-effective for use during hospitalization, and the spray product preserves skin integrity over a longer period of time, beyond average hospitalization duration.
As is so often the case, research projects are born out of nurses asking "why" questions about their practice. This project was no different and is best illustrated with this patient story.
Max, in his early 60s, was an un-kept, homeless man admitted to the hospital with a large myocardial infarction for a nearly five-week stay. His size (six foot, 4 inches, 420-pound frame) and illness had a strong effect on the staff's ability to provide care. He did not fit in the bed, and the pressure on his legs and heels, as well as the presence of 3+ pitting edema, led to sloughing of his skin. The insertion site from the coronary angiogram and intra-aortic balloon pump procedures done on admission had not healed due to the presence of a body rash from the use of multiple antibiotics, combined with the effects of urinary and fecal incontinence and moisture from perspiration.
The first day, Mary, a registered nurse, cared for Max; he was well into his stay (23rd hospital day). She was determined to provide a bath this day because Max had been successful in resisting one for a week. Mary opened the cabinet in Max's room to reveal more than a dozen skin care products: lotion, soaps, foams, and powders. It was obvious that each caregiver was approaching skin care for Max in a different manner. Mary was at a loss as to where to begin and was discouraged by the inconsistency of his skin care. She wondered, "Were we doing more harm to the skin when using these different products? When mixed together over time, do the products hasten skin break down?" Mary's first move was to initiate a consult for the hospital wound/skin nurse, and together, a plan was developed and implemented. Ultimately, this skin care experience led to further discussion and research. Mary's question was the catalyst for the We Help Incontinent Patients' Skin (WHIPS) study.
It is widely accepted that fecal and urinary incontinence can contribute to skin breakdown, ranging from mild erythema to chemical erosion and pressure ulcers (Beeckman, Schoonhoven, Verhaeghe, Heyneman, & Defloor, 2009; Carr & Benoit, 2009; Driver, 2007; Fiers, 1996; Gray, 2004; Gray, Ratliff, & Donovan, 2002; Gray et al., 2007; Hunter et al., 2003; Junkin & Selekof, 2007; Lewis-Byers, Thayer, & Kahl, 2002; Nazarko, 2007; Nix, 2002, Thompson, Langemo, Anderson, Hanson, & Hunter, 2005; Wishin, Gallagher, & McCann, 2008). This is especially challenging in critical care and acute medical-surgical areas where patients are less mobile with multiple, compromising health problems (Bliss, Johnson, Savik, Clabots, & Gerding, 2000; Wishin et al., 2008). Although hospital protocols may be in place that address care of the patient with incontinence or preventing skin breakdown, it is common to see a variety of incontinence skin care products at the bedside, as well as various interventions used by nursing. The inconsistencies in practice contribute to unpredictable patient outcomes, overuse and misuse of product, and undo expense (Nix, 2000).
Abstract and Introduction
Abstract
Perineal protection products were compared for their efficacy in preventing skin breakdown in the hospitalized patient with urinary and/or fecal incontinence. Each product was used for the duration of the hospital stay with daily observations for perineal skin condition. Results indicated the spray product and wipe product were comparable in rate of skin breakdown prevention. Findings suggest the wipe product is more cost-effective for use during hospitalization, and the spray product preserves skin integrity over a longer period of time, beyond average hospitalization duration.
Introduction
As is so often the case, research projects are born out of nurses asking "why" questions about their practice. This project was no different and is best illustrated with this patient story.
Max, in his early 60s, was an un-kept, homeless man admitted to the hospital with a large myocardial infarction for a nearly five-week stay. His size (six foot, 4 inches, 420-pound frame) and illness had a strong effect on the staff's ability to provide care. He did not fit in the bed, and the pressure on his legs and heels, as well as the presence of 3+ pitting edema, led to sloughing of his skin. The insertion site from the coronary angiogram and intra-aortic balloon pump procedures done on admission had not healed due to the presence of a body rash from the use of multiple antibiotics, combined with the effects of urinary and fecal incontinence and moisture from perspiration.
The first day, Mary, a registered nurse, cared for Max; he was well into his stay (23rd hospital day). She was determined to provide a bath this day because Max had been successful in resisting one for a week. Mary opened the cabinet in Max's room to reveal more than a dozen skin care products: lotion, soaps, foams, and powders. It was obvious that each caregiver was approaching skin care for Max in a different manner. Mary was at a loss as to where to begin and was discouraged by the inconsistency of his skin care. She wondered, "Were we doing more harm to the skin when using these different products? When mixed together over time, do the products hasten skin break down?" Mary's first move was to initiate a consult for the hospital wound/skin nurse, and together, a plan was developed and implemented. Ultimately, this skin care experience led to further discussion and research. Mary's question was the catalyst for the We Help Incontinent Patients' Skin (WHIPS) study.
It is widely accepted that fecal and urinary incontinence can contribute to skin breakdown, ranging from mild erythema to chemical erosion and pressure ulcers (Beeckman, Schoonhoven, Verhaeghe, Heyneman, & Defloor, 2009; Carr & Benoit, 2009; Driver, 2007; Fiers, 1996; Gray, 2004; Gray, Ratliff, & Donovan, 2002; Gray et al., 2007; Hunter et al., 2003; Junkin & Selekof, 2007; Lewis-Byers, Thayer, & Kahl, 2002; Nazarko, 2007; Nix, 2002, Thompson, Langemo, Anderson, Hanson, & Hunter, 2005; Wishin, Gallagher, & McCann, 2008). This is especially challenging in critical care and acute medical-surgical areas where patients are less mobile with multiple, compromising health problems (Bliss, Johnson, Savik, Clabots, & Gerding, 2000; Wishin et al., 2008). Although hospital protocols may be in place that address care of the patient with incontinence or preventing skin breakdown, it is common to see a variety of incontinence skin care products at the bedside, as well as various interventions used by nursing. The inconsistencies in practice contribute to unpredictable patient outcomes, overuse and misuse of product, and undo expense (Nix, 2000).
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