Incontinence Associated Dermatitis (IAD) and Pressure Injuries (PIs) are frequently occurring but largely preventable skin injuries. Many clinicians find it difficult to recognise the difference between IAD and PIs resulting in misdiagnosis and inappropriate treatment (Campbell, Gosley, Coleman, & Coyer, 2016).

IAD is inflammation of the skin because of incontinence and may be accompanied by redness, blistering, erosion of the skin, and secondary infection (Beeckman et al., 2015). IAD can be found wherever there is skin contact with urine and/or faeces. Individuals with faecal and urinary incontinence are at higher risk of developing IAD than those with urinary incontinence alone.

PIs are a localised injury to the skin and/or underlying soft tissue usually over a bony prominence or associated with a medical device (European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, & Pan Pacific Pressure Injury Alliance, 2019). They occur as a result of intense and/or prolonged pressure in combination with shear (European Pressure Ulcer Advisory Panel et al., 2019).

There are several key differences between IAD and PIs based on the history, symptoms, location, the shape or edge of the affected area, presentation or depth, and other characteristics (Dissemond et al., 2021). The main differentiator between IAD and PIs is the presence of urinary and/or faecal incontinence. If the individual does not have incontinence, then it is not considered IAD.

From the 1 April 2023, the Department of Health and Aged Care have added six additional quality indicators for residential aged care. In addition to reporting PIs, it will now be a mandatory requirement for facilities to report on the percentage of care recipients with IAD (Australian Government Department of Health and Ageing, 2022).

Preserving skin integrity is the best way to prevent IAD and PIs from occurring.

Written by Dr Michelle Gibb, founder of Wound Specialist Services.

References:

Australian Government Department of Health and Ageing. (2022). National Aged Care Mandatory Quality Indicator Program Manual 3.0 - Part A. Commonwealth of Australia

Beeckman, D., Campbell, J., Campbell, K., Chimentao, D., Coyer, F., Domansky, R., . . . Wang, L. (2015). Proceedings of hte Global IAD Expert Panel. Incontinence-associated dermatitis: moving prevention forward. Wounds International. Retrieved from www.woundsinternational.com

Campbell, J., Gosley, S., Coleman, K., & Coyer, F. (2016). Combining pressure injury and incontinence-associated dermatitis prevalence surveys: an effective protocol? Wound Practice and Research, 24(3), 170-177.

Dissemond, J., Assenheimer, B., Gerber, V., Hintner, M., Puntigam, M. J., Kolbig, N., . . . Kottner, J. (2021). Moisture-associated skin damage (MASD): A best practice recommendation from Wund-D.A.CH. J Dtsch Dermatol Ges, 19(6), 815-825. doi:10.1111/ddg.14388

European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, & Pan Pacific Pressure Injury Alliance. (2019). Prevention and Treatment of Pressure Injuries: Clinical Practice Guideline. The International Guideline. Retrieved from