3M Cavilon Advanced Skin Protectant for IAD

Transcription

1 3M Cavilon Advanced Skin Protectant for IAD

2 Table of Contents 01 Value Summary: Cavilon Advanced Skin Protectant Meeting Goals Incontinence Associated Dermatitis Landscape 02 Overview of IAD Burden of Illness 03 Cavilon Advanced Skin Protectant for moderate to severe IAD Description of Cavilon Advanced Skin Protectant Clinical Value Economic Value 04 Appendix A: Bibliography

3 s 01 Value Summary 3M Cavilon Advanced Skin Protectant

4 Incontinence-associated dermatitis (IAD) occurs frequently, is time-consuming, costly to manage, and painful for patients Definition Incontinence-associated dermatitis (IAD) is skin damage associated with urine and/or fecal exposure 1 Burden of IAD Prevention and Management of IAD IAD is common1, resource intensive 2,3 and costly IAD is associated with pain and discomfort, with downstream impact on patient s quality of life 4,5, and perceived quality of care 6 IAD is a known risk factor for pressure ulcers 7,8 and secondary fungal infections 4 Prevention is aimed at avoiding or minimizing exposure to urine or stool combined with a structured skin care regimen 4,9 For management of IAD, the skin care regimen should protect the skin from further exposure to irritants, establish a healing environment, and eradicate any cutaneous infection 4,9 IAD challenges Lack of a clinically effective and patient and clinician friendly product for moderate to severe IAD and high risk patients Evidence suggests that IAD persists despite the use of current skin care regimens 10 Current products can be time-consuming for clinicians, requiring frequent application and removal 3 Current products can interfere with absorbent products that are used in the management of IAD 11,12 The frequent removal and reapplication of current products is painful for the patient 5 1Gray, JWOCN 2007;34(1): 45-54; 2 Plante, Association for Advancement of Wound Care. Atlanta, Ga.; Morris L. Wounds UK 2011; 7(2): Beeckman, Wounds International Junkin, Nursing 2008;38(11 Suppl):56hn CMS HCAPS 7 Demarre, J Adv Nurs 2014; Aug 19 8 Park, J WOCN 2014; 41(5): Gray M. J WOCN 2012;39(1): Bliss D. J WOCN 2011;38(4): Hart J. Nursing Scotland 2002, Issue: July/August 12 Zehrer CL. Ostomy Wound Manage 2005; 51(12): 54-58;

5 Evidence suggests that IAD persists despite the use of standardized skin care regimens 1 Critically Ill Adults 1 81% of patients still had IAD at discharge from the ICU (median time in ICU = 7days) 81% at 7 days In a study of critically ill patients (n=45) across 3 surgical/trauma critical care units in urban US hospitals, the median time to onset was 4 days (1-6 days) and 81% of ICU patients still had IAD at discharge (median of 7 days) with the median time to IAD healing of 11 days (range, 1-19 days). 1Bliss D, J WOCN 2011;38(4):

6 Cavilon Advanced Skin Protectant is an effective barrier that helps in prevention and management of moderate to severe IAD Adheres to wet, weepy tissue Cavilon Advanced Skin Protectant adheres to wet, weepy tissue, creating an effective barrier to caustic irritants and allowing skin to heal in the most extreme cases 1 Cavilon Advanced Skin Protectant Durable Cavilon Advanced Skin Protectant reduces frequency of applications to 2-3 times per week and reduces nursing time Reduces pain associated with IAD care Cavilon Advanced Skin Protectant can reduce patient s pain 1 associated with IAD, improving quality of life and the patient s experience 1Brennan MR et al. JWOCN. Accepted for publication 2016.

7 s 02 Incontinence Associated Dermatitis (IAD) Landscape Overview

8 Incontinence-associated dermatitis (IAD) can range in severity from erythema to partial-thickness skin loss and infection 1 Incontinence-associated dermatitis (IAD) is a skin damage associated with urine and/or fecal exposure Category 1 (Mild IAD ) Erythema +/- edema Affected skin is red* but intact Category 2 (Moderate-to-Severe IAD) Moderate Severe Erythema +/- edema; +/- vesicles/bullae/skin erosion; +/- denudation of skin; +/- skin infection Affected skin is red* with skin breakdown *Or paler, darker, purple, dark red or yellow in patients with darker skin tones 1Beekman et al, Wounds international 2015.

