• Healingpotentialissignificantlycompromisedinthecriticallyillandskindamagehasthepotentialtocreateseriousconsequencessuchasinfection1

• Evenminorskininjurycancreatediscomfortandpainandaddtopatientsuffering2,3,4

• Skindamageconstitutesanegativeclinicaloutcomeandapoorpatientexperience2

• Strengthenyourpressureinjurypreventionprogramandavoidcostsassociatedwithskindamage

Incontinence Skin Care Solutions in Critical Carefromthe3M™Cavilon™ProfessionalSkinProtectionRange

inCriticalCareSkinBreakdown

Preventing

Cavilon™

Incontinence Associated Dermatitis (IAD) in Critical Care

Up to 95% of incontinent patients in ICUwerefoundtohave

IncontinenceAssociated

Dermatitis5

FaecalincontinenceanddiarrhoeaareacommonprobleminIntensiveCareUnitsoccurringinuptohalfofcriticallyillpatients.6

Thereasonsincludemedications,lackoffibreintubefeedingformulas,physiologicalfactorsassociatedwithstress,criticalillnessordisturbancesingutfloracausedbyantibioticsandantacids.7Liquidstoolsarealsoassociatedwithmalabsorptionandcompromisednutrition,whichhasbeenassociatedwithanincreasedlikelihoodofIADinhospitalisedpatients.8

Faecesactasadirectchemicalirritanttotheskinanddiarrhoeagreatlyincreasestheriskofskindamageandsuchexposurecausesanirritantdermatitis.Itcanprogressrapidlytocompletelossofepidermisiftheskinisleftinadequatelyprotectedorfaecalmatterisnotdiverted.Microbialimbalanceisalsothoughttooccurwithchronicwetnessandfaecalincontinence.Opportunisticfungalinfectionmayoccur,furtherincreasingmorbidity.9Inaddition,pathogenictoxins,suchasthoseresultingfromClostridium difficileincreasetheriskforsecondaryinfectionsandskindamage.10

Less Risk/Severity of Damage Greater Risk/Severity of Damage

UrinaryIncontinence FaecalIncontinenceofLiquidStoolMixedIncontinence(Faecalandurinary)

Infrequentepisodes Frequentorcontinuousepisodes

Skinintact,healthy Skindamagepresent

Promptandeffectiveskincareafterincontinenceepisode Infrequentorinadequateskincare

Understanding and Assessing Risk of IAD 11,12

IncreasedRiskofPIFormation

Incontinence

Moisture

IncreasedFriction

IncreasedShear

IAD and the Link to Pressure Injury

Identify the RISK!PanPacificClinicalPracticeGuidelineforthePreventionandManagementofPressureInjury,(2012)statesthatanimperativeinthepreventionofpressureinjuriesistheassessmentandidentificationofpatients at riskandimplementation of an individualised prevention plan.13

A risk factor is any factor that either contributes to increased exposure of the skin to excessive pressure or diminishes the skin’s tolerance to pressure.

Moisture, friction and shear are identified extrinsic risk factors.13

Moisture–Moisturealtersresilienceoftheepidermistoexternalforcesbycausingmaceration,particularlywhentheskinisexposedforprolongedperiods.Moisturecanoccurduetoincontinence,woundexudateandperspiration.Someformsofmoisture,particularlyincontinence,createaddedriskbyexposingtheskintoamorealkalinepHwhichincreasesenzymaticactivity,irritation,potentialskinerosionandriskofsecondaryinfection.Wetskinismorelikelytosustainmechanicaldamagefromfriction.

Friction–Amechanicalforcethatoccurswhentwosurfacesmoveacrossoneanother,creatingresistancebetweentheskinandcontactsurface,thatleadstoshear.

Shear–Amechanicalforcecreatedfromaparallelloadthatcausesthebodytoslideagainstresistancebetweentheskinandacontactsurface.Theouterlayersoftheskinremainstationarywhiledeepfaciamoveswiththeskeletoncreatingdistortioninthebloodvesselsandlymphaticsystembetweenthedermisanddeepfacia.Thisleadstothrombosisandcapillaryocclusion.

