Use of Cavilon no Sting Barrier Film in Reducing the Prevalence of Moisture-Associated Skin Damage - Essay Example

The Potential use of Cavilon no sting barrier film in reducing the Prevalence of MASD/IAD Valanie Lezama NUR 601 Mercy College The Potential use of Cavilon no sting barrier film in reducing the Prevalence of MASD/IAD Introduction Moisture-associated skin damage (MASD) is a term that is commonly used to refer to a wide range of skin problems that usually occur due to prolonged exposure of the skin to various sources of moisture such as urinary/faecal incontinence, perspiration and wound exudates (Zehrer and Newman, 2005). It includes incontinence associated dermatitis (IAD) as a result of chronic skin exposure to urine, stool, or both and can extend from the buttocks throughout the perineal area and posterior/ inner thighs. According to Bliss et al. (2011), the skin lesions caused by moisture are often characterized by an inflammation which may or may not be seen as skin erosion (loss of some or all of the epidermis leaving a denuded surface) or cutaneous secondary skin infection. Although the prevalence of MASD/IAD is widely varied, incidences of fecal and urinary incontinence and other forms of Perineal dermatitis are generally high among older people and long term care residents with up to 50% of these individuals experiencing the problem at some point of their lives. Moisture-associated skin damage (MASD) is both painful and costly and the costs associated with urinary incontinence alone currently estimated to be over $26.3 billion annually. MASD/IAD has significant implications to patient care and may result in a number of issues including pain, secondary skin infections and misidentification, which can lead to ineffective treatment plans. In a study conducted by Junkins and Selekof (2007), 24 patients had fecal incontinence and 23 of those patients developed IAD. MASD/IAD increases a patients risk for pressure ulcer development (Driver, 2007). Numerous previous studies have shown that the use of preventive methods may decrease the incidence of MASD/IAD. However, there is a still research gap and it is uncertain as to which products are more effective. The purpose of this study is to critically investigate the feasibility of using Cavilon no sting barrier film in reducing the Prevalence of MASD/IAD. Specific Aims and Objectives The primary goal of this study is to determine the effectiveness of the Cavilon no sting barrier film spray compared to the use of Aloe-Vesta skin ointment in critically ill patients that are incontinent. The other specific objectives include: i. To determine the relative cost effectiveness of using Cavilon no sting barrier film spray compared to other common alternatives. ii. to evaluate two different methods to prevent MASD/IAD in critically ill patients iii. To highlight some of the potential limitations of the drug Research Questions The research question is: Can Cavilon no sting barrier film be used as an effective medication in reducing the prevalence of Moisture-associated skin damage MASD/ incontinence associated dermatitis (IAD)? Background and Innovation Previous studies by Denat and Khorshid (2011) and Beeckman, Verhaeghe, Defloor, Schoonhoven and Vanderwee (2011) have shown that the use of preventive methods may decrease the incidence of MASD/IAD, however it is uncertain as to which products are more effective. Some of the products used in the studies includedperineal washcloths impregnated with dimethicone 3%, pH neutral soap and water (Beeckman, et al., 2011), and perineal pouches (Denat & Khorshid, 2011).The results of these two studies showed a decrease in MASD/IAD and increased compliance when a one –step skin care protocol was implemented. Background In her research, Nazarko (2013) used a qualitative design to investigate the potential reasons why adults may develop faecal incontinence and the best ways of treating and managing intractable faecal incontinence. A number of previous empirical researches were reviewed and the results indicated that faecal incontinence is just but a symptom with various diverse contributing factors. The author concluded that the key to treatment of the condition should begin with the identification of the cause before working out the treatment plan. A cross sectional descriptive survey research conducted by Bayon et al. (2012) sought to empirically evaluate the prevalence, management as well as the awareness of acute faecal incontinence in intensive care units. The researchers employed a cross sectional research design across 4 countries namely the United Kingdom, Germany, Italy and Spain. The results indicated that a significant majority of the respondents had low to moderate awareness