9 High risk patients are those with fecal incontinence, especially where loose stool is present high risk population All patients or residents with incontinence are at risk but those with mixed incontinence are the most vulnerable especially when stools are liquid or diarrhea is present 1 Severe-to-moderate IAD occurs in ~35% of cases 2 Formed feces +/- urine Liquid feces +/- urine Liquid stool increases the risk and severity of IAD 26% 9% 65% IAD Risk Urine Type of incontinence Mild Moderate Severe 1Beekman et al, Wounds international 2015; 2 Gray M and Baros S. Presented at the 23 rd Annual Meeting of the Wound Healing Society; SAWC Spring/WHS Joint Meeting, Denver, CO May 1-5, 2013.

10 IAD is a risk factor for pressure injury (ulcer) development 1-3 The risk of developing pressure ulcers has been found to increase as the severity score for IAD increases 2 Patients with IAD are at a significantly higher risk of superficial sacral pressure ulcers odds ratio The likelihood of developing a pressure ulcer increases by a ratio of 1.9 for every 1-point increase in IAD severity score (odds ratio = 1.9, 95% CI = ) 2 44% Superficial sacral pressure ulcers developed in 44.4% of patients who had IAD versus 12.2% of patients who did not have IAD (n=610) odds ratio Patients with IAD are at an increased risk of superficial sacral pressure ulcers with an odds ratio of 2.99 (CI: , p=0.19) 1 1Demarre, J Adv Nurs 2014;Aug 19; 2 Park KH, J WOCN 2014;41(5):424-29; 3 Beeckman, Wounds International 2015

11 IAD is associated with pain, discomfort, depression, and poor quality of life 1 Pain associated with IAD can have a negative impact on patients health and well-being 1-3 You have to manage time, as well as the patient s pain and discomfort. And then there is this anguish that starts because we see it very clearly. The patients are on a respirator, so we feel it right away, the machines ring loudly, the cardiac rhythm increases, the pressure increases... they dread it. Before we have even touched them. 4 Pai n Incre ased morbi dity 2 Decr ease d mobili Redu ced qualit ty 2 y of Poor care 3 qualit Poten y of tial life incre 1 ase in lengt h of stay 2 -Nurse responding to impact of diarrhea on nurses everyday work 1Beeckman, Wounds International 2015; 2 Junkin, Nursing 2008;38(11 Suppl):56hn1-10; 3 CMS HCAHPS; 4 Guillemin, Int J Nurs Pract May 1;21(S2):38-45

12 Skin integrity and pain management are recognized as key indicators of quality of care 1,3 Quality Joint Commission for Accreditation of Health Care Organizations and the Centers for Medicare and Medicaid Services (CMS) recognize skin breakdown as a key indicator for quality of care 4 Pain management is one of nine key topics reported in the Centers for Medicare and Medicaid Services (CMS) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores 1 Pain Management Questions Represents over 3 Million patients discharged from 4,136 hospitals between July 2013 and June How often was your pain well Never + Sometimes Usually Always controlled? How often did the hospital staff do everything they National results for could to help you with your pain? 1 Pain Management Questions 7% 22% 71% 1CMS HCAHPS; 2 CMS HCAHPS Hospital Characteristic Chart; 3 Meraviglia, Adv Skin Wound Care 2002;15(1):24-9; 4

