Moisture Associated. Skin Damage (MASD) Full Disclosure. Thank. Full Disclosure. Moisture Associated 3/20/2015
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1 Some Slides are Intentionally Left Blank Moisture Associated Skin Damage (MASD) Karen Lou Kennedy-Evans RN, FNP, APRN-BC Thank Catholic Health Wound Symposium Dr. Lee Ruotsi Julianne Nowak APN Full Disclosure RN 45 years FNP 41 years 40 Years in LTC Full Disclosure RN 45 years FNP 41 years 40 Years in LTC 1983 (32 years ago) Wound Care Team in LTC 1995 (20 years ago) First Incontinent Clinic Fort Wayne, IN Moisture Associated Skin Damage (MASD) 1. Incontinence Associated Dermatitis (IAD) 2. Intertriginous Dermatitis (ITD) 3. Periwound Moisture Associated Dermatitis 4. Peristomal Moisture Associated Dermatitis Gray et al J WOCN May/June
2 AKA Diaper Dermatitis Perineal Dermatitis Excoriation (Incorrect term) Denuding (Correct term) Irritant Dermatitis Allergic contact dermatitis Moisture Lesions Diaper Rash Moisture Associated Skin Damage (MASD) 1. Incontinence Associated Dermatitis (IAD) 2. Intertriginous Dermatitis (ITD) 3. Periwound Moisture Associated Dermatitis 4. Peristomal Moisture Associated Dermatitis Gray et al J WOCN May/June 2011 Educational Objectives Compare the difference between pressure ulcers and moisture associated skin damage and the treatment options for both. Moisture Control Problem Treat Moisture Problem Pressure Control Problem 2
3 Treat Pressure Problem Treat Pressure Problem Medical Issues Nutritional Issues Moisture Associated Skin Damage (MASD) Inflammation of the skin: with or without erosion or secondary cutaneous infection. Moisture Associated Skin Damage (MASD) Caused by prolonged exposure to various sources of moisture Urine, stool, perspiration, wound exudates, mucous, saliva and their contents. Gray et al J WOCN May/June 2011 Moisture Associated Skin Damage (MASD) Incontinence Associated Dermatitis (IAD) 1. Incontinence Associated Dermatitis (IAD) 2. Intertriginous Dermatitis (ITD) 3. Periwound Moisture Associated Dermatitis 4. Peristomal Moisture Associated Dermatitis Gray et al J WOCN May/June 2011 Inflammation of the skin that occurs when urine or stool comes into contact with perineal or perigenital skin. Gray et al J WOCN May/June
4 Think Sunburn! Color: Red, erythematous Skin Glissens Location: Area in contact with urine, stool or perspiration 4
5 Location: Area in contact with urine, stool or perspiration Depth: Superficial Location: Area in contact with urine, stool or perspiration Depth: Superficial Edges: Diffuse Location: Area in contact with urine, stool or perspiration Depth: Superficial Edges: Diffuse Blanches: Yes Multiple What looks like Stage II Small linear Irregular Borders Incontinent Not Perineal Dermatitis Perineal Area (2 Postage Stamps Would Cover) 5
6 Inflammation Glistens Toilet Paper Bright red in light skinned persons Due to serous exudate Kissing Lesions Linear Pressure Ulcer or IAD or MASD First Time Seen Day 14 6
7 Day 1 Day 9 Day 14 Satellite Lesions Islands in Front of the Coastline epuclas2 Day 7 Kissing Lesions 7
8 Yellow Slough Location, Location, Location Buttock Gluteal Fold/Cleft Inner Thighs Posterior Thighs Perineal Area Incontinent of Urine and Stool Scarring, deep tissue areas, multiple irregular/irregular borders, open areas, unilateral 9 3 Google: Fecal Incontinent Episode Fecal Incontinence 8
9 Wash Clothes Disposable Wash Clothes No-Rinse Spray Incontinent Cleansers KLKE Google: FIE Episode #1 two weeks ago Enough Supplies?? KLKE: Fecal Incontinent Episode 5 Wash Clothes 2 Bath Towels Disposable Brief 11 Pairs of Gloves 9
10 LTC F-tag 315 KLKE: Fecal Incontinent Episode Incontinence Adult brief Not diaper 2 Lighter Soiled 7 Heavily Soiled Clean Till Clear! Fecal Incontinent Episode 22/7/5 5 Lightly Contaminated Wash Clothes Fecal Incontinent Episode Incontinent Brief: Use to clean 22/7/5 22 Gloves 7 Heavily soiled wash clothes 5 Lighter soiled wash clothes 10