rates of the condition and its clinical challenges. The researchers concluded that the occurrence of AFId in care settings may be an underestimated clinical problem that should now be addressed. On the other hand, Peterson et al. (2014) carried out a research on the use of AACN Levels of Evidence and the ways of choosing the best evidence to provide guidance to clinical practice. The authors used a qualitative research study in which a number of previous publications were reviewed. The results indicated that numerous barriers exist between the acquisition of new knowledge and its implementation in improving patient care. The researchers concluded that a number of AACN sources such as hierarchical rating systems and practice alerts should be used to help determine the strength of studies. Similarly, Driver (2007) performed an observational study which consisted of 308 adult patients experiencing fecal incontinence in a medical-surgical intensive care unit. The study was conducted in two phases with the use of two different products. The goals of this observational performance study were to determine staff compliance with the skin care protocol implemented as well as how soon will evidence of skin breakdown presented in patients with fecal incontinence. Patients were observed for a total of eight weeks. Although the findings were valuable, it is acknowledged that further studies were needed to determine the impact of each risk factor of IAD and which patient benefit most from intervention. Another researcher, Bianchi (2012) employed a systematic literature review to investigate the various methods that can be used to avoid the occurrence of incontinence-associated dermatitis (IAD). Based on the research findings, the author concluded that clinicians can significantly reduce the incidences of IAD and the associated embarrassment, pain and discomfort simply by adopting the tips they have proposed. In addition, a study conducted by Bliss, Thorson, Ehman, Lebak and Beilman (2011)looked at , forty-five adult patients in the surgical/trauma critical care unit (ICU) were monitored over a period of 1-19 days to determine how early the development of Incontinence-associated dermatitis (IAD) unfolds in critically-ill patients with fecal incontinence. It was noted that IAD developed in 36% of patients within an average of 4 days. The researchers concluded that early monitoring and implementation of preventive measures such as conducting hourly rounds and performing frequent incontinent care were recommended to prevent IAD. Finally, current preventive measures for MASD/IAD include daily skin assessments and application of a skin protectant/barrier ointment after care; however, thereit has been demonstrated that is very little compliance by staff with the application of the ointment is not a priority (Driver, 2007). Voegeli (2008) provided data that shows washing with soap and water was disruptive to the skin’s protective barrier, therefore application of a skin protectant would to prevent further insult to the skin. Innovation Although there are a number of previous researches regarding the potential ways of reducing the Prevalence of MASD/IAD, the is still a significant research gap as none of the researches have identified which of the many preventive methods for MASD/IAD is more effective for the patients. The present research will therefore seek to fill this gap by determinig the efficacy and effectiveness of the Cavilon no sting barrier film spray compared to alternatives particularly the use of Aloe-Vesta skin ointment in critically ill patients that are incontinent. In addition, unlike the previous researches that have offered varied treatment options based on the source of the moisture, location and the nature of the proposed use of Cavilon no sting barrier film offers numerous benefits some of which may include its non irritating characteristics (alcohol free), thereby reducing the potential for stinging, faster drying, water proofing effectiveness and clear film which guarantees visibility of the skin and the areas around the wound. Generally, Cavilon no sting barrier film is a common alcohol-free liquid barrier film that normally dries quickly to form a transparent breathable coating on the skin. With its key ingredients being Hexamethyldisiloxane, Polyphenylmethylsiloxane, Acrylate Terpolymer and Isooctane, the film are particularly designed to protect both intact and damaged skin from various sources of incontinence such as faeces, urine and other body fluids as well as from friction and adhesive friction. This is critically important in the management of moisture related skin damage. Theoretical Framework There are a number of theoretical underpinnings supporting the present