Preventing · 2013-10-13 · Incontinence Associated Dermatitis (IAD) in Critical Care Up to 95% of...
Transcript of Preventing · 2013-10-13 · Incontinence Associated Dermatitis (IAD) in Critical Care Up to 95% of...
• Healingpotentialissignificantlycompromisedinthecriticallyillandskindamagehasthepotentialtocreateseriousconsequencessuchasinfection1
• Evenminorskininjurycancreatediscomfortandpainandaddtopatientsuffering2,3,4
• Skindamageconstitutesanegativeclinicaloutcomeandapoorpatientexperience2
• Strengthenyourpressureinjurypreventionprogramandavoidcostsassociatedwithskindamage
Incontinence Skin Care Solutions in Critical Carefromthe3M™Cavilon™ProfessionalSkinProtectionRange
inCriticalCareSkinBreakdown
Preventing
Cavilon™
Incontinence Associated Dermatitis (IAD) in Critical Care
Up to 95% of incontinent patients in ICUwerefoundtohave
IncontinenceAssociated
Dermatitis5
FaecalincontinenceanddiarrhoeaareacommonprobleminIntensiveCareUnitsoccurringinuptohalfofcriticallyillpatients.6
Thereasonsincludemedications,lackoffibreintubefeedingformulas,physiologicalfactorsassociatedwithstress,criticalillnessordisturbancesingutfloracausedbyantibioticsandantacids.7Liquidstoolsarealsoassociatedwithmalabsorptionandcompromisednutrition,whichhasbeenassociatedwithanincreasedlikelihoodofIADinhospitalisedpatients.8
Faecesactasadirectchemicalirritanttotheskinanddiarrhoeagreatlyincreasestheriskofskindamageandsuchexposurecausesanirritantdermatitis.Itcanprogressrapidlytocompletelossofepidermisiftheskinisleftinadequatelyprotectedorfaecalmatterisnotdiverted.Microbialimbalanceisalsothoughttooccurwithchronicwetnessandfaecalincontinence.Opportunisticfungalinfectionmayoccur,furtherincreasingmorbidity.9Inaddition,pathogenictoxins,suchasthoseresultingfromClostridium difficileincreasetheriskforsecondaryinfectionsandskindamage.10
Less Risk/Severity of Damage Greater Risk/Severity of Damage
UrinaryIncontinence FaecalIncontinenceofLiquidStoolMixedIncontinence(Faecalandurinary)
Infrequentepisodes Frequentorcontinuousepisodes
Skinintact,healthy Skindamagepresent
Promptandeffectiveskincareafterincontinenceepisode Infrequentorinadequateskincare
Understanding and Assessing Risk of IAD 11,12
IncreasedRiskofPIFormation
Incontinence
Moisture
IncreasedFriction
IncreasedShear
IAD and the Link to Pressure Injury
Identify the RISK!PanPacificClinicalPracticeGuidelineforthePreventionandManagementofPressureInjury,(2012)statesthatanimperativeinthepreventionofpressureinjuriesistheassessmentandidentificationofpatients at riskandimplementation of an individualised prevention plan.13
A risk factor is any factor that either contributes to increased exposure of the skin to excessive pressure or diminishes the skin’s tolerance to pressure.
Moisture, friction and shear are identified extrinsic risk factors.13
Moisture–Moisturealtersresilienceoftheepidermistoexternalforcesbycausingmaceration,particularlywhentheskinisexposedforprolongedperiods.Moisturecanoccurduetoincontinence,woundexudateandperspiration.Someformsofmoisture,particularlyincontinence,createaddedriskbyexposingtheskintoamorealkalinepHwhichincreasesenzymaticactivity,irritation,potentialskinerosionandriskofsecondaryinfection.Wetskinismorelikelytosustainmechanicaldamagefromfriction.
Friction–Amechanicalforcethatoccurswhentwosurfacesmoveacrossoneanother,creatingresistancebetweentheskinandcontactsurface,thatleadstoshear.
Shear–Amechanicalforcecreatedfromaparallelloadthatcausesthebodytoslideagainstresistancebetweentheskinandacontactsurface.Theouterlayersoftheskinremainstationarywhiledeepfaciamoveswiththeskeletoncreatingdistortioninthebloodvesselsandlymphaticsystembetweenthedermisanddeepfacia.Thisleadstothrombosisandcapillaryocclusion.