11 Clean! Clean? Guess NOT!!!! REALLY Clean This Time. Fecal Incontinent Episode Episode #1 two weeks ago Episode #2..the very next patient More clean brief space to use! 11
12 What s in the top drawer??? Dimethicone Emollient softens and moisturizes skin Zinc Based Antifungal Film Barriers: Polymer/Terpolymer Cyanoacrylates Liquid Skin Protectant/Medical Grade Glue 12
13 Moisture Associated Skin Damage (MASD) 1. Incontinence Associated Dermatitis (IAD) 2. Intertriginous Dermatitis (ITD) 3. Periwound Moisture Associated Dermatitis 4. Peristomal Moisture Associated Dermatitis Intertriginous Dermatitis In-ter-trig-i-nous (ITD) Gray et al J WOCN May/June 2011 Intertriginous Dermatitis Location Erythema and inflammation of the skin Inside and adjacent to skin folds, Sometimes accompanied by Erosion Denudation Caused by exposure to Chronic perspiration. Gray M et al. Journal of Wound, Ostomy & Continence Nursing 2011; 38(3): 233. Intertriginous Dermatitis Moisture Control Problem SKIN FOLD High Volume Perspiration Poor Evaporation Gray M et al. Journal of Wound, Ostomy & Continence Nursing 2011; 38(3):
14 LOCATION LOCATION LOCATION Skin Fold Gluteal Cleft Moisture Control Problem TUCSON BUTT Pressure Ulcer Location Gaymar Pictorial Guide 14
15 Larger Skin Folds in Larger People Skin Fold Neck Upper back Flank Upper-medial thigh Posterior legs Ankles Any skin fold Thin patients Groin Under the breast Any Skin Fold Intertriginous Dermatitis Sometimes Under the arm Left Breast Left Breast Moisture Control Problem Skin Fold 15
16 Kissing Lesions Kissing Lesions Intertriginous Dermatitis Recurrent Intertrigal Injuries Upper Thigh Skin Folds Courtesy: KL Kennedy LLC Gently lift up skin folds to prevent recurrent tear injury. Recurrent Intertrigal Injuries Multiple Skin Folds 16
17 Skin Folds (9) From Knee Down Moisturize!!!!! Grade II: Covers mons pubis Skin Inspection LOOK! INSPECTION You can t see what you don t look at! Ya Need to See! Skin Fold Cleansing PAT Do NOT rub 17
18 Prevention and Treatment of moisture Silver impregnated fabrics Translocates moisture Prevention and Treatment Moisture, Shear and Friction Drag sacrum and heels getting in and out of bed. Consider using silk-like fabrics rather than cotton or cotton-blend fabrics to reduce shear and friction. Strength of Evidence = B p. 76 Clinical Practice Guideline Translocation of moisture National Pressure Ulcer Advisory Panel Treatment Absorbent fabric Translocates moisture Absorbent disposable sheets Collects, absorbs and retains skin-fold moisture Absorbent bed linens Reduces/Absorbs moisture Blackett et al. Journal of Wound, Ostomy & Continence Nursing 2011; 38(2): Skin Fold Upper Inner Thigh 18
19 Moisture Control Problem Complex Problem Differential Diagnosis Remains A Challenge Umpire: I call them the way I see them. I see them the way I call them. They ARE the way I call them. Pressure Ulcer (MASD) Dr. William Eaglestein WOCN/HBC Moisture Associated Skin Damage (MASD) 1. Incontinence Associated Dermatitis (IAD) 2. Intertriginous Dermatitis (ITD) 3. Periwound Moisture Associated Dermatitis 4. Peristomal Moisture Associated Dermatitis Gray et al J WOCN May/June
20 MASD 3 Part Series 2011 Incontinence Associated Dermatitis (IAD) Best Practice for Clinicians Moisture-Associated Skin Damage: Overview & Pathophysiology J WOCN May/June 2011 Incontinence-Associated Dermatitis and Intertriginous Dermatitis J WOCN July/August 2011 Peristomal Moisture-Associated Dermatitis and Periwound Moisture-Associated Dermatitis J WOCN September/October 2011 Wound, Ostomy and Continence Nursing Society Published 10/14/2011 Moisture Control Issue Go Green Questions? 20
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