IAD and Assessment and Diagnosis

Careful assessment and clear diagnosis of IAD can be complex in patients with risk factors for skin conditions, including pressure ulcers. We will go into more detail in a few moments, but the main concepts that are important to address include the differentiation between ‘moisture-associated’ and ‘incontinence-associated’ skin lesions and pressure ulcers. Misdiagnosis is fairly common, which can lead to some mismanagement issues that can prolong or worsen the condition. However, there is some cross-over in treatment strategies, so it is good to know that practice management recommendations suggest that if the diagnosis remains unclear, a standard set of skin care interventions can be instituted to help in managing either condition.

Differentiation between pressure ulcers and moisture lesions

The assessment of IAD start with a continence assessment, which should include the frequency of incontinence, especially fecal incontinence with diarrhea. Other assessments to differentiate moisture lesions from pressure ulcers are shown in this table and include differentiating the cause, location, shape and edge, depth, and presence of necrosis. And it might sound obvious, but moisture lesions are associated with the presence of moisture. It’s amazing how often this goes unnoticed. And pressure ulcers are usually found in the presence of either pressure or shear over bony prominences. Pressure ulcers tend to have a distinct edge and shape with a deeper depth, while moisture lesions are more diffuse and usually superficial. And a sometimes While necrotic tissue may be present in a pressure ulcer, moisture ulcers are not associated with necrosis.

Also, noting the presence of some other factors can be very important to differentiating pressure ulcers from IAD or other moisture lesions. These include the general condition of the skin, if the patient has compromised mobility, poor personal hygiene, reduced cognitive awareness, poor nutritional status, critical illness, or the use of antibiotic or immunosuppressive medications, all of which are risk factors. In addition, the assessment of pain, pyrexia, and the use of occlusive containment products for incontinence should be considered.

Locations at higher risk for IAD include the perineum, peri-genital areas, buttocks, gluteal fold, thighs, lower back, lower abdomen and skinfolds that may be chronically exposed to moisture from urinary and fecal incontinence. Each of those areas can be assessed for the typical characteristics of IAD, including the presence of lesions, skin erosion, erythema, maceration, and signs of bacterial or fungal infection.

IAD prevention and management

The early detection of skin damage is key to integrating prevention measures into the treatment plan. And a single assessment isn’t enough. The clinical team and caregiver should continually assess the patient for skin damage in order to alter the treatment regimen to best prevent and manage IAD.

Continence management to reduce leakage and other sources of skin exposure to urinary and fecal matter is the foundation for IAD prevention and treatment. If diarrhea incontinence cannot be resolved through the reduction of risk factors, a good example of which is diarrhea associated with antibiotics, then it may be necessary to consider fecal management systems. The appropriate use and maintenance of continence devices, including pads, urinary sheaths, and stool diversion systems are important prevention and management interventions.

If non-invasive interventions fail, a risk versus benefit analysis (with the risk being a potential catheter-associated urinary tract infection and the benefit being the reduced risk for IAD) may suggest the temporary use of indwelling catheters that can help to protect skin from urinary exposure. Good catheter management will minimize skin contact with urine.

A structured skin care regimen should include skin cleansing, skin protection, and the restoration of the skin barrier function. New technologies introduced to body pads can draw excess fluids away from the skin to prevent occlusion and over-hydration of the stratum corneum.