13 s 02 Incontinence Associated Dermatitis (IAD) Landscape Burden of Illness

14 IAD is a common problem Although IAD is known to be a common problem, wide variation in reported IAD prevalence and incidence exists. This is likely due to differences across care settings and the diagnosis of IAD 6 Range of reported prevalence and incidence6 36% 22.8% IAD incidence for patients with FI in the critical care setting 1 41% IAD prevalence for patients in the LTAC setting 4 43% IAD prevalence for incontinent patients in the acute care setting % [NLD]IAD prevalence of incontinent patients in academic hospitals 2 50% 5.6% Prevalence High Low 25% 3.4% Incidence FI = Fecal incontinence LTAC = Long term acute care Nursing home residents with IAD 7 42% IAD prevalence for incontinent patients in the hospital setting 3 1Bliss et al. J Wound Ostomy Continence Nurs ; 2 Kottner et al. Int J Nurs Stud. 2014; 3 Campbell et al. Int Wound J. 2014; 4 Long et al. J Wound Ostomy Continence Nurs. 2012; 5 Gray M and Bartos S. Presented at the 23rd Annual Meeting of the Wound Healing Society. 2013; 6 Gray M et al. Journal of Wound, Ostomy and Continence Nursing. 2007; 7 Nix and Haugen. Drugs Aging 2010;27(6):491-6

15 Incontinence Associated Dermatitis (IAD) is a frequent complication of urinary and/or fecal incontinence 13 Prevalence range reported in the literature Prevalence of incontinence in acute care settings 50% 38% 25% 13% 0% Urinary Incontinence % 46% Fecal Incontinence % 7% Double (fecal and urinary) Incontinence % 20% IAD occurs in 43% 13 of patients with urinary or fecal incontinence 1Nair, Aust J Ageing 2000;19(2):81-4. ; 2 dasilva, Rev Esc Enferm USP 2005;39(1):36-45; 3 Mecocci, Dement Geriatr Cogn Disord 2005;20: Sgadari, Age Ageing 1997;26(Suppl 2):49-54.; 5 Fonda, Aust Clin Rev 1988;8(30):102-7; 6 Bliss, Nurs Res 2000;49:101-8, 7 Schultz, Urol Nurs 1997;17:23-8; 8 Nelson, JAMA 1995;274(7):559-61; 9 Nelson, Dis Colon Rectum 1998;41:1226-9; 10 Ouslander, J Am Geriatr Soc 1993;41:1083-9; 11Ouslander, JAMA 1982;248: ; 12 Lyder, J ET Nurs 1992; 19 (1): ; 13 Gray, JWOCN 2007;34(1):45-54

16 IAD is time-consuming to manage Fifty percent (50%) of nurses reported that the management of a patient with diarrhea caused them to work overtime once a month, while for 17% of nursing aides and 5% of nurses this happened once a week. 1 x x x 6 = 3.86 hrs./day 1 patient with liquid stool 2 nurses 17 minutes 33 seconds 6 episodes /day 2 Above calculation was based on a questionnaire completed and returned by 146 of the 204 ICU caregivers, corresponding to 75% of answers among nurses and 73% among nursing aides in Switzerland 1. Two nurses are the standard of care to clean and position a patient. Another survey of 962 questionnaires completed by nurses (60%), physicians (29%) and pharmacists or purchasing personnel (11%) in Germany (n=94), Italy (n=165), Spain (n=144) and the UK (n=127) estimated that one patient experiencing five episodes of fecal incontinence would consume 3.75 hours of nursing time 3 1Heidegger et al. International Journal of Nursing Studies 59 (2016) ; 2 Bliss et al. J WOCN 2007;34(2): ; 3 Bayon-Garcia. Intensive and Critical Care Nursing (2012) 28,

17 IAD is costly to manage 1 patient with IAD for 1 week 3.86 hours/ day 1,2 (assumes 2 nurses x 17.5 min x 6 episodes ) Nursing time $697.39/wk. x $25.81 per hour 3 (Blend of RN & CNA) Barrier + cleanser cost $15.12/wk. 6 + x 6 episodes / day 4 $ midpoint of $ = ~$713 per week / IAD patient Solid data on the cost of IAD is lacking, however, available estimates confirm that IAD can be costly to manage Total estimated cost of IAD in the US in 1995 was $136.3 million 6 in nursing home residents with urinary incontinence In a separate study, Wilson et al. estimated the 1995 cost of moderate-to-severe IAD at $69-$504 per episode 5 for the institutionalized elderly A more recent study conducted in 2014 estimated the weekly cost of managing IAD at $ in Canada. This included the cost of products (assumed to be petroleum-based creams) and nursing time. 1Bayon-Garcia et al. Intensive and Critical Care Nursing (2012) 28, ; 2 Heidegger et al. International Journal of Nursing Studies 59 (2016) Bureau of Labor Statistics (median hourly cost of Nursing Assistant) 4 Bliss et al. JWOCN 2007;34(2): ; 5 Wilson, Obstetrics & Gynecology, 2001;98(3): ; 6 Wagner and Hu, Urology. 1998;51: ; 7 Woo KY. Int Wound J 2014; 11:

