Pathway for the treatment of patients using incontinence pads
These guidelines are secondary to establishing and addressing the cause of the incontinence / excoriation
All of the recommended creams and films are safe with incontinence pads and do not block them from absorbing
DO NOT USE SOAP – only Hydromol ointment should be used as a soap substitute
NO SUDOCREM, CONOTRANE, VASELINE OR ZINC & CASTOR OIL
Skin Type / Clinical intervention / Product/ Healthy and intact, but patient uses incontinence pads on a regular basis
*Ensure that pads are correctly fastened/worn not just laid on the bed or chair / Prevention of damage:
Wash area at each pad change with warm water and Hydromol ointment, rinse properly
Put small amount of Hydromol ointment between palms of your hands and rub together until it becomes like an oil, then apply a thin layer to whole area
If this is not managing the skin step up to the next stage shown below. / Hydromol Ointment
/ Patient has incontinence or has an excessive sweating problem.
Healthy, intact skin but patient has been assessed as ‘at risk’ of skin damage secondary to moisture.
No erythema. / Prevention :
§ Maintain skin hygiene and emollients
§ Replace pads when indicated.
§ Establish & address the cause of the incontinence.
§ Only consider barrier product if patient has been assessed as at risk (e.g. faecal leakage, concordance issues with pad changing regime) / MEDI DERMA S barrier cream 2g
Sachet (x20)
Tube 90g
/ Simple moisture lesion
Skin is moist with diffuse erythema.
There is Superficial skin damage present.
This is not associated with pressure. / § 1st line -Cleanse using Hydromol Ointment as a soap substitute after every episode of incontinence.
If this fails to work:
§ 2nd line -apply barrier preparation after every 3rd wash
§ Manage cause of skin breakdown.
§ If unable to manage incontinence seek advice and support from bladder &bowel service
§ Refer to TV to aid management of skin.
§ Improve hydration to help combat concentrated urine / Medi derma S barrier film
1ml & 3ml foam applicators
/ Complicated moisture lesion
Spreading erythema.
Extensive excoriation.
Up to 50% of affected skin is broken.
Oozing / bleeding may be present.
High bacterial load is usually present.
There may be fungal involvement. / § Skin has been assessed as excoriated due to urine and/or faeces
§ Skin is in an inflammatory stage or has a high bacterial load but not infected
§ If unable to manage incontinence seek advice and support from bladder &bowel service
§ Refer to TV to aid management of skin
§ Improve hydration to help combat concentrated urine / Medihoney barrier cream
Sachets –2g
Tube -50g
(indicated for treatment of mild fungal infection).
If gross fungal infection consider antifungals.
Extra points:
1. Make sure you assess properly for incontinence pads and use the correct ones
2. Only use creams mentioned above – these are on the current formulary and are safe to use with incontinence pads, and will not damage skin. Remember CREAMS DO NOT PREVENT PRESSURE DAMAGE!
3. Promoting good nutrition and hydration improves skin condition, and extra hydration helps urine be less concentrated and therefore burn less
- Remember to re-position patients who are immobile to reduce the risk of pressure damage