Development of a cumulative irritation model for incontinence-associated dermatitis

Cultural adaptation and validation of the Ghent global IAD monitoring tool (GLOBIAD-M) for Brazilian Portuguese

BACKGROUND

Incontinence-associated dermatitis (IAD) poses a significant challenge for individuals experiencing incontinence, characterized by irritative contact dermatitis due to prolonged exposure to urine and/or faeces.

OBJECTIVE

This study aimed to culturally adapt the Ghent Global IAD Monitoring Tool - GLOBIAD-M to Brazilian Portuguese and to assess the adapted version's measurement properties quality.

METHOD

A clinimetric study was conducted, comprising cultural adaptation and psychometric assessment. Cultural adaptation followed international guidelines, while psychometric properties were evaluated for content validity, inter-rater reliability, and correlation with other variables (thermography). Inter-rater reliability was assessed through clinical and photographic evaluations. The study samples included linguists and, IAD specialists, nurses, and adult patients with IAD according to the cultural adaptation or psychometric evidence assessment.

RESULT

The process of cultural adaptation resulted in a cumulative coefficient of variation ratio (CVR) of 0.66. Subsequently, the study included 57 patients and 57 nurses for clinical assessments, totalling 166 evaluations of IAD. The inter-rater reliability among nurses was deemed satisfactory, with a Gwet coefficient of 0.77. Moreover, out of 215 photographic assessments conducted by 54 nurses, there was a 92.1 % concurrence in the categorization of IAD. Furthermore, thermography analysis revealed significant temperature differences between healthy individuals and those with IAD, particularly in patients categorized under IAD Cat. 1B, showing a difference of 1.90 °C.

CONCLUSION

and Impact on Clinical Practice: The results confirm the availability of the GLOBIAD-M in its Brazilian Portuguese version. This tool will allow health professionals to obtain a standardized IAD classification and monitoring in Brazil, enhancing its diagnostic accuracy and aiding clinical decision-making.

Selective detection of urease-producing bacteria on the genital skin surface in patients with incontinence-associated dermatitis

We aimed to investigate the association between the presence of cutaneous urease-producing bacteria and the development of incontinence-associated dermatitis (IAD) using an original urea agar medium as a step toward developing advanced preventive measures. In previous clinical assessments, we developed an original urea agar medium to detect urease-producing bacteria via the medium's colour changes. In a cross-sectional study, specimens were collected via the swabbing technique at genital skin sites in 52 stroke patients hospitalised in a university hospital. The primary objective was to compare the presence of urease-producing bacteria between the IAD and no-IAD groups. Determining the bacterial count was the secondary objective. The prevalence of IAD was 48%. A significantly higher detection rate of urease-producing bacteria was observed in the IAD group than in the no-IAD group (P = .002) despite the total number of bacteria being equivalent between them. In conclusion, we discovered that there was a significant association between the presence of urease-producing bacteria and IAD development in hospitalised stroke patients.

Humidity-Sensing Mattress for Long-Term Bedridden Patients with Incontinence-Associated Dermatitis

Designing new medical devices with advanced humidity sensors is of great significance for patients with incontinence-associated dermatitis (IAD). The primary goal of this study is to test the humidity-sensing mattress system for patients with IAD in clinical settings. The design of the mattress is set at 203 cm, with 10 × 3 sensors, dimensions of 19 × 32 cm, and a weighted bearing of 200 kg. The main sensors consist of a humidity-sensing film, a thin-film electrode (6 × 0.1 mm), and a glass substrate (500 nm). The sensitivity of the test mattress system showed that the resistance-humidity sensor was at a temperature of 35 °C (V0 = 30 V, V0 = 350 mV), with slope at 1.13 V/fF, f = 1 MHz, 20-90% RH, and a response time of 20 s at 2 μm. In addition, the humidity sensor reached 90% RH, with a response time of less than 10 s, a magnitude of 107-104 Ω, 1 mol%, CrO1.5, and FO1.5, respectively. This design is not only a simple, low-cost medical sensing device, but also opens a new pathway for developing humidity-sensing mattresses in the field of flexible sensors, wearable medical diagnostic devices, and health detection.

