Incontinence-associated dermatitis consensus statements, evidence-based guidelines for prevention and treatment, and current challenges

In 2009, a multinational group of clinicians was charged with reviewing and evaluating the research base pertaining to incontinence-associated dermatitis (IAD) and synthesizing this knowledge into best practice recommendations based on existing evidence. This is the first of 2 articles focusing on IAD; it updates current research and identifies persistent gaps in our knowledge. Our literature review revealed a small but growing body of evidence that provides additional insight into the epidemiology, etiology, and pathophysiology of IAD when compared to the review generated by the first IAD consensus group convened 5 years earlier. We identified research supporting the use of a defined skin care regimen based on principles of gentle perineal cleansing, moisturization, and application of a skin protectant. Clinical experience also supports application of an antifungal powder, ointment, or cream in patients with evidence of cutaneous candidiasis, aggressive containment of urinary or fecal incontinence, and highly selective use of a mild topical anti-inflammatory product in selected cases. The panel concluded that research remains limited and additional studies are urgently needed to enhance our understanding of IAD and to establish evidence-based protocols for its prevention and treatment.<br/

Incontinence-associated dermatitis: a comprehensive review and update

In 2010, an international consensus conference was held to review current evidence regarding the pathology, prevention, and management of incontinence-associated dermatitis (IAD). The results of this literature review were published in a previous issue of this Journal. This article summarizes key consensus statements agreed upon by the panelists, evidence-based guidelines for prevention and management of IAD, and a discussion of the major challenges currently faced by clinicians caring for these patients. The panelists concur that IAD is clinically and pathologically distinct from pressure ulcers and intertriginous dermatitis, and that a consistently applied, structured, or defined skin care program is effective for prevention and management of IAD. They also agreed that differential assessment of IAD versus pressure ulceration versus intertriginous dermatitis remains a major challenge. Panel members also concur that evidence is lacking concerning which products and protocols provide the best outcomes for IAD prevention and treatment in individual patients. Issues related to differential assessment, product labeling and utilization, staff education, and cost of care are the primary focus of this article.<br/

Incontinence-associated dermatitis: moving prevention forward

Incontinence-associated dermatitis (IAD) represents a significant health challenge worldwide and is a well-recognised risk factor for pressure ulcer development. Recent consensus work has identified gaps in our current understanding and practice. The ability of clinicians to deliver evidence-based practice is hampered by lack of standardised definitions and terminology, high-quality studies, and international or national guidelines.In September 2014, a group of international experts met in London to review knowledge deficits in IAD and to advance best practice principles to address these gaps. Key topics included: risk assessment for IAD; the role of IAD in pressure ulcer development; assessment and categorisation of IAD; and development of a severity-based approach to treatment. Following the meeting, an initial draft was developed and underwent extensive review by the expert working group. The document was then sent to a wider group of experts for further review. For the clinician providing hands-on patient care, the information presented in this document details practical guidance on how to assess, prevent and manage IAD based on available evidence and expert opinion. For clinical leaders, a step-by-step guide for advancing IAD prevention within their care setting is provided in addition to information on developing a structured prevention programme. It is the expert panel’s intention that this document will help promote effective skin care strategies for the prevention of IAD, improving patient quality of life and clinical outcomes worldwide. It is also hoped that this document will raise awareness of the need for accurate, standardised data collection for IAD, and the development of high-quality studies to advance our evidence bas

Incontinence-associated dermatitis: Moving prevention forward:Addressing evidence gaps for best practice (Proceedings from the Global IAD Expert Panel)

Incontinence-associated dermatitis (IAD) represents a significant health challenge worldwide and is a well-recognised risk factor for pressure ulcer development. Recent consensus work has identified gaps in our current understanding and practice. The ability of clinicians to deliver evidence-based practice is hampered by lack of standardised definitions and terminology, high-quality studies, and international or national guidelines