Wound Care Made Incredibly Easy

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Moisture-associated skin damage

When data become available for the time of the COVID pandemic, it is likely that the rates of IAD and other skin issues will show an increase due to severity of patient condition, staff shortages, and dif ficulty working with personal protective equipment.

Etiology

According to Wounds International, the factors most closely associ ated with increased risk of damage due to incontinence include the type of fluid (e.g., liquid stool is more damaging due to moisture ex posure and enzymes present to digest food); frequency of stools; the duration of exposure; frequency of cleansing; and being incontinent of both urine and feces (Fletcher et al., 2020). One reason dual incon tinence is more damaging is that urea from urine sitting on the skin is changed to ammonia with an alkaline pH, and when skin becomes more alkaline, its effectiveness as a barrier decreases. In a study using synthetic urine–soaked premium wicking pads for females over 65 with healthy skin, within 15 minutes of lying on the pads, their skin pH went from a normal 5.67 to a higher pH of 6.25 and their skin barrier function was affected, including a significant in crease in erythema and self-reported discomfort (Phipps et al., 2019). Whenever skin becomes more alkaline, the enzymes in stool, includ ing lipases and proteases, become active and are more corrosive to skin. Stool that has a pH higher than 7.5 causes inflammation with out any additional factors. Fecal incontinence It’s helpful to have an excellent relationship with your nutrition ther apy colleagues when caring for patients with fecal incontinence. They can often recommend dietary changes, nutritional products contain ing soluble fiber, along with medications prescribed by health care providers, to get patients closer to producing formed stool. When stool is formed, even if an involuntary evacuation occurs, it is less likely to cause any skin damage. For the nonambulatory patient, while working to resolve diarrhea, there are several “invasive” fecal collection devices on the market as well as noninvasive devices available for use.

Resolving incontinence

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DigniShield™ Stool Management System. Courtesy © Becton, Dickinson and Company.

Evans-Smith, P. (2014). Taylor's clinical nursing skills . Lippincott Williams & Wilkins.