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Case Study
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Skin injury due to incontinence: multisite case studies comparing barrier A with barrier B Laura Herbe, RN, BSN, CWOCN, Toni Horton, RN, BSN, CCN, Hillcrest Hospital Cleveland Clinic Health System, Mayfield Heights, OH; Mary Ann Sammon, RN, BSN, CWOCN, Cleveland Clinic Foundation, Cleveland, OH; Dasie Wilson, RNC, BSN, MPA, CCCN, CWCN, ET, Cons Clinical Problem: Patients experiencing both urinary and fecal incontinence, or diarrhea have an increased risk for dermatitis and denudement that can result in physical discomfort. .Description of Past Management: When denudement is present, barrier pastes are used to protect and promote skin healing however; typically these barrier products do not allow visibility of the skin leading to premature removal to assess the skin. Current Clinical Approach: An ideal skin protectant should have excellent moisture barrier and skin adhesion functionality while providing visibility of the skin. These case studies compared a newly formulated clear protective barrier (Barrier A) designed to provide moisture holdout while adhering to denuded skin with a marketed protective barrier paste (Barrier B). Patients were entered into a case study if they had fecal incontinence and denudement with or without erythema. A no rinse foam cleanser followed by the selected barrier was used after each incontinent episode. The patients were evaluated for a minimum of three (3) days to a maximum of ten (10) days. Patient Outcomes: Eleven (11) patients completed the case studies: Five (5) using Barrier A and six (6) using Barrier B. Erythema, denudement, and itching/burning were reduced. Barrier A provided skin assessment without removal. Barrier B required removal to assess the skin. Conclusion: Health care providers preferred Barrier A to Barrier B as it provided protection while allowing visual assessment of the skin condition Products: Barrier A: Critic-Aid¨ Clear Moisture Barrier, Coloplast Corp, Skin Health Division, Marietta, GA, patent pending.Barrier B: Sensi-Care¨ Protective Barrier, ConvaTec, Division of E. R. Squibb & Sons L.L.C., Princeton, NJ. Fiers SA. Breaking the cycle: the etiology of incontinence dermatitis and evaluating and using skin care products. Ostomy Wound Manage. 1996;42(3):32Ð40 Health Care Financing Administration Data for Urinary Incontinence Panel [HCFA], 1989 Hu T, Kaltrieder l, Igou J. The cost-effectiveness of disposable versus reusable diapers: a controlled experiment in a nursing home. J Gerontol Nurs. 1990;15(2):19Ð24 Haugen V. Perineal skin care for patients with frequent diarrhea or fecal incontinence. Gastroenterol Nurs. 1997;20(3):87Ð90.. |
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