Patients
with faecal incontinence
PressureInjury
are 22x morelikelytodevelopa
14
Frequentorcontinuousepisodes
Infrequentorinadequateskincare
Differentiation Between Pressure Injuries and Moisture Lesions15
TheassessmentofIAD,includingriskassessmentanddifferentiationfromotherformsofskindamagesuchaspressureinjuriesorskintears,remainsachallengeforbothexpertandnon-specialtynurses.11
ThemostclinicallyrelevantargumentfordifferentiatingIADversuspressureinjuryistheimpactofaccuratepreventionandtreatment.11
3www.epuap.orgDefloor T., et al, Differentiation between pressure ulcers and moisture lesions, European Pressure Ulcer Advisory Panel Reviews, Volume 6, Issue 3, 2005
Moisture Lesions vs Pressure UlcersDifferentiation Between Pressure Ulcers and Moisture Lesions
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Location
Shape
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Edges
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A combination of moisture and friction may cause moisture lesions in skin folds, but most commonly they are present in the anal cleft.
Diffuse, different superficial spots are more likely to be moisture lesions. In a kissing ulcer (copy lesion) at least one of the wounds is most likely caused by moisture.
Moisture lesions are superficial (partial thickness skin loss). In cases where the moisture lesion gets infected, the depth and extent of the lesion can be enlarged.
There is no necrosis in a
moisture lesion.
Moisture lesions often have
diffuse or irregular edges
If redness is not uniformly
distributed, the lesion is likely to
be a moisture lesion.
A pressure ulcer is most likely to
occur over a bony prominence.
Circular wounds or wounds with
a regular shape are most likely
pressure ulcers, however, the
possibility of friction injury has to
be excluded.
Pressure ulcers vary in depth
depending on classification.
A black necrotic scab on a bony
prominence is a pressure ulcer
classification 3 or 4.
If the edges are distinct, the
lesion is most likely to be a
pressure ulcer.
If redness is non-blanchable, this is most likely a pressure ulcer. For people with darkly pigmented skin, persistent redness may manifest as blue or purple.
Moisture Lesions vs Pressure Ulcers A5 card.indd 1 13/7/11 09:59:45
www.epuap.orgDefloorT.,etal,Differentiationbetweenpressureulcersandmoisturelesions,EuropeanPressureUlcerAdvisoryPanelReviews,Volume6,issue3,2005.15
Factors Associated with Increased Risk of Pressure Injury13
Pan Pacific Clinical Practice Guideline for the Prevention and Management of Pressure Injury, (2012).13
Meeting the StandardsGovernmentsacrossAustraliaandNewZealandarelookingattheimplementationofsafetyandqualityinitiativestoimprovethequalityofhealthcare.AnexampleofthisisStandard8:PreventingandManagingPressureInjuriesfromtheNationalSafetyandQualityHealthServiceStandards,(2011).16
Standard8requireshealthserviceorganisationstohavegovernancestructuresandsystemsinplaceforthepreventionandmanagementofpressureinjuries,inparticular:
• Developingandimplementingpolicies,proceduresand/orprotocolsthatarebasedoncurrentbestpracticeguidelines,(Standard8.1)
• Undertakingqualityimprovementactivitiestoaddresssafetyrisksandmonitoringthesystemsthatpreventandmanagepressureinjuries,(Standard8.3)
• Conductingacomprehensiveskininspectionintimeframessetbybestpracticeguidelinesonpatientswithahighriskofdevelopingpressureinjuriesatpresentation,regularlyasclinicallyindicatedduringapatient’sadmissionandbeforedischarge(Standard8.6)
• Implementingandmonitoringpressureinjurypreventionplansandreviewingwhenclinicallyindicated(Standard8.7)
PressureInjuryRisk
Pressure
Impairedmobility
Moisture
Extrinsicfactors Intrinsicfactors
NutritionImpairedactivity
Shear Demographics
Skintemperature
Impairedsensoryperception
Friction Oxygendelivery
Chronicillness
Tissuetolerance
Reproduced with permission of AWMA. All rights reserved.
Prevention Makes Sense!Findingsfromastudythatlookedatthetimetodevelop,theseverityandtheriskfactorsofIncontinenceAssociatedDermatitis(IAD)amongstcriticallyillpatientswithfaecalincontinenceencouragedcriticalcarenursestoinstitute a defined skin care regimenforprevention and treatment of IAD for patients with faecal incontinence.9
Create and Implement an Effective Skin Damage Prevention Protocol with Cavilon No Sting Barrier Film
Cavilon No Sting Barrier Film is:• Fragrance-free,preservative-freeandlatexfree17
• Hypoallergenic17
• Non-cytotoxic17-canbeusedonintactanddamagedskin
• Costeffective4,18• Compatiblewithchlorhexidinegluconate17(CHG)and
povidoneiodine-willnotinterferewithantimicrobialprepsusedforpatientbathingoratinfusionsites
Aconsistentlyapplied,defined,orstructuredskincareregimenisrecommendedforpreventionandtreatmentofIAD.11
AssessforIADriskwhenperformingyourpressureinjuryriskassessment.
