Key Facts
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- Incontinence-associated dermatitis (IAD) is a common problem for patients with incontinence, affecting as many as 36% of critical care patients, with rates increasing as patients are more vulnerable to infection.
- IAD is uncomfortable, expensive, and dangerous alone, but is also associated with increased risk of secondary infections, or development of pressure ulcers.
- Because of the leaky nature of existing catheter options, particularly internal catheters, IAD prevention is costly and labor intensive, leading to $3,000-$5,000 in additional spending per patient, before accounting for secondary infections.
- Advances in prevention and treatment may come from improving catheter alternatives reducing leakage around the perineum, and the use of external catheters.
IAD Incidence and Risk Factors
Incontinence-associated dermatitis is a prevalent issue, particularly for elderly women and women using internal catheters. In elder care settings, overall incidence hovers around 5%–7% in long-term care settings–and soars to as high as 36% among critical care patients. Notably, this accounts for the entire patient population; narrowing the sample to patients experiencing incontinence, IAD incidence is as high as 89% in some settings. As a spillover consequence of incontinence and mobility challenges, it can exacerbate existing problems and grow the discomfort already caused by incontinence and internal catheter use.
IAD can appear for anyone impacted by urinary or fecal incontinence, but any number of comorbid factors can significantly boost the risk of a patient contracting IAD, including impaired cognitive function, poor nutrition, raised body temperature, mobility challenges, use of certain medications, and leakage from devices used to manage incontinence.
The Impact of IAD on Patients and Hospitals
As an isolated condition, IAD can appear less than serious beyond the discomfort it causes for a patient. However, in context, IAD can lead to secondary infections and far more serious conditions for the patient. One study on IAD showed that 32% of patients with IAD contracted a fungal infection related to IAD, and IAD is one of the most significant risk factors for pressure ulcers, which makes prevention and treatment of IAD critically important to a patient’s health.
The consequences of these conditions on the hospital side can be dramatic. Current IAD prevention techniques for patients with incontinence have been shown to entail $3,307 more spent per patient on incontinent patients than continent patients, and $5,851 more per patient if they contracted an IAD, not accounting for any secondary infections–already 34% more than spending on an average patient. While the existing materials for IAD prevention are relatively inexpensive, the labor hours required to manage the condition drive a significant chunk of that cost. Moreover, the cost of treating some secondary infections, as well as pressure ulcers, can cost up to $150,000 per patient.
IAD Prevention and Treatment
Existing research suggests that IAD prevention for women with incontinence can be labor-intensive, requiring regular thorough cleaning of the perineum with soaps that approximate the pH of the skin. If a patient does contract IAD, skincare needs to alleviate it and prevent further complications can radically increase with maintenance and cleaning required as often as multiple times a day, depending on the patient’s degree of incontinence.
While external urinary devices have been shown to alleviate other conditions related to incontinence, existing alternatives to catheters often entail significant leakage that can put a patient at risk of IAD. The danger associated with urine and fecal matter making prolonged contact with the skin means that any leakage from incontinence aids must be addressed quickly to prevent skin damage. Best-suited improvements to prevention techniques may come from preventing skin contact with urine or stool altogether, to alleviate the labor associated with frequent cleaning by nurses and the discomfort to the patient.
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