Clinical Q&A: Paediatric Incontinence-Associated Dermatitis Best Practices

Medline Canada was proud to support and contribute to Canada’s first Best Practice Recommendations for Paediatric Incontinence-Associated Dermatitis (PIAD), published by Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC). Download the PIAD Best Practice Guideline, here.

We chatted with Shelley Masyoluk, a registered nurse, NSWOC, a Paediatric Community of Practice member, Medline’s Director of Clinical Engagement and a key contributor to the recommendations to help us better understand the work related to the PIAD recommendations.

What is PIAD? How often does it happen, and who is most impacted?

Paediatric Incontinence-Associated Dermatitis (PIAD) is an inflammatory skin reaction in the diaper area, also known as diaper rash. It’s caused by urine and feces irritating the skin, so when babies wear diapers, it can contribute to the development of incontinence-associated dermatitis. Since this condition is common, developing best practice recommendations was a priority.

Who is the team behind the recommendations?

NSWOCC is a community of registered nurses with specialized knowledge in wound, ostomy and continence. We are interested in skin conditions and improving them. The organization approached Medline Canada to help make the project happen, and we’re thankful to have received an unrestricted educational grant from the company.

It was great that Medline wanted to get involved with this project, as it was a new initiative — we currently don’t have national recommendations for PIAD in Canada. We’ll have a vast audience of NSWOCs, registered nurses, physicians, and other allied healthcare professionals working with neonates and children. We've been working on the recommendations for about two years.

Why was there a need to develop the recommendations?

The first objective of this project was to create a network of NSWOCs interested in paediatric wound, ostomy and continence. Secondly, we wanted to provide paediatric-related wound, ostomy and continence initiatives within our NSWOCC community and develop ongoing strategies aligning with our mission. Lastly, we wanted to identify areas for improvement in specialized wound, ostomy and continence paediatric care. Specifically, we wanted to explore the incontinence-associated dermatitis that affects infants and children older than 32 weeks of gestational age.

Can you explain some of the details of the recommendations?

We arrived at nine best-practice recommendations based on the evidence that we found. After reviewing 258 articles, we identified recommendations we thought were important based on the literature. Then the Delphi methodology was implemented – used to gain consensus – and finally, a peer review was done to assess the validity and quality of our work.

Our final document includes the following recommendations:

1. Complete a holistic assessment. Perform a head-to-toe assessment while considering the underlying etiology, pain, effectiveness of previous management and treatment strategies, and assessment of cultural practices.
2. Advocate a consistent approach for the prevention and treatment that addresses five components – cleansing, air, skin barrier, diapers and education.
3. Streamline skin care products within your health care organization, including skin cleansers, skin barrier creams and cleansing cloths. Review the rationale for skin barriers, ingredients to avoid and their accessibility and availability.
4. Define the recommended skincare regimen (usually 3-5 days) before reassessing unless the condition worsens. Examples include adverse reactions, new or persistent signs/symptoms of increasing infection/inflammation or pain.
5. Seek advice from an NSWOCC or a qualified wound care specialist if management strategies are not effective.
6. Add an antifungal if Candida is diagnosed. A prescription for these products may be required.
7. Standardize documentation and communication with all health care professionals, the child (if age appropriate) and their family.
8. Educate and collaborate with those involved in the care of the infant/child about the care plan for prevention and management. Provide ongoing education.
9. Refer to the Paediatric Incontinence-Associated Dermatitis (PIAD) quick reference guide for classification and management principles

How will the recommendations help address PIAD in treatment and care?

This is only the beginning. We have the recommendations — now we’re bringing them to those who can use them. Our primary audience will be pediatric hospitals, and the clinicians specialized in wound ostomy and continence who are treating babies in the hospital. But it's also parents and families with babies at the end of the day who will significantly benefit from these recommendations.

I think having the information consolidated and summarized onto one page (quick reference guide), accompanied by photos, will help. The QRG focuses on the key takeaways the nurses and other healthcare professionals working with infants and children need to know.

Download the PIAD Best Practice Recommendations here.