Evidence Based Analysis on the use of Skin Protectant Creams

Anika Ogunleye & Minh Dat Nguyen

Seneca College

NUR 402

Judith Card

March 11th 2022

 During the Winter 2021 clinical placement, when taking care of geriatric patients at the

Reactivation center, skin cleansers and protectants were a routine used to protect skin from

incontinence matter to reduce the risk of incontinence-associated dermatitis (IAD), mainly when

patients were unable to get out of bed and perform perineal self-care. Incontinence-associated

dermatitis (IAD) is a skin condition caused by prolonged contact with urine and stool,

particularly liquid stool.

With the PICO created, CINAHL was used with major keywords, including dermatitis,

perineal, incontinence, skin care, wound healing, acute care, and additional keywords, including

emollient product evaluation. This search gave the result of the article "Effectiveness of skin

cleanser and protectant regimen on incontinence‐associated dermatitis outcomes in acute care

patients: A cluster randomized trial." The intervention chosen was skin protectant creams. In this

study, three interventions were tested, and each intervention was a combination of a skin cleanser

and a skin protectant along with this hospital's specific body wipe. Participants of this study were

all aged 21 years or older and diagnosed with Incontinence associated dermatitis (IAD) (Glass et

al., 2021). Treatment number one consisted of the skin cleanser (3M Cavilon No-Rinse Skin

Cleanser) and a moisturizer containing a liquid acrylic terpolymer skin protectant layer (Glass et

al., 2021). Treatment number two consisted of a different brand skin cleanser (Conveen

EasiCleanse) used with a zinc oxide-based barrier cream. Treatment number three was the

control group of the study, and it consisted of participants receiving the standard hospital care for

IAD management in which incontinence was removed using a body wipe, and hospital-issued

zinc oxide barrier cream was applied. The first two treatments were applied using the same

method. First the skin cleanser was sprayed onto the skin, body wipes were used to remove any

incontinence followed by application of the skin protectant (Glass et al., 2021). The article's title
accurately describes the content of the article by defining the intervention and the specific group

that will be receiving the treatment. The abstract presents a clear overview of the entire article

from introduction to conclusion. The introduction describes Incontinence Associated Dermatitis

(IAD), which is the condition that is presented as the main focus of the study and describes the

main strategies currently used for IAD management. In addition, the introduction provides an

overview of skin protectants, cleansers and the evidence that exists for the use of these products.

The purpose of this study was described as the aims of the study. The purpose was to examine

the effectiveness of two different skin cleansing and protectant regimes in promoting skin

healing from IAD and the prevention of further skin deterioration, comparing it against the

current method of IAD management. The research questions are not clearly defined; however,

readers can understand the questions attempted to be answered. Research questions should be

clearly defined to prevent the reader from guessing what the researchers were attempting to

answer. The importance of this particular research effort is to study the prevention and treatment

regimens for patients who are at higher risk for IAD due to the higher climate in Singapore.

Glass et al (2021) state "Current gaps in evidence, combined with the worrying prevalence

of IAD in the acute care environment, reinforce the need to investigate the effectiveness of

skin cleansing and protectant products in our acute care settings to ensure the provision of

optimal care for persons with IAD” (page number). There is no specific literature review, but

there is mention that this study is the first to evaluate the effectiveness of a cleanser and

protectant regimen specifically for IAD in a tropical climate. This study was conducted as an

open-label study where both health providers and patients know the treatment being given. This

method is appropriate because it is important for healthcare providers in a hospital setting to

remain transparent with their patients on their treatment. Patients were randomly assigned to one
of the three treatments using a software. The results are presented using flow charts and tables.

The statistics are explained clearly, with explanations for each treatment method studied. They

recommend "healthcare institutions to introduce a structured skin care regimen of skin cleaning

and protectant or any patients at risk of direct skin exposure to urinary, fecal, or dual

incontinence" (Glass et al., 2021). This regimen is significant to nurses because they would be

the primary provider putting these regimens into their practice. The main limitation mentioned

was the inability to reach the desired sample size due to the COVID-19 outbreak, which limited

access to the patients in the hospital. This study was conducted in a tertiary hospital, which

prevented a full seven-day long-term follow-up on the treatment patients. There are no specific

recommendations specifically written for nursing practice, future research or policymakers.