18 03 Cavilon Advanced Skin Protectant for moderate to severe IAD Product Description s

19 Cavilon Advanced Skin Protectant is a novel barrier used for patients with, or at risk of moderate-to-severe IAD Product Description: The protective barrier creates an environment that allows healing 1,2 In a case series evaluating Cavilon Advanced Skin Protectant for management of severe IAD, a WOC Nurse described the performance of the product as miraculous when she observed the rapid improvement in skin condition. The product is durable requiring reapplication only 2-3 times per week 1 The product adheres to, and forms a barrier on wet, weeping tissue 1,2 The product forms a barrier that helps to control minor bleeding and weeping of serous fluid 2 The liquid is non-stinging and comfortable during application, wear and cleansing 1 The protective film coating reduces pain associated with Incontinence Associated Dermatitis (IAD) 1 The product attaches to the skin and does not require removal 1 The product allows easy cleansing - stool and other soil can be easily removed without disturbing the film 1 The product is transparent allowing visualization of the underlying skin 1 The product is a single use device minimizing the risk of cross-contamination 1 1Brennan, Accepted for publication in JWOCN Been R. Accepted for publication in Wound Repair & Regeneration. DOI: /wrr (In an animal model translations to humans not shown.)

20 Cavilon Advanced Skin Protectant was designed to be the ideal barrier product to prevent and manage IAD per best practice recommendations 1 Characteristics of Ideal Products Clinically proven to prevent and/or treat IAD Low irritant potential/hypoallergenic Does not sting on application Transparent or can be easily removed for skin inspection Removal/cleansing considers caregiver time and patient comfort Does not increase skin damage Does not interfere with the absorption or function of incontinence management products Compatible with other products used (e.g. adhesive dressings) Acceptable to patients, clinicians and caregivers Minimizes number of products, resources and time required to complete skin care regimen Cost-effective 1Beeckman, Wounds International Available to download from

21 s 03 Cavilon Advanced Skin Protectant for moderate to severe IAD Clinical Value

22 Cavilon Advanced Skin Protectant adheres to wet, weepy tissue, protecting the skin from irritants and creating an environment to allow healing 1 Adheres to wet, weepy tissue Proven to adhere to wet, weepy tissue; creating a healing environment Cavilon Advanced Skin Protectant showed significant (p=0.013) improvement for patients with severe IAD (n=16); 4 of the 12 patients with epidermal skin loss had complete re-epithelialization with 4-6 applications of the product. 1 Cavilon Advanced Skin Protectant Reduces pain associated with IAD care Durable Untreated wounds produced 1.9 times more fluid (4.328 g) compared to wounds treated with Cavilon Advanced Skin Protectant (2.231 g) (N=6, preclinical) % greater re-epithelization (p=0.003, 95% CI= 9.2%-27.5%) was seen in wounds covered with Cavilon Advanced Skin Protectant compared to untreated wounds (N=7) 2 1Brennan, Accepted for publication in JWOCN Been R. Accepted for publication in Wound Repair & Regeneration. DOI: /wrr (In an animal model translations to humans not shown.

23 Cavilon Advanced Skin Protectant has been shown to significantly improve severe cases of IAD even in the presence of continued incontinence 1 Results from 16 patients with severe IAD from two facilities providing nursing care 24h/day 1 The IAD score improved in 13 of 16 patients with severe IAD The median percent improvement in IAD score was 96%, significantly different from zero, p=0.013 by Wilcoxon Signed-Rank test Four of the 12 patients with epidermal skin loss had complete reepithelialization with 4-6 applications of the product IAD Score* 1,956 1,884 IAD Score at enrollment IAD Score at study end 1, *IAD Score: Sum of 6 zones scored using the 3M Skin Assessment Tool Patient Number (n=16) 1Brennan, MR. Accepted for publication in JWOCN 2016