Patients

with faecal incontinence

PressureInjury

are 22x morelikelytodevelopa

14

Frequentorcontinuousepisodes

Infrequentorinadequateskincare

Differentiation Between Pressure Injuries and Moisture Lesions15

TheassessmentofIAD,includingriskassessmentanddifferentiationfromotherformsofskindamagesuchaspressureinjuriesorskintears,remainsachallengeforbothexpertandnon-specialtynurses.11

ThemostclinicallyrelevantargumentfordifferentiatingIADversuspressureinjuryistheimpactofaccuratepreventionandtreatment.11

3www.epuap.orgDefloor T., et al, Differentiation between pressure ulcers and moisture lesions, European Pressure Ulcer Advisory Panel Reviews, Volume 6, Issue 3, 2005

Moisture Lesions vs Pressure UlcersDifferentiation Between Pressure Ulcers and Moisture Lesions

Moi

stur

e Le

sion

sM

oist

ure

Lesi

ons

Moi

stur

e Le

sion

s

Moi

stur

e Le

sion

sM

oist

ure

Lesi

ons

Moi

stur

e Le

sion

s

Pres

sure

Ulc

ers

Pres

sure

Ulc

ers

Pres

sure

Ulc

ers

Pres

sure

Ulc

ers

Pres

sure

Ulc

ers

Pres

sure

Ulc

ers

Location

Shape

Depth

Necrosis

Edges

Colour

A combination of moisture and friction may cause moisture lesions in skin folds, but most commonly they are present in the anal cleft.

Diffuse, different superficial spots are more likely to be moisture lesions. In a kissing ulcer (copy lesion) at least one of the wounds is most likely caused by moisture.

Moisture lesions are superficial (partial thickness skin loss). In cases where the moisture lesion gets infected, the depth and extent of the lesion can be enlarged.

There is no necrosis in a

moisture lesion.

Moisture lesions often have

diffuse or irregular edges

If redness is not uniformly

distributed, the lesion is likely to

be a moisture lesion.

A pressure ulcer is most likely to

occur over a bony prominence.

Circular wounds or wounds with

a regular shape are most likely

pressure ulcers, however, the

possibility of friction injury has to

be excluded.

Pressure ulcers vary in depth

depending on classification.

A black necrotic scab on a bony

prominence is a pressure ulcer

classification 3 or 4.

If the edges are distinct, the

lesion is most likely to be a

pressure ulcer.

If redness is non-blanchable, this is most likely a pressure ulcer. For people with darkly pigmented skin, persistent redness may manifest as blue or purple.

Moisture Lesions vs Pressure Ulcers A5 card.indd 1 13/7/11 09:59:45

www.epuap.orgDefloorT.,etal,Differentiationbetweenpressureulcersandmoisturelesions,EuropeanPressureUlcerAdvisoryPanelReviews,Volume6,issue3,2005.15

Factors Associated with Increased Risk of Pressure Injury13

Pan Pacific Clinical Practice Guideline for the Prevention and Management of Pressure Injury, (2012).13

Meeting the StandardsGovernmentsacrossAustraliaandNewZealandarelookingattheimplementationofsafetyandqualityinitiativestoimprovethequalityofhealthcare.AnexampleofthisisStandard8:PreventingandManagingPressureInjuriesfromtheNationalSafetyandQualityHealthServiceStandards,(2011).16

Standard8requireshealthserviceorganisationstohavegovernancestructuresandsystemsinplaceforthepreventionandmanagementofpressureinjuries,inparticular:

• Developingandimplementingpolicies,proceduresand/orprotocolsthatarebasedoncurrentbestpracticeguidelines,(Standard8.1)

• Undertakingqualityimprovementactivitiestoaddresssafetyrisksandmonitoringthesystemsthatpreventandmanagepressureinjuries,(Standard8.3)

• Conductingacomprehensiveskininspectionintimeframessetbybestpracticeguidelinesonpatientswithahighriskofdevelopingpressureinjuriesatpresentation,regularlyasclinicallyindicatedduringapatient’sadmissionandbeforedischarge(Standard8.6)

• Implementingandmonitoringpressureinjurypreventionplansandreviewingwhenclinicallyindicated(Standard8.7)

PressureInjuryRisk

Pressure

Impairedmobility

Moisture

Extrinsicfactors Intrinsicfactors

NutritionImpairedactivity

Shear Demographics

Skintemperature

Impairedsensoryperception

Friction Oxygendelivery

Chronicillness

Tissuetolerance

Reproduced with permission of AWMA. All rights reserved.

Prevention Makes Sense!Findingsfromastudythatlookedatthetimetodevelop,theseverityandtheriskfactorsofIncontinenceAssociatedDermatitis(IAD)amongstcriticallyillpatientswithfaecalincontinenceencouragedcriticalcarenursestoinstitute a defined skin care regimenforprevention and treatment of IAD for patients with faecal incontinence.9

Create and Implement an Effective Skin Damage Prevention Protocol with Cavilon No Sting Barrier Film

Cavilon No Sting Barrier Film is:• Fragrance-free,preservative-freeandlatexfree17

• Hypoallergenic17

• Non-cytotoxic17-canbeusedonintactanddamagedskin

• Costeffective4,18• Compatiblewithchlorhexidinegluconate17(CHG)and

povidoneiodine-willnotinterferewithantimicrobialprepsusedforpatientbathingoratinfusionsites

Aconsistentlyapplied,defined,orstructuredskincareregimenisrecommendedforpreventionandtreatmentofIAD.11

AssessforIADriskwhenperformingyourpressureinjuryriskassessment.

