Categories of Risk Factors for IAD

To better understand the development of IAD, let’s explore some of the risk factors in more detail. There are several categories and specific risk factors for developing IAD. Incontinence itself is a risk factor. Prolonged exposure to urine and feces can increase the risk for IAD, such as when the urinary and fecal management systems and procedures aren’t effectively managing leakage, or incontinence products aren’t being changed frequently enough, or if the patient is suffering from a poor skin cleaning regimen.

•  Incontinence and skin exposure to urine and feces •  Inadequate assessment of continence •  Inappropriate treatment •  Compromised self-care and mobility •  Medications, poor nutritional status, and critical illness

 

Exposure to urine and feces

Both urinary and fecal incontinence are risk factors in the development of IAD, but patients with fecal incontinence are at a higher risk. The reason is because feces contain enzymes, including lipid-digesting and protein-digesting enzymes that can damage the skin. Patients with liquid stools may have higher levels of these enzymes. Fecal incontinence with diarrhea is associated with a higher risk profile than with formed stools.

Urinary incontinence may be a result of leakage from a temporary catheter as well as ongoing urinary incontinence. The ammonia in urine can increase the skin’s alkalinity, which can cause irritation and provide an environment for bacteria to grow. Bacterial infection, in turn, can lead to skin damage, especially in cracks and fissures that may have been present due to dry skin. Damp and warm skin is an ideal environment for fungal infections. With exposure to moisture, the skin can become waterlogged and macerated so that even gentle rubbing can cause damage.

In addition, frequent incontinence events increase the risk for moisture-related skin damage. And, as mentioned a couple of slides ago, the highest level of risk is in patients who experience both urinary and fecal incontinence.

Chronic stress may pose a problem in that it can depress sex hormones in both men and women. This can lead to increases in visceral fat deposits which have been shown to increase insulin resistance.   Inadequate initial assessment IAD risk may be increased if an initial assessment of continence is inadequate and leads to mismanagement of symptoms, application of inappropriate interventions, or over-reliance on containment products. For instance, if absorbent pads are double padded and not changed frequently enough, moisture may be held against the skin surface causing over-hydration and maceration, especially in cases where plastic-backed pads have been used.

 

Inadequate treatment

In some cases, incorrect products, such as thick and occlusive skin products like petroleum jelly and zinc oxide, may reduce the moisture uptake of absorbent products and cause over-hydration of skin tissues. Even frequent skin care with soap and water can increase dryness and cause friction, leading to skin damage.

 

Compromised self-care and mobility issues

A patient who cannot adequately manage incontinence, has cognitive limitations, or has compromised mobility may be at increased risk for IAD. Continence problems may be present in patients with dementia. Aging is associated with changes in the skin as well as bladder and bowel function. Aging skin is more prone to damage because of thinning in the epidermis and dermis layers, and up to a 20% decrease in the volume of the skin layer. This can result in reduced blood vessels, nerve endings, and collagen that then leads to a reduced sensation of touch, a loss of moisture retention, and rigidity.

It is common in aging to have a decrease in urinary flow, which can be associated with prostate enlargement, recurrent urinary tract infections, and other issues. Bowel function may change with increased risks for diverticular disease and constipation.

 

Medications and other issues And, of course, medications may play a key role. Antibiotics can cause diarrhea, and immunosuppressant and steroid medications can lead to a thinning of the skin and easy bruising. And poor nutritional status can compromise skin integrity and the ability to maintain adequate skin hydration and healing. And critical illness can have a detrimental affect on the body's self-regulation and healing processes.