Case Series to Determine the Impact of an Absorbent Underpad on the Prevention and/or Improvement of Incontinence Associated Dermatitis in SNF Residents

Clinical Problem: Incontinent Associated Dermatitis (IAD) is a known risk factor for pressure ulcer (PU) development. In skilled nursing facilities (SNF), >50% of residents are incontinent of either urine or stool. ¹ WOC nurses frequently see SNF residents with moisture-associated skin problems and are well-positioned to educate staff on new clinical approaches to manage IAD.

Past Management: Using diaper-type briefs for bed and chair-bound incontinent residents and  ambulatory residents not toileted when in bed was common practice.

Current Clinical Approach: A one-month prospective multicenter, IRB approved, open label case series evaluated IAD prevention and/or improvement in bed, chair-bound or ambulatory residents normally wearing diaper-type briefs when in bed. A premium air-laid super absorbent underpad* replaced past management. Change frequency was individualized, occurring when the pad was determined to be moist. Usual skin care regimens were otherwise followed. Costs of past management vs. the premium underpad were compared. Skin integrity and perineal skin breakdown risk at baseline and weekly were documented on the Perineal Assessment Tool (PAT) ² and IAD Skin Assessment Tool.³

Patient Outcomes: Twenty-one females and 5 males, average age 83 were evaluated. 24 had IAD at enrollment. Average score for all subjects with IAD decreased from 2.5 at baseline to 0.7 at week 4. The average PAT score for all subjects decreased from 8.6 to 7.3 over 4 weeks. Cost per day using the premium pad averaged $1.64 versus cost of usual care of $8.62, primarily due to less pad changes.

Conclusions: Absence of controls limits generalization to the SNF population; however, the  inverse relationship observed between PU and IAD rates during and after the study suggest that frequent staff education regarding differentiation of IAD and partial-thickness pressure ulcers is equally important in combination with using premium underpads. 

 

*Disposable Wing ™ Quilted MVP Underpad (Covidien, Mansfield, MA)