Ask for Cavilon No Sting Barrier FilmCavilon No Sting Barrier Film is like no other barrier film.Theproducts’unique3Mformulationcontainsablendofnotonebuttwopolymers,includingaTerpolymerandaHomopolymer(plasticizer).TheTerpolymerisderivedfromthreedistinctmonomers,thatprovidesaprotectivecoatingontheskin,creatingahighlyeffectivebarrier.TheHomopolymerenhancesthefilms’abilitytoflexwiththeskinandhelpstomaintainacontinuous,protectivecoating.Otherbarrierfilmscontainonlyonepolymerandsomeutilsealcoholasasolvent.

EarlymonitoringandpreventionofIAD,especiallyinpatientswithdiminishedcognitionorwithfrequentleakageoflooseorliquidfaeces,arerecommendedtopromoteskinhealth.9

Cavilon No Sting Barrier Film is an alcohol-free moisture barrier that forms a waterproof, flexible coating to protect the skin from body fluids, adhesives and friction. It is breathable and transparent allowing for continuous visualisation and monitoring of skin. It is flexible and conforms to the skin during movement or position changes.

Reduce or eliminate exposure to stool

Cleanse the skin with a pH balanced soap or liquid cleanser.

Protect the skin with Cavilon No Sting Barrier Film

Inonesimpleapplication,itcanhelpyoupreventIAD,damageduetofriction, moistureandadhesivetrauma.

Cavilon No Sting Barrier Film is versatile and meets the multiple skin protection

needs in critical care patients.

Protectionfromfaecalincontinence/diarrhoea

Pressureandfrictiondamagefromrespiratorydevices

Skinstrippingfromadhesives,e.g.centrallinedressings

Skinstrippingfromtapeusedtosecureendotrachealtubes

Damagetoskinaroundtracheostomyfromsecretions

Peritubedamagearoundleakingdrains

Radiationtherapy

IncontinenceAssociatedDermatitis(IAD)

Damagearoundfixators/pins

Frictionfromprosthesis

Frictiondamageoverelbowsandheels

Damageinskinfoldsfrommoistureandfriction

Frictionoverelbowsandheels

Skinstrippingfromadhesives:NPWT,tapes,dressings,ostomypouches

Damagefromwoundexudateorostomydrainage

damageduetofriction,

Ordering InformationCatalog No. Product Size Items/Box Boxes/Case

3343 3M™Cavilon™NoStingBarrierFilmCovers a 15cm x 15cm area

1.0mLwand 25 4

3344E 3M™Cavilon™NoStingBarrierFilmCovers a 12.5cm x 12.5cm area

1.0mLwipe 30 6

3344 3M™Cavilon™NoStingBarrierFilmCovers a 12.5cm x 12.5cm area

1.0mLwipe 25 4

3345 3M™Cavilon™NoStingBarrierFilmCovers a 25cm x 25cm area

3.0mLwand 25 4

3346 3M™Cavilon™NoStingBarrierFilm 28mLspray 12 1

(Australia Only)

(Australia Only)

(New Zealand Only)

Application of Cavilon No Sting Barrier FilmWhen used to protect the skin from incontinence in the critical care setting

reapply every 24 hours - For patients at higher risk of skin damage (e.g. constant diarrhoea stooling) more frequent applications (every 12 hours) may be necessary.

When used to protect skin from adhesive dressings, tapes or devices

reapply each time the dressing and/or adhesive product is changed.

When used for other skin protection needs such as peritube or periwound protection

reapply every 24 hours or as needed

3M and Cavilon are trademarks of 3M.Please recycle. © 3M 2013. All rights reserved.

Critical&ChronicCareSolutionsDivision3M New Zealand Limited94 Apollo Drive, Rosedale 0632Freephone 0800 80 81 82www.Cavilon.co.nz

Critical&ChronicCareSolutionsDivision3M Australia Pty. LimitedABN 90 000 100 096Building A, 1 Rivett RoadNorth Ryde NSW 2113Phone 1300 363 878www.Cavilon.com.au

Evidencebased:thereareover70piecesofclinicalevidencesupportingtheefficacyandcosteffectivenessofCavilonNoStingBarrierFilmformultipleclinicaluses,includingpreventionofIAD.Thisrepresentsmoreevidencethananyothermoisturebarrierorbarrierfilm.WithCavilonNostingBarrierFilmyoucanbeconfidentthatyouareprovidingevidencebasedcare.