Ask for Cavilon No Sting Barrier FilmCavilon No Sting Barrier Film is like no other barrier film.Theproducts’unique3Mformulationcontainsablendofnotonebuttwopolymers,includingaTerpolymerandaHomopolymer(plasticizer).TheTerpolymerisderivedfromthreedistinctmonomers,thatprovidesaprotectivecoatingontheskin,creatingahighlyeffectivebarrier.TheHomopolymerenhancesthefilms’abilitytoflexwiththeskinandhelpstomaintainacontinuous,protectivecoating.Otherbarrierfilmscontainonlyonepolymerandsomeutilsealcoholasasolvent.
EarlymonitoringandpreventionofIAD,especiallyinpatientswithdiminishedcognitionorwithfrequentleakageoflooseorliquidfaeces,arerecommendedtopromoteskinhealth.9
Cavilon No Sting Barrier Film is an alcohol-free moisture barrier that forms a waterproof, flexible coating to protect the skin from body fluids, adhesives and friction. It is breathable and transparent allowing for continuous visualisation and monitoring of skin. It is flexible and conforms to the skin during movement or position changes.
Reduce or eliminate exposure to stool
Cleanse the skin with a pH balanced soap or liquid cleanser.
Protect the skin with Cavilon No Sting Barrier Film
Inonesimpleapplication,itcanhelpyoupreventIAD,damageduetofriction, moistureandadhesivetrauma.
Cavilon No Sting Barrier Film is versatile and meets the multiple skin protection
needs in critical care patients.
Protectionfromfaecalincontinence/diarrhoea
Pressureandfrictiondamagefromrespiratorydevices
Skinstrippingfromadhesives,e.g.centrallinedressings
Skinstrippingfromtapeusedtosecureendotrachealtubes
Damagetoskinaroundtracheostomyfromsecretions
Peritubedamagearoundleakingdrains
Radiationtherapy
IncontinenceAssociatedDermatitis(IAD)
Damagearoundfixators/pins
Frictionfromprosthesis
Frictiondamageoverelbowsandheels
Damageinskinfoldsfrommoistureandfriction
Frictionoverelbowsandheels
Skinstrippingfromadhesives:NPWT,tapes,dressings,ostomypouches
Damagefromwoundexudateorostomydrainage
damageduetofriction,
Ordering InformationCatalog No. Product Size Items/Box Boxes/Case
3343 3M™Cavilon™NoStingBarrierFilmCovers a 15cm x 15cm area
1.0mLwand 25 4
3344E 3M™Cavilon™NoStingBarrierFilmCovers a 12.5cm x 12.5cm area
1.0mLwipe 30 6
3344 3M™Cavilon™NoStingBarrierFilmCovers a 12.5cm x 12.5cm area
1.0mLwipe 25 4
3345 3M™Cavilon™NoStingBarrierFilmCovers a 25cm x 25cm area
3.0mLwand 25 4
3346 3M™Cavilon™NoStingBarrierFilm 28mLspray 12 1
(Australia Only)
(Australia Only)
(New Zealand Only)
Application of Cavilon No Sting Barrier FilmWhen used to protect the skin from incontinence in the critical care setting
reapply every 24 hours - For patients at higher risk of skin damage (e.g. constant diarrhoea stooling) more frequent applications (every 12 hours) may be necessary.
When used to protect skin from adhesive dressings, tapes or devices
reapply each time the dressing and/or adhesive product is changed.
When used for other skin protection needs such as peritube or periwound protection
reapply every 24 hours or as needed
3M and Cavilon are trademarks of 3M.Please recycle. © 3M 2013. All rights reserved.
Critical&ChronicCareSolutionsDivision3M New Zealand Limited94 Apollo Drive, Rosedale 0632Freephone 0800 80 81 82www.Cavilon.co.nz
Critical&ChronicCareSolutionsDivision3M Australia Pty. LimitedABN 90 000 100 096Building A, 1 Rivett RoadNorth Ryde NSW 2113Phone 1300 363 878www.Cavilon.com.au
Evidencebased:thereareover70piecesofclinicalevidencesupportingtheefficacyandcosteffectivenessofCavilonNoStingBarrierFilmformultipleclinicaluses,includingpreventionofIAD.Thisrepresentsmoreevidencethananyothermoisturebarrierorbarrierfilm.WithCavilonNostingBarrierFilmyoucanbeconfidentthatyouareprovidingevidencebasedcare.
