Absorbent Products and Skin Integrity in the Adult Incontinent Population

Paloma Garcia Duran, Sury Hacker, Sophia Jones, Amanda Mudge, and Kelsey Tolar

Sam Houston State University School of Nursing

Clinical Question
What are the effects of incontinence and the use of absorbent
products on skin integrity of patients in an inpatient setting?

Literature Review
Urinary incontinence increases with age and affects 46% to 72% nursing
home residents (Shigeta et al., 2010).
56 to 67 % of nursing home residents with urinary incontinence use
absorbent products, such as pads and briefs, as a urinary collection
strategy (Shigeta et al., 2010).
Skin damage, such as incontinence-associated dermatitis (IAD) and
pressure ulcers, is a common complication of pad use (Shigeta et al.,
2010).
Due to the decreasing cell replacement rates that occur with age, elderly
people have thinner skin, which increases the risk for skin breakdown
(Shigeta et al., 2010).
The prevalence rates of IAD varies between 5-50%, while the
prevalence of IAD and simultaneous use of diaper and absorbent pads is
prevalent in a 17% of the Japanese older patients with incontinence
(Sugama et al., 2012).
The cost of treating pressure ulcers is more than $10 billion per year to
Medicare, Medicaid, private insurance, and patients (Twersky et al.,
2012).

Method
Systematic Reviews,
Meta-Analysis, EBP
Guidelines
Randomized
Controlled
Trials
Controlled Trials
without
Randomization

Strong Evidence

Weak Evidence

Shigeta et al. (2010). Factors Influencing Intact Skin in

Women with Incontinence Using Absorbent Products:
Results of a Cross-sectional, Comparative Study.

controlled trial without randomization, fourth level of

hierarchy.

Sugama et al. (2012). Efficacy of an improved absorbent

pad on an incontinence-associated dermatitis in older
women: cluster randomized controlled trial.

Twersky et al. (2012). A Randomized, Controlled Study to

Assess the Effect of Silk-like Textiles and High-absorbency
Adult Incontinence Briefs on Pressure Ulcer Prevention.

Evaluation

Skin hydration and pH were significantly higher in the dual incontinent group
(both urine and feces) compared to only fecal incontinent group (Shigeta et al.,
2010).
Absorbent pad surface pH and excessive sweating were significantly related to
skin pH, and that a relationship between pad environment and skin integrity
was present (Shigeta et al., 2010).
The experimental group that received the new more absorbent pad, which
incorporates frontal absorption and a backflow prevention mechanism,
recovered from IAD significantly quicker than the control group (Sugama et
al., 2012).
Moisture content of the stratum corneum, nor skin pH, was significantly
different among the groups being compared on Sugama et al. (2012) study.
The number of adverse events between the experimental group receiving silklike linens and the control group was not significantly different, meaning that
silk-like linens did not increase the risk for falls (Twersky et al., 2012).
The experimental group using silk-like textiles and higher absorbent pads
developed less facility-acquired pressure ulcers than the control group
(Twersky et al., 2012).

More research is necessary because of several limitations of the studies.

Shigeta et al. (2010) studys limitations: (a) researchers fail to provide
methodological details and proof of reliability, (b) the sample size is
unclear and inadequate, (c) the perineal care method of the facility is not
evaluated nor considered as an extraneous variable, (d) the study only
focused on the effect of one type and brand of adult diapers, and (e) the
researchers excluded men from the study which limits the generalizability
of the study.
Sugama et al. (2012) studys limitations: (a) the lack of enough
experimental diapers for the study, and (b) interaction of treatment and
setting, due to the specific frequency, procedures, and skin care routines
determined by the care standards of the Japanese facility where the study
was taking place.
Twersky et al. (2012) studys limitations: (a) conflict of interest due to the
involvement and financial backing of the companies that produce the new
textile being analyzed, (b) lack of information to determine that the
instruments were valid and reliable to collect the data, and (c) the length of
the study, (d) the difference in the washing process between the control
and experimental textiles, (e) the lack of sampling randomization, (f) only
men participated in the study when target population were all residents of
the facility that served as platform for the study, and (g) the lack of
information regarding how perineal care was performed in the facility.

Decision about Practice

Cohort Studies or Case

Control Studies
Evidence from Systematic
Reviews of Descriptive and
Qualitative Studies
Evidence from the Opinion of
Authorities and/or Reports of Expert
Committees

Synthesis of Findings

randomized controlled trial, fifth level of hierarchy.

randomized controlled trial, fifth level of hierarchy.

Based on the research and strength of evidence, our clinical recommendation

is the use of silk-like textiles and highly absorbent products to protect the skin
integrity of the older incontinent adult population.
Closer assessment and monitoring of skin integrity in incontinent adult
population is recommended as a way to early detect the development of skin
breakdown.

Discussion
Many factors may contribute to a patient developing skin damage,
including the type of material of which the absorbent product is made,
cleansing techniques, frequency of changing briefs, skin pH, and excessive
sweating. These factors have to be taken into consideration in future
studies.
Researchers need to develop their studies carefully, which includes
evaluating the type of design, variables, population, and unpredictable
events.
More studies are necessary to develop EBP guidelines and such studies
should include participants from both genders.

References

Schmidt, N. A., & Brown, J. M. (2015). Evidence-based practice for nurses: Appraisal and application of
research (3rd ed). Sudbury, MA: Jones & Bartlett.
Shigeta, Y., Nakagami, G., Sanada, H., Konya, C., & Sugama, J. (2010). Factors influencing intact skin in
women with incontinence using absorbent products: Results of a cross-sectional, comparative study. Ostomy
Wound Management, 56(12), 26, 1-14. Retrieved from http://www.o-wm.com.ezproxy.shsu.edu/content/crosssectional-comparative-study-factors-influencing-intact-skin-women-incontinence
Sugama, J., Sanada, H., Shigeta, Y., Nakagami, G., & Konya, C. (2012). Efficacy of an improved absorbent pad
on incontinence associated dermatitis in older women: Cluster randomized controlled trial. BMC Geriatrics,
12(22), 17. doi:10.1186/147123181222
Twersky, J., Montgomery, T., Sloane, R., Weiner, M., Doyle, S., Mathur, K., ... & Schmader, K. (2012). A
randomized, controlled study to assess the effect of silk-like textiles and high-absorbency adult incontinence
briefs on pressure ulcer prevention. Ostomy Wound Management, 58(12), 18-24. Retrieved from
http://www.owm.com.ezproxy.shsu.edu/article/randomized-controlled-study-assess-effect-silk-textiles-and-highabsorbency-adult-incontinen