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™ AT HOME ™ WHERE HEALING HAPPENS™ TWO-STEP HOSPITAL-GRADE SYSTEM INCONTINENT SKIN CARE Cleanses, moisturizes and protects red, irritated skin Calms to help prevent more severe skin damage Incontinence Dermatitis Patient Education D. Elizabeth McCord, Ph.D., FAPWCA Incontinence is a common and life-changing problem for many people including both patients and their caregivers. We have used a team approach in the preparation of this booklet about caring for the skin of someone with incontinence. Nurses, pharmacists, and physicians have worked together to provide you with information that we hope you will find useful for preventing or treating some of the most common skin-related issues experienced by people with incontinence. With warm regards, WARNING: Consult your healthcare provider. This booklet is provided as a guideline only. These statements have not been evaluated by the FDA. What is Incontinence-Associated Dermatitis? Excreted wastes (i.e., urine and stool) cause a significant amount of skin breakdown when in contact with skin and result in a condition called incontinence-associated dermatitis (IAD). The breakdown and irritation of skin seen in IAD usually happens due to a combination of the following: • Direct irritating effects of excreted waste on skin • Excessive moisture • The presence of undesirable bacteria and yeast • Direct irritation from undergarments or other incontinence care products • Improper cleansing Excreted waste is typically at a different pH than the skin and it also contains digestive enzymes and other irritating compounds. The longer that skin is in contact with excreted waste, the more likely a person will experience IAD and other complications including chronic wounds and infections. Prevention is Paramount The primary skin care goal for a person with incontinence is to prevent any skin breakdown from happening. This can be done by limiting the exposure of the skin to excreted wastes and maintaining appropriate moisture levels. When this is done properly, it greatly reduces the chance of skin breakdown and subsequent complications including wounds and infections. Absorptive undergarments (i.e. diapers and pads) can trap moisture, excreted waste, and pathogens close to the skin, so they need to be changed frequently to prevent IAD. However, changing undergarments frequently enough to prevent IAD or its complications is often not possible or practical for a variety of reasons. The use of special skin cleansers and protectants is almost always required to prevent IAD. Tips for Preventing IAD: • Change undergarments as soon as possible after becoming soiled • Use undergarments that are properly fitted and have the appropriate level of absorption and waste-containment • Work with healthcare professionals who will educate and guide you through the best possible care protocols • Work with your healthcare team to prepare a written plan tailored to your needs, wants, and expectations to help ensure you receive the appropriate level of care and support • Use this handy guide as a reminder of how to make sure your skin and body remain healthy Helpful Tips If any of the following symptoms develop on your skin, immediately contact your healthcare provider, as they could be the sign of a serious complication or infection: • Redness, warmth, swelling or pain • Open sores or bleeding • Weeping or oozing skin Two-Step Hospital Grade System Kit Getting Started 1. Purchase the Incontinent Skin Care Kit from your local pharmacy. Your health care provider may suggest additional items like disposable undergarments, a mirror, gentle cleansers, and gentle sanitary wipes. 2. Change undergarments as soon as possible after they have been soiled, following the appropriate procedure recommended by your healthcare team including gentle cleansing and application of a skin protectant. 3. Bathe daily or as recommended by your healthcare team using water that is warm but not hot. You can use a thermometer to be sure to keep the water between 90 to 95 degrees F. 4. Use a soft towel to gently pat your skin dry, avoiding heavy rubbing that can damage the skin. 5. Examine the skin thoroughly and record any changes during each undergarment change. 6. Keep a diary and record your findings so that you will be able to document any changes in your skin and will not have to rely solely on memory. Products Found In the Incontinent Skin Kit Improving Incontinence Ideally, the best way to avoid IAD would be to resolve the issue of incontinence altogether. This is not possible in all situations, but there are a number of medical conditions and medications that could actually be contributing to incontinence. In these cases there are some interventions that might help improve symptoms of incontinence such as changing medications or incorporating physical exercises. Talk to your healthcare providers about the causes and treatments for incontinence to help determine what options are available. Using a Clinically Proven Treatment System 1. Remove soiled undergarments and cleanse the skin by spraying Antiseptic Skin Cleanser-CS onto the affected areas. The container will release the product from any angle – even up-side down. Rinse with warm water. You may gently use a soft moistened cloth or wipe to assist in the removal of waste. 2. Gently pat dry with a soft cloth and carefully check your skin for any signs of redness, irritation, or sores. Be sure to notify a healthcare professional of any changes or concerns. 3. Gently apply SkinMineralZ™ to dry skin that could potentially come in contact with excreted waste after cleansing with Antiseptic Cleanser-CS. Apply the product using the flat of the hand and a gentle stroking motion. Avoid applying pressure that can damage skin. 4. Put on the appropriate clean undergarment, ensuring proper fit and comfort. SkinMineralZ™ can be used on the skin around the waist and leg bands of the undergarment to help protect against irritation. Reducing Exposure to Irritants Skin that is damaged from incontinence is very sensitive to irritants. You need to protect your skin from anything that could increase dermatitis, and this includes ingredients commonly found in products used on skin that can be affected by IAD. 1. Avoid skin products, undergarments, and sanitary wipes (toilet tissue) with artificial colors or fragrances or deodorizers. 2. Avoid use of traditional soaps and cleansers that contain irritating ingredients such as sodium laureth sulfate (SLS) or ethanol/alcohol. 3. Only use products that are pH balanced and hypoallergenic. 4. Avoid the use of cloths, wipes, or tissues with abrasive texture. 5. Be aware that laundry detergents and dryer sheets used on undergarments, bedding, and cloths/towels can potentially contribute to skin irritation. Conclusion Keeping skin clean, intact, appropriately hydrated, and out of contact with excreted wastes are the most important factors in preventing and treating IAD. The severity of IAD and development of complications are dependent on several factors, many of which are easily managed. Early interventions focused on prevention, plus early detection and treatment of problem areas can greatly help reduce the risk of pressure ulcers and infections. It’s important to pay close attention to your skin and report any problems to your healthcare provider. You are a big part of your skin health, and if you take good care of your skin every day as suggested, you will have taken control of an important part of your health care to ensure the best quality of life for yourself. Health Care Professional Team Healthcare Educator Name: ___________________________________________ Company/Title: _____________________________________ Address: _________________________________________ City: _____________________ State: ______ Zip: __________ Phone: ___________________________________________ Email: ___________________________________________ Notes: ___________________________________________ Physician Name: ___________________________________________ Company/Title: _____________________________________ Address: _________________________________________ City: _____________________ State: ______ Zip: __________ Phone: ___________________________________________ Email: ___________________________________________ Notes: ___________________________________________ Other Name: ___________________________________________ Company/Title: _____________________________________ Address: _________________________________________ City: _____________________ State: ______ Zip: __________ Phone: ___________________________________________ Email: ___________________________________________ Notes: ___________________________________________ Two-Step Hospital Grade Kits Available • Antifungal Skin Care • Fragile Skin Bruising Care • Chronic Dry Skin Care • Incontinent Skin Care • Diabetic Skin Care • Radiation Skin Care • Edema Skin Care • Venous Skin Care Booklet Provided By R1424A © 2016 – All Rights Reserved Order # 56118