Wound Care Made Incredibly Easy

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External threats to skin integrity

Area at risk for ITD Warning signs

Interventions

If only mild erythema is present, zinc oxide can be applied to both sides of a nonadherent pad and replaced twice daily after gently cleansing with an acidic pH cleanser. For more serious damage or suspected fungal/bacterial infec tion, consider using a wicking textile with silver; leave 2 in of it outside the fold to allow evaporation to occur. Consider a zinc oxide paste, ointment, or spray for preven tion of mild ITD in this area. Zinc oxide paste can be applied to an anal leakage pad or to both sides of a nonadherent pad. Cleanse gently after each incontinence episode with a pH-balanced cleanser (acidic), and reapply. If there are denuded areas, pastes containing carboxy methylcellulose/pectin applied to the denuded skin may be helpful. These products and zinc oxide barriers should only be removed every few days to bare skin and reapplied. In the interim, cleanse stool and urine off the paste, and apply more paste as needed. For toes, weave a rope of lamb’s wool between the toes to help wick moisture and prevent surfaces from touching. If fungus is suspected, consider an antifungal spray rather than cream or ointment that holds moisture. For fingers and palms with contractures, use wicking tex tile with silver, leaving at least 2 in of the cloth out in the air to facilitate evaporation.

Inframammary (below the breasts) or below

Any inflammation or rash; su perficial peeling; maceration, especially along the deepest crease; foul odor Complaints of pruritus (itching) or pain in the skin fold Any inflammation or rash; mac eration or skin split along the deepest crease Complaints of pruritus (itching) or pain in the skin fold

the pannus (fatty abdominal apron)

Gluteal cleft (crease between the buttocks)

Maceration (whitish appear ance of skin) often followed by inflammation and fungal or Gram-negative bacterial infection Complaints of burning or pruri tus (itching) if sensation is intact

Interdigital Toes, especially with deformities such as hammer toes Fingers, especially with hand contractures

Incontinence-associated dermatitis

Incontinence-associated dermatitis (IAD), also called incontinence associated skin damage and perineal dermatitis, is skin injury due to fecal, urinary, or dual incontinence. IAD has received more attention in the last few decades. Prior to recent years, regardless of the age of the affected person, it was called “diaper rash” and incontinence briefs were called “diapers.”

Get wise to wounds

Copyright © 2023 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. The first IAD prevalence study in acute care showed that a rate of 42.5% of patients with incontinence in two U.S. hospitals had related skin injuries (Junkin & Selekof, 2007). A study in multiple American acute care facilities showed a 45.7% prevalence of IAD among patients with incontinence (Gray & Giuliano, 2018). A later study showed a 36.2% prevalence in acute care in Brazil (Ferreira et al., 2020). Though it seems like IAD prevention is not improving, that may be due to better reporting and lower use of urinary catheters, especially in acute care.