ResourcesthatareavailabletoyouincriticalcareincludeICUProtocols,CavilonNoStingBarrierFilmClinicalEvidenceSummaries,PatientProductApplicationSheetsetc.TheseresourcescanbemadeavailabletoyoufromyourCritical&ChronicCareSolutionsDivisionTerritoryManager.

References

1. Williams,D.T.andHarding,K.(2003).HealingResponsesofSkinandMuscleinCriticalIllness.CriticalCareMedicine.31(8):s547–557

2. BestPracticeStatement.CareoftheOlderPerson’sSkin.London:WoundsUK,2012(Secondedition).

3. DoughtyD,JunkinJ,KurzP,SelekofJ,GrayM,FaderM,BlissDZ,BeeckmanD,LoganSIncontinence-AssociatedDermatitis:ConsensusStatements,Evidence-BasedGuidelinesforPreventionandTreatment,andCurrentChallenges.JWoundOstomyContinenceNurse.2012;39(3):303-315.

4. Bliss,D.Z,Zehrer,C.L,Savik,K,Smith,G&Hedblom,E.(2007).AnEconomicEvaluationofFourSkinDamagePreventionRegimensinNursingHomeResidentswithIncontinence.JournalofWoundOstomy&ContinenceNursing.34(2):143–152.

5. Peterson,K.J,Bliss,D.Z,Nelson,C&Savik,K.(2006).PracticesofNursesandNursingAssistantsinPreventingIncontinence–AssociatedDermatitisinAcutely/CriticallyIllPatients.AmericanJournalofCriticalCare.(Abstract).15(3):325

6. Patrick–Heselton,J.(2011).FaecalIncontinenceinCriticalIllness.NursingTimes.107(46):23–26

7. Ferrie,S.(2007).ManagingDiarrhoeainIntensiveCare.AustralianCriticalCare.20(1):7–13

8. Junkin,J.&Selecof,J.L.(2007).PrevalenceofIncontinenceandAssociatedSkinInjuryintheAcuteCareInpatient.JournalofWoundOstomy&ContinenceNursing.34(3):260–269

9. Bliss,D.Z,Savik,K,Thorson,M.A.L,Ehman,S.J,Lebak,K&Beilman,G.(2011).Incontinence–AssociatedDermatitisinCriticallyIllAdults:TimetoDevelop,SeverityandRiskFactors.JournalofWoundOstomy&ContinenceNursing.38(4):433–445

10.Black,J.M,Gray,M,Bliss,D.Z,Kennedy–Evans,K.L,Logan,S,Baharestani,M.M,Colwell,J.C,Goldberg,M&Ratcliff,C.R.(2011).MASDPart2:Incontinence–AssociatedDermatitisandIntertriginousDermatitis

11.Gray,M,Beeckman,D,Bliss,D.Z,Fader,M,Logan,S,Junkin,J,Selekof,J&Doughty,D.(2012)Incontinence–AssociatedDermatitis:AComprehensiveReviewandUpdate.JournalofWoundOstomy&ContinenceNursing.39(1):1–14

12.Beeckman,D,Schoonhove,L,Verhaeghe,S,Heyneman,A&Defloor,T.(2009).PreventionandTreatmentofIncontinence–AssociatedDermatitis:LiteratureReview.JournalofAdvancedNursing.65(6):1141–1153

13.AustralianWoundManagementAssociation.(2012).PanPacificClinicalPracticeGuidelineforthePreventionandManagementofPressureInjury.AWMA.CambridgePublishing,OsbournePark,WA

14.Maklebust,J&Magnan,M.(1994).RiskFactorsAssociatedwithhavingaPressureUlcer.ASecondaryDataAnalysis.AdvancesinWoundCare.7(6):25–42

15.DefloorT.,etal.(2005).Differentiationbetweenpressureulcersandmoisturelesions,EuropeanPressureUlcerAdvisoryPanelReviews.6(3).

16.AustralianCommissiononSafetyandQualityinHealthCare(ACSQHC).(September2011).NationalSafetyandQualityHealthServiceStandards,ACSQHC,Sydney.

17.3MDataonFile.18.Bale,S,Tebble,N,Jones,VandPrice,P.(2004).TheBenefitsofImplementingaNew

SkinCareProtocolinNursingHomes.JournalofTissueViability.14(2):44–50.