24 Cavilon Advanced Skin Protectant protects skin even in the presence of a caustic irritant 1 average normalized irritation score Mean skin irritation scores at 48 hours after caustic challenge in guinea pig intact skin model (n=24) Cavilon Advanced Skin Protectant P < Score Clinician Erythema Assessment scale 0 Clear skin with no signs of erythema 1.7 Untreated control In a pre-clinical animal model, a single application of Cavilon Advanced Skin Protectant prevented skin breakdown from simulated incontinence fluid and provided protection for at least 48 hours The average normalized irritation score was 0.2 for Cavilon Advanced Skin Protectant protected wounds and 1.7 for untreated wounds Untreated sites had 8.5 times more irritation compared to sites treated with Cavilon Advanced Skin Protectant 1 Almost clear; slight redness 2 Mild erythema, definite redness 1 Been R. Accepted for publication in Wound Repair & Regeneration. DOI: /wrr ( (In an animal model translations 3 to humans Moderate not erythema; shown.) marked redness 4 Severe erythema; fiery redness

25 Cavilon Advanced Skin Protectant provides an environment for re-epithelization even in the presence of a caustic irritant 1 In a pre-clinical animal model, 18.3% greater reepithelization (p=0.003, 95% CI= 9.2%-27.5%) was seen in partial thickness wounds covered with Cavilon Advanced Skin Protectant compared to untreated wounds Untreated sites had 8.5 times more irritation compared to sites treated with Cavilon Advanced Skin Protectant The unique characteristics of the new skin protectant, along with the environment it provided for skin protection, resulted in a greater degree of re-epithelialization despite the continued presence of a simulated caustic fluid. Mean percent wound re-epithelialization at 96 hours in porcine partial-thickness wound model Mean % wound re-epithelialization 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 80.6% Cavilon Advanced Skin Protectant P = % Untreated N = 70 N = 65 1 Been R. Accepted for publication in Wound Repair & Regeneration. DOI: /wrr ( (In an animal model translations to humans not shown.)

26 Cavilon Advanced Skin Protectant significantly reduced the amount of weeping exudate 1 In a pre-clinical animal model, there was a significant (p=0.001) reduction in the amount of exudate weeping from partial thickness wounds over 96 hours following a single application of Cavilon Advanced Skin Protectant Mean weight of fluid absorbed with gauze immediately and 96 hours after wound creation in porcine partial-thickness wound Untreated wounds produced 1.9 times more fluid (4.328 g) compared to wounds treated with Cavilon Advanced Skin Protectant (2.231 g) The results indicate that the formulation helped reduce the amount of minor bleeding and weeping from wounds compared to untreated wounds, and that this effect could last at least 96 hours. Fluid Absorbed (g) Cavilon Advanced Skin Protectant Untreated control Immediately (p=0.001) 96 hours (p<0.001) 1 Been R. Accepted for publication in Wound Repair & Regeneration. DOI: /wrr ( (In an animal model translations to humans not shown.)

27 Cavilon Advanced Skin Protectant has proven durablility, requiring less frequent applications and reducing nursing time required to prevent and manage IAD Adheres to wet, weepy tissue A durable product 1 that eliminates the need for frequent applications Cavilon Advanced Skin Protectant Durable Cavilon Advanced Skin Protectant need only be applied 2-3 times per week Reduces pain associated with IAD care

28 Cavilon Advanced Skin Protectant is highly durable which reduces frequent applications Many products require application with every episode of incontinence Assumes 6 episodes/day 1 x 7 days ~42 applications / week Cavilon Advanced Skin Protectant is highly durable, requiring application 2 to 3 times per week, instead of with every cleansing applications / week Minimizing frequent contact with damaged skin may help promote healing and reduce patient discomfort associated with IAD and IAD care 1Bliss et al. J WOCN 2007;34(2): Brennan, Accepted for publication in JWOCN 2016.

