Automating Perineal Hygiene Effectively Treats Incontinence Associated Dermatitis, Maintains Independence, and Improves Quality of Life

Background:

Loss of independence in perineal hygiene forces transition from independent to full nursing settings and affects quality of life. Treatment of perineal dermatitis, including pH balanced cleanser and application of zinc oxide barrier manages dermatitis but relapse is common. We evaluated whether an automated system combining water-based toileting, cleanser and zinc oxide application could maintain hygiene and manage incontinence-associated dermatitis. We hypothesized that automating perineal hygiene (APH) would allow those with limitations in toileting to continue to live independently, treat dermatitis, maintain healing, and improve quality of life.  

Methods:

We enrolled 48 residents of 2 Continuing Care Retirement Communities with inadequate perineal hygiene living in independent or assisted living settings at risk for progression to higher levels of nursing care. Subjects were provided a toileting device, cleanser, and 2% zinc oxide spray cans designed for use with the device. Graded skin assessments using the Kennedy scale, quality of life and caregiver surveys were administered at baseline, weekly for 6 weeks, and monthly for 36 weeks.  

Results:

Baseline:  45% fecal incontinence, 73% urinary incontinence, 94% active dermatitis.

After 36 weeks, all subjects remained in baseline living environments.

The percentage who viewed overall health and quality of life as good to excellent improved with APH. Impact of toileting on quality of life, and effect of toileting on the relationship between subjects and caregivers improved.

47 of 48 subjects had documented dermatitis at baseline, average severity score 4/9, range 2-7. After 6 weeks, 43/48 had complete healing. At 10 weeks dermatitis healed universally.  Discontinuation of APH led to rapid recurrence of dermatitis, again healed with reinstitution of APH.

Conclusions:

Incontinence and dermatitis is common in independent and assisted living settings. Patients overestimate ability to independently maintain hygiene. APH durably treats dermatitis, allows patients to remain independent, and improves quality of life.