Comparing efforts on 3 continents to improve clinical practice for prevention and treatment of IAD

Skin consequences of incontinence (Incontinence Associated Dermatitis- IAD) are a burden on healthcare worldwide. This poster compares the efforts of experts on three continents to improve knowledge and practice. Just like good New Orleans Jambalaya, the recipe for success in improving IAD practice has many ingredients. 

Improving practice first requires accurately identifying and quantifying the problem. This is not yet possible because there is worldwide confusion regarding the identification of IAD as distinct from pressure ulcers (PU).  In fact, the European PU Advisory Panel (EPUAP) together with the US NPUAP states in their Guidelines¹ that IAD should not be called a Stage 2 pressure ulcer. Further, the Austrian PU Prevention Association recently awarded a research grant with the aim of differentiating between PU and IAD.

The first IAD consensus statement in the US, published in 2007² by Gray et al, called for more research.  New evidence on best practices for IAD can be found in a 2009 literature review by Beeckam et al,³ of Belgium, who found that timely, consistent use of no-rinse products containing a protectant improves outcomes, yet this practice has not been widely adopted. 

The Institute for Healthcare Improvement (IHI) recommends a one-step disposable incontinence barrier cloth rather than soap⁴.  One of the authors describes the process of bringing dimethicone into Brazil and the successes that followed. Similar results were seen in a comparative study in Austria⁵.  Two PhD candidates in Austria are testing the IAD-IT and the PAT, tools for identification and treatment of IAD. Ultimately, until consensus is reached, valid and reliable tools are used and assessment skills expand, we will not know the true extent of either skin injury, nor be able to effectively prevent or treat the significant problem of IAD.