29 Cavilon Advanced Skin Protectant can help reduce patient s pain 1 associated with IAD and IAD care Adheres to wet, weepy tissue Eliminates difficult cleansing and does not require product removal minimizing irritating and frequent contact with damaged skin Cavilon Advanced Skin Protectant Durable Cavilon Advanced Skin Protectant is easy to cleanse, does not require removal and is applied 2-3 times per week 100% of patients who reported IAD-associated pain on Day 1 (n=9), saw a reduction in pain with the use of Cavilon Advanced Skin Protectant 1 Better patient comfort can improve patient experience and perceived quality of care Reduces pain associated with IAD care 1Brennan, Accepted for publication in JWOCN 2016

30 Cavilon Advanced Skin Protectant can help reduce patient s pain 1 associated with IAD and IAD care Pain at Day 1 Pain at study end Pain Score Patient Number* *Study enrolled 16 patients with severe IAD. 4 patients were unresponsive or paraplegic and 2 patients (No. 1 and 10) reported no pain throughout the study. 1 patient s pain score were missing % of patients reporting pain on Day 1 saw a reduction in pain with the use of Cavilon Advanced Skin Protectant, with baseline pain scores of 7-10 reduced to = No pain; 10 = Worst pain 1Brennan, Accepted for publication in JWOCN 2016

31 Cavilon Advanced Skin Protectant does not need to be removed and can help reduce patient pain and discomfort 1 associated with IAD and IAD care Many paste/ointment products require removal during cleansing in order to inspect the wound ~42 product removal/ week Cavilon Advanced Skin Protectant does not require removal and is transparent, allowing inspection of damaged skin 0 product removal/ week Assumes 6 episodes per day 2 x 7 days Minimizing frequent contact with damaged skin can reduce patients pain and discomfort associated with IAD and IAD care 1Brennan, Accepted for publication in JWOCN Bliss et al. J WOCN 2007;34(2):

32 s 03 Cavilon Advanced Skin Protectant for moderate to severe IAD Economic Value

33 Cavilon Advanced Skin Protectant can reduce nursing time to manage IAD zinc oxide paste 2 nurses Application Time: 1 min 01 sec 1 Cleansing Time: 13 mins 32 sec 1,2, hours per week per average IAD patient What could you accomplish with more time? 6 episodes per day 1 for an average case of urinary and fecal incontinence Cavilon Advanced Skin Protectant Application Time*: 0 min 45 sec 2 Cleansing Time: 2 mins 4 2 nurses 3.9 hours per week per average IAD patient** Potential savings of 16.5 hours per week per average IAD patient * Time reported as per application * 3 applications per week Two nurses are the standard of care to clean and position a patient 1Bliss D. JWOCN 2007; 34(2): Heidegger CP. International J of Nursing Studies Jul 31; 59: Lewis-Byers K. Ostomy Wound Manage. 2002; 48(12): Brennan MR. Accepted for publication in JWOCN 2016

34 15-episode example Cavilon Advanced Skin Protectant can reduce nursing time to manage IAD zinc oxide paste 2 nurses Application Time: 1 min 01 sec 1 Cleansing Time: 13 mins 32 sec 1,2, hours per week per average IAD patient 15 episodes per day for a severe case of fecal incontinence Cavilon Advanced Skin Protectant Application Time*: 0 min 45 sec 2 Cleansing Time: 2 mins 4 2 nurses 9.6 hours per week per average IAD patient** What could you accomplish with more time? Potential savings of 41.3 hours per week per severe IAD patient * Time reported as per application * 3 applications per week Two nurses are the standard of care to clean and position a patient 1Bliss D. JWOCN 2007; 34(2): Heidegger CP. International J of Nursing Studies Jul 31; 59: Lewis-Byers K. Ostomy Wound Manage. 2002; 48(12): Brennan MR. Accepted for publication in JWOCN 2016

35 Cavilon Advanced Skin Protectant can reduce total overall cost zinc oxide paste 2 nurses $677 per week 6! $12 per week 6 episodes per day 1 for an average case of urinary and fecal incontinence 20.4 hours per week $33.23 per hour 2 Cavilon Advanced Skin Protectant 2 nurses $129 per week 6 times per day 3! $0.29 per application $27 per week Potential savings of $533 per week per IAD patient 3.9 hours per week $33.23 per hour 2 Two nurses are the standard of care to clean and position a patient 3 times per week $9.00 per application 1Bliss D. JWOCN 2007; 34(2): Bureau of Labor Statistics. Occupational Employment Statistics for Nursing Assistant. (May 2015). Accessed on 5/18/2016 <

