Prevention and management. Jill Campbell, PhD candidate

Transcription

1 Prevention and management Jill Campbell, PhD candidate

2 DIVIDER PAGE Prevention and management of IAD Please copy this page where you need it 2

3 Beeckman et al (2015). Algorithm for prevention and management of IAD

4 There are two key interventions essential for prevention and management 4

5 There are two key interventions essential for prevention and management 1.Manage incontinence 5

6 There are two key interventions essential for prevention and management 1.Manage incontinence 2. Implement a structured skin care regimen 6

7 7 1.Manage Incontinence

8 Manage incontinence Assess to determine aetiology Identify/treat reversible causes; Delirium Infection; urinary tract infection, Clostridium difficile Constipation/ faecal impaction Diuretics/ sedatives/narcotics Overflow incontinence; Benign prostatic hyperplasia, urethral stricture Limited mobility 8

9 Manage incontinence cont. Develop individualised care plan Ensure appropriate containment products used Promote mobility Establish toileting program Provide toilet substitutes Nutrition Fluids Refer if necessary 9

10 A word on indwelling urinary catheters Last resort due to nosocomial infection risk Consider for temporary urinary diversion 10

11 A word on faecal management systems May be necessary. Mostly seen in ICU Seek specialist input 11

12 12 Implement a pressure injury prevention plan

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14 2. Implement a structured skin care regimen 14

15 15 Structured skin care program

16 Structured skin care program CLEANSE: to remove urine and/or faeces 16

17 Structured skin care program CLEANSE: to remove urine and/or faeces PROTECT: to avoid or minimise exposure to urine/faeces and friction 17

18 Structured skin care program CLEANSE: to remove urine and/or faeces PROTECT: to avoid or minimise exposure to urine/faeces and friction RESTORE: when appropriate to support and maintain barrier function 18

19 Product selection for IAD General characteristics of ideal product for prevention and management Clinically proven to prevent and/or treat IAD Close to skin ph Low irritant potential/hypoallergenic Transparent or can be easily removed for skin inspection Removal - 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 Minimises number of products, resources and time required to complete skin care regimen Cost-effective

20 Principles of CLEANSE Cleanse daily and after every episode of faecal incontinence Avoid standard bar (alkaline) soaps Gentle technique, minimal friction avoid rubbing/scrubbing of skin Choose gentle, no-rinse liquid skin cleanser or premoistened wipe with ph similar to normal skin Use soft, disposable non-woven cloth (avoid regular washcloths with nubby texture) Gently dry skin If gentle soap is not available, cleansing with plain water is preferred (minimum standard)

21 Principles of PROTECT Performance of skin protectant is determined by total formulation - not just the main barrier ingredient (e.g. petrolatum, zinc oxide, dimethicone) Not all products provide equal protection If the skin is getting worse or not improving, you need a more protective barrier!

22 Principles of PROTECT Apply skin protectant at frequency consistent with its ability to protect the skin According to manufacturer s instructions Skin protectant should be compatible with other products (e.g. skin cleansers) Apply skin protectant to all skin that comes into contact with or potentially will contact urine and/or faeces

23 When to RESTORE the skin barrier Moisturizers can be used to support and maintain integrity of the skin barrier (i.e. restore) Moisturizers typically contain: Emollients: smooth and soften skin (e.g. oils and synthetics) Humectants: draw in and hold water in the stratum corneum (e.g. urea and glycerine) Some formulated with lipids similar to those found in healthy stratum corneum (e.g. ceramides) Not all moisturizers are capable of skin barrier repair A moisturizer is NOT indicated when skin is overhydrated/macerated nor when there is erosion (denudation) of epidermis

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25 Treat superimposed infection IAD commonly complicated by secondary infection Mostly caused by Candida albicans Presents as maculopapular rash with characteristic satellite lesions commonly at margins of erythema Can also present as nonspecific confluent rash, so diagnosis is difficult. Obtain microbiological culture to confirm diagnosis 25

26 IAD Pain Similar to the pain of a burn Jill Campbell. IAD in Critical Care

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28 A severity-based approach to treatment

29 Assessing patient response Evaluate skin at regular intervals For first 3-5 days, adhere to structured skin care plan After 3-5 days, revaluate, modify if no improvement or skin deteriorates Consider: Could there be infection present? Is cleansing adequate and frequent enough? Is the barrier/protectant insufficient to protect from the irritant/moisture challenge? Do you need a more protective barrier? Is pad change frequency adequate? If appropriate, REFER

30 Download free from: 30 Beeckman et al (2015). Proceedings of the global IAD expert panel. Incontinence-associated dermatitis: Moving prevention forward,

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32 Thank you for your attention