ResourcesthatareavailabletoyouincriticalcareincludeICUProtocols,CavilonNoStingBarrierFilmClinicalEvidenceSummaries,PatientProductApplicationSheetsetc.TheseresourcescanbemadeavailabletoyoufromyourCritical&ChronicCareSolutionsDivisionTerritoryManager.
References
1. Williams,D.T.andHarding,K.(2003).HealingResponsesofSkinandMuscleinCriticalIllness.CriticalCareMedicine.31(8):s547–557
2. BestPracticeStatement.CareoftheOlderPerson’sSkin.London:WoundsUK,2012(Secondedition).
3. DoughtyD,JunkinJ,KurzP,SelekofJ,GrayM,FaderM,BlissDZ,BeeckmanD,LoganSIncontinence-AssociatedDermatitis:ConsensusStatements,Evidence-BasedGuidelinesforPreventionandTreatment,andCurrentChallenges.JWoundOstomyContinenceNurse.2012;39(3):303-315.
4. Bliss,D.Z,Zehrer,C.L,Savik,K,Smith,G&Hedblom,E.(2007).AnEconomicEvaluationofFourSkinDamagePreventionRegimensinNursingHomeResidentswithIncontinence.JournalofWoundOstomy&ContinenceNursing.34(2):143–152.
5. Peterson,K.J,Bliss,D.Z,Nelson,C&Savik,K.(2006).PracticesofNursesandNursingAssistantsinPreventingIncontinence–AssociatedDermatitisinAcutely/CriticallyIllPatients.AmericanJournalofCriticalCare.(Abstract).15(3):325
6. Patrick–Heselton,J.(2011).FaecalIncontinenceinCriticalIllness.NursingTimes.107(46):23–26
7. Ferrie,S.(2007).ManagingDiarrhoeainIntensiveCare.AustralianCriticalCare.20(1):7–13
8. Junkin,J.&Selecof,J.L.(2007).PrevalenceofIncontinenceandAssociatedSkinInjuryintheAcuteCareInpatient.JournalofWoundOstomy&ContinenceNursing.34(3):260–269
9. Bliss,D.Z,Savik,K,Thorson,M.A.L,Ehman,S.J,Lebak,K&Beilman,G.(2011).Incontinence–AssociatedDermatitisinCriticallyIllAdults:TimetoDevelop,SeverityandRiskFactors.JournalofWoundOstomy&ContinenceNursing.38(4):433–445
10.Black,J.M,Gray,M,Bliss,D.Z,Kennedy–Evans,K.L,Logan,S,Baharestani,M.M,Colwell,J.C,Goldberg,M&Ratcliff,C.R.(2011).MASDPart2:Incontinence–AssociatedDermatitisandIntertriginousDermatitis
11.Gray,M,Beeckman,D,Bliss,D.Z,Fader,M,Logan,S,Junkin,J,Selekof,J&Doughty,D.(2012)Incontinence–AssociatedDermatitis:AComprehensiveReviewandUpdate.JournalofWoundOstomy&ContinenceNursing.39(1):1–14
12.Beeckman,D,Schoonhove,L,Verhaeghe,S,Heyneman,A&Defloor,T.(2009).PreventionandTreatmentofIncontinence–AssociatedDermatitis:LiteratureReview.JournalofAdvancedNursing.65(6):1141–1153
13.AustralianWoundManagementAssociation.(2012).PanPacificClinicalPracticeGuidelineforthePreventionandManagementofPressureInjury.AWMA.CambridgePublishing,OsbournePark,WA
14.Maklebust,J&Magnan,M.(1994).RiskFactorsAssociatedwithhavingaPressureUlcer.ASecondaryDataAnalysis.AdvancesinWoundCare.7(6):25–42
15.DefloorT.,etal.(2005).Differentiationbetweenpressureulcersandmoisturelesions,EuropeanPressureUlcerAdvisoryPanelReviews.6(3).
16.AustralianCommissiononSafetyandQualityinHealthCare(ACSQHC).(September2011).NationalSafetyandQualityHealthServiceStandards,ACSQHC,Sydney.
17.3MDataonFile.18.Bale,S,Tebble,N,Jones,VandPrice,P.(2004).TheBenefitsofImplementingaNew
SkinCareProtocolinNursingHomes.JournalofTissueViability.14(2):44–50.