Pather P, Hines S, Kynoch K, Coyer F, et al.
JBI database of systematic reviews and implementation reports. Date of publication 2017 May 1;volume 15(5):1473-1496.
1. JBI Database System Rev Implement Rep. 2017 May;15(5):1473-1496. doi:
10.11124/JBISRIR-2016-003015.
Effectiveness of topical skin products in the treatment and prevention of
incontinence-associated dermatitis: a systematic review.
Pather P(1), Hines S, Kynoch K, Coyer F.
Author information:
(1)1Nursing Research Centre and The Queensland Centre for Evidence-Based Nursing
and Midwifery: a Joanna Briggs Institute Centre of Excellence, Mater Health
Services, Brisbane, Australia 2School of Nursing, Queensland University of
Technology (QUT), Brisbane, Australia 3Intensive Care Services, Royal Brisbane
and Women's Hospital, Brisbane, Australia.
BACKGROUND: Incontinence-associated dermatitis (IAD) is inflammation of the skin
resulting from repeated contact with urine and/or feces. It causes pain,
redness, swelling and excoriation, and may lead to complications such as fungal
skin infections and pressure injuries. It is important to prevent and treat IAD
to avoid complications and improve patient outcomes. A number of products are
available for protecting skin, but evidence on their effectiveness is limited.
OBJECTIVES: The current review aimed to establish the effectiveness of topical
skin products in reducing the occurrence and/or severity of IAD.
INCLUSION CRITERIA TYPES OF PARTICIPANTS: Adult patients over the age of 18
years with incontinence and/or diarrhea.
TYPES OF INTERVENTION: Topical skin products as individual interventions or part
of a skin care regimen.
TYPES OF STUDIES: Both published and unpublished study designs including
randomized controlled trials, non-randomized controlled trials,
quasi-experimental, before and after, prospective and retrospective cohort,
case-control, analytical cross-sectional, descriptive study designs including
case series, individual case reports and descriptive cross-sectional studies
across all care settings for inclusion.
OUTCOMES: The primary outcome of interest was the absence or non-development,
reduction or resolution, new development or increase in the occurrence of IAD or
the increase in severity of IAD. The secondary outcome was any adverse effect
caused by the skin care products used.
SEARCH STRATEGY: A three-step search strategy to find both published and
unpublished papers was utilized in this review. Studies were limited to those
published in English from 1980 to 2016.
METHODOLOGICAL QUALITY: Papers selected were assessed by two independent
reviewers using the Joanna Briggs Institute Meta-Analysis of Statistics
Assessment and Review Instrument (JBI-MAStARI).
DATA EXTRACTION: Data were extracted using the standardized data extraction tool
in JBI-MAStARI. The data extracted included specific details about the
interventions, populations, study methods and outcomes.
DATA SYNTHESIS: Studies were assessed for methodological quality and statistical
significance to determine validity and generalizability of study results. It was
not possible to pool studies to conduct meta-analysis or test for heterogeneity.
RESULTS: There were a limited number of clinical trials that compared products
for efficacy in preventing and treating IAD. Assessment tools and severity
scores used to measure skin damage outcomes were dissimilar and prone to
subjectivity. It was difficult to ascertain superiority of any individual
product.
CONCLUSION: Information on barrier protective efficacy, side effects and cost
can be valuable to both clinicians and care providers. More randomized
controlled trials on product effectiveness for prevention and treatment of IAD
are highly recommended.
DOI: 10.11124/JBISRIR-2016-003015
PMID: 28498177 [Indexed for MEDLINE]
