K Lenne USL Medical 2012

 Maintenance of healthy, intact perineal skin constant challenge when caring for incontinent people  Urinary and faecal incontinence can have devastating effect on the skin of an individual regardless of age  In severe cases skin is so badly damaged that a moisture lesion or pressure ulcer can develop

 42% incontinence sufferers skin conditions (IAD)  Long term use pads frequently results in IAD in otherwise healthy skin  7% 65 yrs+ affected FI  Long term elderly care 66% FI  1 in 4 in residential care  Ageing population FI increase  Major implications for patients + health system

 Complex cascade events involving attack of skin by physical, chemical, enzymatic and microbial factors.  Moisture, physical irritants, chemical irritants, faecal enzymes, ph and microbes all play a roll in the downward cycle of events.

 Moisture  Excessive moisture from urine, sweat + frequent washing increases friction - rubbing against pads  Skin overhydrated + stratum corneum swells - more permeable to microbial growth  Physical and chemical irritants  Frequent washing significant source of both to skin  Soaps and cleansers- most contain surfactants to lower skin surface tension making it easier to loosen + wash away contaminants  Ph often very alkaline

 Stool, enzymes and pH  Proteolytic and liptolytic enzymes deactivated GT  Faeces + urea mix and release ammonia  Shifts acid mantle skin towards alkalinity  This alkaline ph reactivates the digestive enzymes  If barrier function compromised more likely to be attacked by bacteria  60% faecal matter comprised bacteria 4–500 species micro organisms  These pathogens destroy epidermal layer  Bacteria, yeast + fungus invade  Skin taut, painful, erythematous  IAD

 Vicious feedback cycle results in IAD  If person’s condition further compromised by pressure, poor nutrition or disease, major breakdown can easily occur  Quality of life is of primary importance  Add in cost of treating PU can range 5-40k  Advantageous to invest in good skin care regime rather than treat resulting breakdown

 Impaired acid protection mantle  Diminished lipid production  Diminished sweating  Reduced regeneration potential  Ability to fight bacteria + fungi weakened  In a nutshell often malnourished, slow to regenerate and the affects of incontinence stress skin further

 Skin cleansed asap after every episode FI  No soap as cleanser – already dry skin  Soap astringent effect (alkaline ph) dries skin further  Soap also has surfactants which act as irritants, cause further damage  If not rinsed off skin completely damage continues  Even water removes acid protection mantle short term  No rinse skin cleansers better – mild, gentle surfactant, soothing  Emulsify and loosen faeces to cleanse skin- no rubbing

 PH balance to strengthen acid protection mantle  Replenish moisturising substances  Support skin’s own lipid production  Speed up skin’s reproduction  Most products cleanse, moisturise and protect  Hartmann’s Menalind also focus on REGENERATION

 Skin affected by FI may require extra protection and nutritional support for regeneration.  Products used must : provide optimum protection without inhibiting the absorption capacity of incontinence products  NO ZINC + CASTOR OIL, FATTY CREAMS in pad area

 Support epidermal barrier function  Strengthen acid mantle protection  Replenish moisturising substances  Support skin’s own lipid production  Help to speed up skin’s reproduction  Remove and reapply after each episode FI  Creams must be water based  Liquid films contain polymer + solvent  If skin already compromised film may irritate dermis

 Provide superior leakage protection  Rapid fluid absorption and safe storage  Keep skin dry and prevent stratum corneum swelling  Reduce ammonia production  Stabilise ph skin - support skin’s antibacterial effect  Maintain healthy skin temperature

 Minimise episodes FI  Select right continence product that provides superior leakage protection while helping to prevent IAD  Ensure skin cleansing regimes ASAP after every episode FI  Protect at risk skin from damage  Prevent skin damage that so easily can lead to pressure ulcers or moisture lesions  Prevention better than cure