MAD as a Wet Hen: Incontinence Moisture Related Skin Damage

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by Cathy Milne APRN, MSN, BC-ANP/CS, CWOCN
Lisa Corbett APRN, MSN, BC-CS, CWOCN

It seems as if there are many idioms out there related to moisture. Most are not flattering, such as “Mad as a wet hen”. “Wet behind the ears” infers inexperience - much like a child who has not gained the neurophysiological mechanisms to gain continence.

Having to be around someone who is “acting like a wet blanket” sure can spoil a good time, as can an incontinence episode in a public place. The acquaintance, research article, or product described as “all wet” is simply wrong. We would have to agree with this last statement. It is plainly unjust to be wet from incontinence. Both fecal and urinary incontinence still do not get the attention they deserve. Recently, outcomes associated with all of these potentially devastating clinical entities are finally drawing the attention of some health care professionals.

Moisture-associated skin damage (MASD), previously known as moisture-associated dermatitis (MAD), is a broad term used for conditions caused by effluent on the skin. MAD/MASD is now an accepted clinical entity. These include the subcategories of incontinence associated dermatitis (IAD), intertriginous dermatitis (ITD), and peristomal- and periwound-moisture associated dermatitis (PS-MAD, PW-MAD). All are accompanied by an inflammatory skin reaction related to exposure to moisture in the form of wound exudate, feces, urine, saliva, sweat or mucus. As professionals we deal with these substances daily and, for the most part, believe we are doing well by the patients under our care as we aim to correct the underlying disorder spewing these offending agents onto their skin.

As most clinicians know, employing the same intervention in every clinical scenario doesn’t work. Yet, many times we do just that. Many times there is an overlapping of PS-MAD with PW-MAD. ITD and IAD frequently combine to become a mixed clinical entity. This calls for a tool kit of solutions that both health care professionals and our patients can use to remedy the issue. Once again, Kestrel’s IncontinenceSource is ahead of its time. For the past ten years, this has been the clinician’s go-to resource for the tools required for MASD diagnosis and management. From urodynamic equipment to moisture barriers, it’s an abundant wealth of what’s available in this specialty. More importantly, for those who are living with a MASD condition and are empowered to find a solution, IncontinenceSource allows our patients to find items that can enhance their quality of life, whether it is an absorbent product or a skin care item. Whoever said, “It’s a MAD, MAD, world” was not “all wet”, but rather lacked the means to fix it. Please welcome the 2012 edition of IncontinenceSource, available this month, and its companion site, IncontinenceSource.com and use these valuable resources in your practice.

About the Authors
Catherine T. Milne is the Clinical Editor of Incontinencesource, and is the co-owner of Connecticut Clinical Nursing Associates, a practice focusing on direct patient care, consultation, education and research in the fields of wound, ostomy and continence care.

Lisa Q. Corbett the Co-Clinical Editor of IncontinenceSource, and is an advanced practice nurse, board certified in wound, ostomy and continence care, whose role encompasses direct practice, consultation, research and education for patients in acute care, extended care, home care and clinic settings.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of IncontinenceSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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