The Effect of Different Incontinence Briefs on Skin Barrier Function in Institutionalized Adults

Introduction:  Urinary and fecal incontinence effects on skin barrier function (BF) are well known.^1,2   Increased transepidermal water loss (TEWL) rates are indicative of water loss and poor BF. Unfortunately, increased TEWL is not clinically evident to an examiner’s eye.³

Method:  25 elderly institutionalized subjects (EIS) underwent repeated TEWL readings using their usual* incontinence management product (UIM) using an evaporimeter**.  Subjects were then standardized to a superabsorbent gelling incontinence brief*** (SEP). After one week, subjects underwent repeated TEWL measurements. The patients returned to UIM again repeating TEWL readings after one week. Clinical observations of skin health were also recorded.

Results:  Mean baseline TEWL readings prior to the SEP were 26.6 gm/m² increasing to with 103.1 gm/m² at incontinent episodes (IEs). SEP mean baseline TEWL readings decreased to 14.9 gm/m² with mean readings of 36.2 gm/m² at IEs.  Returning to the UIM, baseline TEWLs increased to a mean of 23.6 gm/m² with TEWL rates of 250.4 gm/m² with IEs. There is statistical significance at p <0.05 using a Student’s t test. No visible skin alterations were noted.

Conclusion: This study suggests that the method of diaper construction can profoundly impact skin BF in the EIS, supporting Akin’s (1997) work. Loss of BF can be demonstrated via increased TEWL yet not clinically observed after changing incontinence products, leading to a false sense of security by clinical staff that routinely uses observation to make clinical decisions regarding the effects of incontinence containment products on skin health.

* Cloth reusable, Tena (Neenah, WI), Rite-Aid (Harrisburg, PA) or Depends (Neenah, WI) disposable briefs

**Vapometer (Delfin Instruments, Finland).

***Tranquility SlimLine Disposable Brief (Principle Business Enterprises, Ohio)