There is mention of the importance of implementing a structured skin care regimen that

emphasizes effective cleaning and skin protection which aids in IAD healing and prevents

further deterioration in skin integrity (Glass et al., 2021). Following this study, the researchers

outlined what should be studied in future research to better understand skin cleansing products so

that more effective products can be created.

Regarding the utilization, the article emphasizes that applying specialized skin cleansers

to incontinent matter like urine and feces after removing it with body wipes is better for skin

healing than using body wipes without a cleanser. When the article is posted, there is no better

structured skin care regimen of skin cleansing that is more effective in preventing IAD skin

deterioration, avoiding skin breakdown by lowering the risk of dermal irritation, and improving

skin conditions in promoting IAD healing. The pH-balanced formulation of the cleansers, in

particular, preserves the stratum corneum's natural acidity, which maintains tissue integrity,

repair damage caused by prolonged exposure to irritants, and results in IAD healing.
Furthermore, the surfactant content in the cleansers lowers surface tension and loosens urine and

fecal debris, reducing the risk of skin overhydration and frictional skin damage which disrupt the

skin barrier, cause inflammation and worsen IAD. As a result, these regimens could be included

in hospital skincare guidelines to help standardize practices for preventing and treating IAD.

Furthermore, easier spoilage removal from tender skin with the cleaners provide patients more

comfort compared to body wipes alone. Because of the weaker adhesion of skin products to

dampened skin, especially in high humidity and warm temperatures, the risk of poor skin healing

increases; thus, this skin cleansing programme is extremely beneficial to health care workers

caring for patients in these nations. (Glass et al., 2021). In short, using in combination a skin

cleanser and protectant is more effective compared to body wipes use alone with skin protectant,

which promote IAD healing (Glass et al., 2021). Patients who received either of the first two

treatments were approximately 3 and 3.4 times as likely to have IAD healing within seven days

compared with patients who received the control treatment (Glass et al., 2021).

For patients with moisture-associated skin damage (MASD), especially IAD, in

"Prevention and management of moisture-associated skin damage," David Voegeli and his

colleagues also propose using a structured skincare regimen, including the use of a gentle skin

cleanser, a protectant, known as barrier product, and moisturizer if prescribed (Voegeli, 2021).

Newer cleansing products combine a cleanser with a protectant and moisturizer and maintain pH

balance to help sustain the typical, slightly acidic skin pH. Following cleansing, the skin should

be protected with a skin protectant or barrier lotion against subsequent moisture contact.

Ordinary soap and water should be avoided since the pH of the soap is usually overly alkaline,

contributing to skin irritation. When skin is moist, it is more vulnerable to friction and shearing

forces, and skin flora can permeate the breached barrier, producing irritation and inflammation.
If left untreated, moisture-associated skin damage (MASD) can quickly develop to excoriation

and skin collapse (Voegeli & Hillery, 2021). Incontinence-associated dermatitis (IAD) is a skin

condition caused by prolonged contact with urine and stool, particularly liquid stool. Kim Van

Wissen (2019) also points out that soap and water are less helpful than a systematic intervention

programme that includes washing, cleansing, moisturizing, and protection in avoiding IAD.

Karen Nelson and her colleagues (2018) suggest that skin cleansing should be handled using an

appropriate foam or spray cleansing solution rather than soap and water when the skin comes

into contact with urine and feces. If foam and spray cleansing solution is not accessible, they

propose using a pH-neutral product like emollients as a soap alternative for skin cleansing

(Nelson, 2018). The regimen of a combined skin cleanser and skin protectant was shown to

promote healing thereby displaying the effectiveness of using this intervention. “The use of

specialised skin cleansers and body wipes in combination with a skin protectant may be more

effective for IAD healing, compared with the use of body wipes alone in combination with a skin

protectant” (Glass et al., 2021). Patients who received either of the first two treatments were

approximately 3 and 3.4 times as likely to have IAD healing within seven days compared with

patients who received the control treatment (Glass et al., 2021).

 References

Voegeli, D., & Hillery, S. (2021). Prevention (and management of moisture-associated skin

damage. British Journal of Nursing, 30(15), S40–S46. https://doi-

org.libaccess.senecacollege.ca/10.12968/bjon.2021.30.15.S40