36 04 Appendix A: Bibliography s

37 Bibliography (1 of 4) Bayon-Garcia C, Binks R, De Luca E, Dierkes C et al. Prevalence, management and clinical challenges associated with acute faecal incontinence in the ICU and critical care settings: The FIRSTTM cross-sectional descriptive survey. Intensive and Critical Care Nursing (2012) 28, Beeckman D et al. Proceedings of the Global IAD Expert Panel. Incontinence associated dermatitis: moving prevention forward. Wounds International Available to download from Been R, Bernatchez SF, Conrad-Vlasak D, Asmus R, Eckholm B, Parks PJ. In vivo methods to evaluate a new skin protectant for loss of skin integrity. Accepted for publication in Wound Repair & Regeneration. DOI: /wrr ( wrr.12455/abstract) Bliss D, Incontinence-Associated Dermatitis in Critically Ill Adults Time to Development, Severity, and Risk Factors. J WOCN 2011;38(4): Bliss D, Zehrer C, Savik K, Smith G, Hedblom E. An Economic Evaluation of Four Skin Damage Prevention Regimens in Nursing Home Residents With Incontinence. J WOCN 2007;34(2): Bliss DZ, Johnson S, Savik K, Clabots CR, Gerding DN. Fecal incontinence in hospitalized patients who are acutely ill. Nurs Res 2000;49: Brennan MR, Milne CT, Agrell-Kann M, Ekholm BP. Clinical evaluation of a barrier film for the management of incontinence associated dermatitis (IAD) in an open label, non-randomized, prospective study. Accepted for publication in Journal of Wound, Ostomy, and Continence Nursing (JWOCN). Bureau of Labor Statistics. Occupational Employment Statistics for Nursing Assisant. (May 2015). Accessed on 5/18/2016 < Campbell et al. Incontinence-associated dermatitis: a cross-sectional prevalence study in the Australian acute care hospital setting. Int Wound J Jun 26

38 Bibliography (2 of 4) CMS. HCAHPS Hospital Characteristics Comparison Charts. Accessed on 3/11/2016 < Report_April_2015_ChartBook.pdf> CMS. Survey of patients' experiences (HCAHPS). Accessed on 3/11/2016 < Patients-Experience.html> dasilva AP, Santos VL. Prevalence of urinary incontinence in hospitalized patients. Rev Esc Enferm USP 2005;39(1): Demarre L, Verhaeghe S, Van Hecke A, et al. Factors predicting the development of pressure ulcers in an at-risk population who receive standardized preventive care: secondary analyses of a multicentre randomised controlled trial. J Adv Nurs 2014; Aug 19. doi: /jan Doughty D, Junkin J, Kurz P et al. Incontinence-associated dermatitis. Consensus statements, evidence-based guidelines for prevention and treatment, current challenges. J WOCN 2012; 39(3): Fonda D, Nickless R, Roth R. A prospective study of the incidence of urinary incontinence in an acute care teaching hospital and its implications on future service development. Aust Clin Rev 1988;8(30): Gray M, Bliss DZ, Doughty DB, Ermer-Seltun J, Kennedy-Evans KL, Palmer MH. Incontinence-associated dermatitis: a consensus. Journal of Wound, Ostomy and Continence Nursing. 2007;34(1):45-54 Gray M. Optimal Management of Incontinence-Associated Dermatitis in the Elderly. Am J Clin Dermatol 2010; 11 (3): Gray M. et al. Moisture-Associated Skin Damage. J Wound Ostomy Continence Nurs. 2011; 38(3): Gray M, Beeckman D, Bliss D, Fader M, Logan S. Incontinence-associated dermatitis: review and update. J Wound Ostomy Continence Nurs 2012;39(1): Gray M and Bartos S. Incontinence Associated Dermatitis in the Acute Care Setting: A Prospective Multi-site Epidemiologic Study. Presented at the 23rd Annual Meeting of the Wound Healing Society. 2013

