Evaluation of cyanoacrylate for prevention of posterior trunk injuries in the ICU population with fecal incontinence

Patients in the intensive care unit (ICU) are at particular risk of skin breakdown. Since the skin is the primary line of defense against mechanical forces, chemicals and pathogens, it is vital that it is well protected. Particularly in patients with incontinence, the skin is exposed to urine and stool, which contain caustic elements that deteriorate the integrity of the skin. Once skin integrity is compromised, it is more susceptible to breakdown and to outside elements. The purpose of this quality improvement project was to evaluate a cyanoacrylate skin protectant for the protection of sacral skin in incontinent ICU patients.

For this process improvement project, 30 ICU patients with fecal incontinence were selected for evaluation. All standard skin care and pressure ulcer prevention protocols were maintained for all patients.   The skin was evaluated for breakdown daily. The number of applications and ampules used were also recorded. All skin injuries were evaluated, including MASD, pressure injuries, and shearing injuries.  Overall, the cyanoacrylate skin protectant helped maintain the integrity of the at-risk skin, and skin breakdown was limited.  This is a beneficial option for ICU patients with fecal incontinence to prevent breakdown since a sacral foam bordered dressing cannot be maintained in patients with fecal incontinence.