The effectiveness of a microclimate management system to improve skin integrity
Lynsey Atkinson – TVN Northern Health and Social Carea Trust
Incontinence associated dermatitis (IAD) poses a significant challenge to healthcare workers and is a well-known risk factor in the development of pressure ulceration1. IAD is included within a broader group of skin conditions known as moisture associated skin damage (MASD). Incontinence associated dermatitis describes the skin damage associated with exposure to urine or stool. It causes considerable pain and discomfort, and can be difficult, time consuming and expensive to treat2. According to a literature review by Beekman et al1, data suggests that IAD is a common problem in healthcare settings. Studies have estimated that it has a:
• prevalence (ie proportion of patients with IAD at a defined point in time) of 5.6%–5.0%
• incidence (ie proportion of patients who develop IAD over a period of time) of 3.4%–25%.
The costs associated with MASD/IAD not only affect patient quality of life but can have significant financial implications.
In 1995, the USA spent an estimated $136.6 million on the treatment of IAD2. The term microclimate refers to the temperature and moisture at the skins’ surface where it comes in contact with a support surface. Microclimate encompasses two of the five factors that contribute to pressure ulcer development – pressure, shear, friction, moisture and temperature. This has prompted the need for consideration of additional features such as the ability to control moisture and temperature when selecting a support surface3. Currently MASD is treated and managed using cleansers, protectants and in some cases topical steroids, antifungals and antibiotics4. Within our organisation, increasing costs in terms of nursing time and consumables, and a raised awareness of microclimate, have prompted the use of other complimentary therapies. The decision was taken to evaluate another type of therapy in the form of a mattress coverlet, which provided microclimate control and could be used on pressure redistributing support surfaces.