research study. Numerous studies have proved that the impact of incontinence can lead to skin breakdown and supports that having a defined skin care protocol as well as the availability of quality incontinence care products decreases the incidence of MASD/IAD . The odds of developing an IAD were greater for critically ill patients with fecal incontinence and the findings from these two studies show the importance of preventive skin care in the critical care setting upon admission. The use of a one-step skin care protocol will encourage compliance by the critical care nurses and therefore decrease the incidence of IAD. The ICU is an area where pressure ulcer rates are known to be the highest. Patients who are admitted into the ICU tend to have multiple comorbidities. Additionally, ICU patients tend to be the most disadvantaged when it comes to maintaining intact skin since they are hemodynamically unstable, may be sedated, receiving mechanical ventilation, and are confined to bed for long periods of time. Another factor that contributes to ICU’s increasing rates is that many of these patients receive vasoactive medications to support blood pressure through the course of their stay to maintain adequate cardiac output. It is those very infusions that are used to control patients’ blood pressures that constrict peripheral circulation therefore depriving the capillary beds of the oxygen and nutrients needed. This decrease in peripheral circulation increases the chances of skin breakdown among there critically ill patients, thus putting them at higher risk for MASD/IADs. References Bayon, G., Binks, R., De Luca, E., Dierkes, C., Franci, A., Gallart, E., Niederalt, G., Wyncoll, D. (2012) Prevalence, management and clinical challenges associated with acute faecal incontinence in the ICU and critical care settings: The FIRSTTM cross sectional descriptive study. Intensive and Critical Care Nursing, 28, 242-250. Beeckman, D., Verhaeghe, S., Defloor, T., Schoonhoven, L., &Vanderwee, K. (2011). A 3-in-1 perineal care washcloth impregnated with dimethicone 3% versus water and pH neutral soap to prevent and treat incontinence-associated dermatitis: A randomized, controlled clinical trial. Journal of Wound, Ostomy & Continence Nursing, 38(6), 627-634. Bianchi, J. (2012). Top tips on avoidance of Incontinence Associated Dermatitis. Management of Moisture Lesions Wounds UK 8, 2, 6­-8. Black, J., Gray, M., Bliss, D., Kennedy-Evans, K., Logan, S.,Baharestani, M.,…Ratliff, C. (2011). MASD part 2: Incontinence associated dermatitis and intertriginous dermatitis. Journal of Wound, Ostomy & Continence Nursing, 38(4), 359-370. Bliss, D., Savik, K., Thorson, M., Ehman, S., Lebak, K., Beilman, G., (2011). Incontinence-associated dermatitis in critically ill adults: Time to development, severity, and risk factors. Journal of Wound, Ostomy & Continence Nursing, 38(4), 433- 445. Center for Medicare and Medicaid Services (2014). Hospital acquired conditions. Retrieved from: http://www.cms.gov/Medicare/Medicare-Fee-for-Service Payment/HospitalAcqCond/index.html?redirect=/hospitalacqcond/06_hospital- acquired_conditions.asp Denat, Y., & Khorshid, L. (2011). The effect of 2 different care products on incontinence-associateddermatitis in patients with fecal incontinence. Journal of Wound, Ostomy & Continence Nursing, 38, 2, 171-176. Driver, D. (2007). Perineal dermatitis in critical care patients. Critical Care Nurse, 27,4, 42-47. Junkin, J., & Selekof, J. (2007). Prevalence of incontinence and associated skin injury in the acute careinpatient. Journal of Wound, Ostomy & Continence Nursing, 34,3, 260-269. Lyman, V. (2009). Successful heel pressure ulcer prevention program in a long-term care setting. Journal of Wound Ostomy & Continent Nursing 36, 6, 616-621. National Pressure Ulcer Advisory Panel (2014). Retrieved on December 9, 2014 from http://www.npuap.org/ Nazarko, L. (2013). Good care and management of faecal incontinence (FI). British Journal of Healthcare Assistants, 7, 9, 424-431. Peterson, M. H., Barnason, S., Donnelly, B., Hill, K., Miley, H., Riggs, L., Whiteman, K. (2014). Choosing the best evidence to guide clinical practice: Application of AACN levels of evidence. Critical Care Nurse, 34, 2, 58-68. Rohwer, K., Bliss, D. Z., & Savik, K. (2013). Incontinence-associated dermatitis in community dwelling individuals with fecal incontinence. Journal of Wound, Ostomy & Continence Nursing, 40, 2 , 181-184 Voegeli, D. (2008). The effect of washing and drying practices on skin barrier function. Journal of Wound, Ostomy & Continence Nursing, 35, 1, 84-90. Zehrer, C, Newman, D. (2005). Assessment of Diaper - Clogging Potential of Petrolatum Moisture Barriers. Ostomy Wound Management 51, 12, 54-58. Read More