39 Bibliography (3 of 4) Hart J. Assessment of the incontinence pad blocking potential of 3M Cavilon Durable Barrier Cream compared with Sudocrem and Zinc and Castor Oil. Nursing Scotland 2002, Issue: July/August. Heidegger CP, Graf S, Perneger T, Genton L, Oshima T, Pichard C. The burden of diarrhea in the intensive care unit (ICU-BD). A survey and observational study of the caregivers opinions and workload. International Journal of Nursing Studies Jul 31;59: Junkin J, Selekof JL. Beyond "diaper rash": incontinence-associated dermatitis: does it have you seeing red? Nursing 2008;38(11 Suppl): 56hn1-10. Kottner et al. Associations between individual characteristics and incontinence-associated dermatitis: A secondary data analysis of a multicentre prevalence study. Int J Nurs Stud Oct;51(10): (n=9992, Austria, Netherlands) Lewis-Byers K, Thayer D. An evaluation of two incontinence skin care protocols in a long-term care setting. Ostomy Wound Manage. 2002; 48(12): Long et al. Incontinence-associated dermatitis in a long-term acute care facility. J Wound Ostomy Continence Nurs May-Jun;39(3): (n=177, US) Lyder C, Clemes-Lowrance C, Davis A, et al. Structured skin care regimen to prevent perineal dermatitis in the elderly. J ET Nurs 1992; 19 (1): Mecocci P, von Strauss E, Cherubini A, et al. Cognitive impairment is the major risk factor for development of geriatric syndromes during hospitalization: results from the GIFA study. Dement Geriatr Cogn Disord 2005;20: Meraviglia M, Becker H, Grobe SJ, King M. Maintenance of skin integrity as a clinical indicator of nursing care. Adv Skin Wound Care Jan-Feb;15(1):24-9. Morris L. Flexi-Seal faecal management system for preventing and managing moisture lesions. Wounds UK 2011; 7(2): Nair B, O'Dea I, Lim L, Thakkinstian A. Prevalence of geriatric syndromes in a tertiary hospital. Aust J Ageing 2000;19(2):81-4. Nelson R, Furner S, Jesudason V. Fecal incontinence in Wisconsin nursing homes: prevalence and associations. Dis Colon Rectum 1998;41: Ovid Full Text [Context Link]

40 Bibliography (4 of 4) Nelson R, Norton N, Cautley E, Furner S. Community-based prevalence of anal incontinence. JAMA 1995;274(7): [Context Link] Nix D, Haugen V. Prevention and management of Incontinence-Associated Dermatitis. Drugs Aging 2010;27(6): Ouslander JG, Kane RL, Abrass IB. Urinary incontinence in elderly nursing home patients. JAMA 1982;248: [Context Link] Ouslander JG, Palmer MH, Rovner BW, German PS. Urinary incontinence in nursing homes: incidence, remission and associated factors. J Am Geriatr Soc 1993;41: [Context Link] Park KH. The effect of a silicone border foam dressing for prevention of pressure ulcers and incontinence-associated dermatitis in intensive care unit patients. J WOCN 2014; 41(5): Plante L, Regan M. Impact of one-step, no-rinse bathing on cost of care and skin tear occurrence in the long-term care setting. Poster session presented at the annual meeting of the Association for Advancement of Wound Care. Atlanta, Ga.;1996. Schultz A, Dickey G, Skoner M. Self-report of incontinence in acute care. Urol Nurs 1997;17:23-8. Sgadari A, Topinková E, Bjørnson J, Bernabei R. Urinary incontinence in nursing home residents: a cross-national comparison. Age Ageing 1997;26(Suppl 2): Stoffel J, Bernatchez SF. Effect on microbial growth of a new skin protectant formulation. Manuscript in preparation (for submission to Advances in Wound Care). Wagner TH, Hu TW. Economic costs of urinary incontinence in Urology. 1998;51: Walt M, Atwood N, Bernatchez SF, Ekholm, BP, Asmus R. Skin protectants made of curable polymers: effect of application on local skin temperature. Manuscript in preparation (for submission to Advances in Wound Care). Wilson L. et al. Annual Direct Cost of Urinary Incontinence. Obstetrics & Gynecology, 2001;98(3): Zehrer CL, Newman DK, Grove GL, Lutz JB. Assessment of diaper-clogging potential of petrolatum moisture barriers. Ostomy Wound Manage 2005; 51(12):