An exploratory study of the effects of the pH of synthetic urine on skin integrity in healthy participants

Background: Incontinence-associated dermatitis (IAD) develops from prolonged exposure of skin to urine and/or stool and represents a common complication in older adults, reducing the quality of life. Increased pH is an important etiologic factor of IAD, however, the relationship between urinary pH and skin barrier disruption remains unclear. Objective: To examine the effects of synthetic urine (s-urine) at various pH on transepidermal water loss (TEWL), stratum corneum hydration (SCH) and skin surface pH. Methods: S-urine solutions (pH 5.0-9.0) were applied to the volar forearms of 15 healthy participants for 2 hrs, with another site serving as the untreated control. Measurements of TEWL, SCH and skin surface pH were obtained at baseline and after each challenge. Skin buffering capacity was also examined in 5 volunteers by recording skin pH at baseline, after 2 hrs exposure and every 5 mins for 40 mins. Results: TEWL and SCH were increased following exposure to s-urine compared to baseline values. Although there was tendency for pH to an increase after exposure, further investigation showed that changes are only temporal as pH value is restored to baseline within 5 mins. There were no significant differences between solutions. Conclusions: This study revealed that urine disrupts healthy skin integrity; however, its effects are not pH dependent. Transient changes were observed on the acid mantle of the skin due to its innate buffering capacity. Future studies need to examine the effects of urine combined with bacteria responsible for pH elevation in patients with urinary incontinence.

Investigating the release of inflammatory cytokines in a human model of incontinence-associated dermatitis

Incontinence-associated dermatitis (IAD) is a painful complication in elderly patients, leading to reduced quality of life. Despite recent attention, its underlying inflammatory mechanisms remain poorly understood. This study was designed to quantify the release of inflammatory cytokines in a human model of IAD. The left volar forearm of ten healthy volunteers was exposed to synthetic urine and synthetic faeces for 2 h, simulating the effects of urinary and faecal incontinence, respectively, and the subsequent cytokine response compared to that of an untreated control site. Inflammatory cytokines were collected using both the Sebutape® absorption method and dermal microdialysis and quantified using immunoassays. Results from the former demonstrated an upregulation in IL-1α, IL-1RA and TNF-α. Synthetic urine caused a higher median increase in IL-1α from baseline compared to synthetic faeces, whereas synthetic faeces were associated with significantly higher median TNF-α levels compared to synthetic urine (p = 0.01). An increase in IL-1α/IL-1RA ratio was also observed with significant differences evident following exposure to synthetic urine (p = 0.047). Additionally, microdialysis revealed a time-dependent increase in IL-1β and IL-8 following exposure of up to 120 min to synthetic urine and synthetic faeces, respectively. This study demonstrated the suitability of both sampling approaches to recover quantifiable cytokine levels in biofluids for the assessment of skin status following exposure to synthetic fluids associated with incontinence. Findings suggest some differences in the inflammatory mechanisms of IAD, depending on moisture source, and the potential of the cytokines, IL-1α and TNF-α, as responsive markers of early skin damage caused by incontinence.

Evaluation of a new topical skin protectant (RD1433) for the prevention and treatment of incontinence-associated dermatitis

Context Incontinence-associated dermatitis (IAD) is a type of moisture-associated dermatitis caused by repeated skin exposure to urine or stool. A product that could mitigate such symptoms would have a significant impact on cost of care and patients' quality of life. Objective This study compared the clinical efficacy of RD1433 and a comparator product (Vaseline®) in preventing and treating experimental IAD skin lesions. Materials and methods For the "prevention" part of the study, skin sites in eight human volunteers were treated daily for 5 d with either RD1433 or Vaseline® immediately prior to synthetic urine exposure. In the "treatment" part, exposure to synthetic urine was substituted for Vaseline® or RD1433 application on the first 2 d to promote the development of skin lesions prior to the application of the products from day three. Product efficacy was quantified by visual scoring and an array of biophysical instruments. Results Both RD1433 and Vaseline® significantly reduced lesion progression when applied as a prophylactic. When applied as a treatment (following establishment of skin lesions), RD1433 demonstrated a statistically significant improvement in several measures of skin function whereas there was no statistically significant improvement following treatment with Vaseline®. Conclusions The findings of this study suggest that RD1433 may be superior to Vaseline® in the prevention and treatment of experimental IAD lesions. Clearly, further work is required to establish the efficacy of RD1433 with patients in a clinical environment.

Incontinence-associated dermatitis: reducing adverse events

Incontinence-associated dermatitis (IAD) is a common problem in patients with faecal and/or urinary incontinence. Urine alters the normal skin flora and increases permeability of the stratum corneum and faecal enzymes on the skin contribute to skin damage. Faecal bacteria can then penetrate the skin, increasing the risk of secondary infection. However, IAD can be prevented and healed with timely and appropriate skin cleansing and skin protection. This includes appropriate use of containment devices. This article also looks at HARTMANN incontinence pads that have been developed to absorb the fluids that cause IAD and maintain the skin's acidic pH. The acidic pH of the skin contributes to its barrier function and defence against infection. Therefore, maintaining an acidic pH will help protect the skin from damage.