40
WOUND CARE TODAY
2015,Vol 2, No 1
FOCUS ON MOISTURE LESIONS
i
S
kin damage as a result of
moisture remains difficult to
diagnose in clinical practice.
Yet there is increasing pressure to
ensure that staff are able to prevent
moisture damage and that it is
differentiated from pressure damage.
Many clinical commissioning groups
(CCGs) have set CQINs in relation
to pressure damage (CQINs, or
the Commissioning Quality and
Innovation payment framework,
enables commissioners to reward
good care by linking a proportion
of healthcare providers’ income to
the achievement of local quality
improvement goals). This could
result in financial penalties for health
services who see pressure ulcers
developing among their patients, thus
the distinction is an important one.
However, despite the attention
being paid at a strategic level,
the cost to the patient should not
be underestimated or forgotten.
Moisture lesions can develop into
Management of moisture-related
skin damage
are often misdiagnosed as such.
However, it is important that the
correct diagnosis and plan of care
is put in place as the treatment for
pressure ulcers and moisture lesions
differs, and even though they often
develop in isolation they can also
occur together. If both are present the
nurse must have a plan of care not
only for the pressure ulcer, but also
for the moisture lesion.
The treatment regimen for a
moisture lesion should improve
the skin rapidly (within hours).
However, pressure ulcer treatment
is usually slower and can take days
rather than hours.
Other causes
The excessive moisture associated
with moisture lesions is not only
derived from incontinence — it can
also be due to perspiration. Rush
(2009) found this was more prevalent
in bariatric patients. The importance
of selecting a surface that will not
cause the patient to sweat and the
use of fans to cool the patient will
help with this.
THE SKIN
The skin is the largest organ in the
body with many functions, including:
i
Protection
Rosie Callaghan, tissue viability nurse specialist,
Worcestershire Health and Care NHS Trust; Jackie
Stephen-Haynes, professor in tissue viability,
Professional Development Unit, Birmingham City
University and consultant nurse, Worcestershire
Health and Care NHS Trust
IN BRIEF
It is important to classify moisture lesions correctly. Treating them
as pressure ulcers not only results in failure to heal, it also causes a
great deal of discomfort and distress for patients.
The prevention of these lesions should be the key aim, with good
holistic assessment including skin and continence status.
Assessments should be revisited on regular basis, especially if the
patients’ health needs change.
KEY WORDS:
Moisture lesion
Assessment
Incontinence
Skin
Rosie Callaghan, Jackie Stephen-Haynes
very painful skin damage that in turn
can affect a patient’s social, physical
and psychological wellbeing (Fader et
al, 2008).
It is important to correctly
diagnose moisture lesions as failure
to do so will lead to the condition
worsening and further skin
breakdown. Consideration also needs
to be given to the increased potential
for pressure ulceration when
moisture damage occurs.
WHAT IS A MOISTURE LESION?
Gray et al (2007) describes the main
characteristics of moisture lesions
as erythema, erosion or loss of skin
barrier function and maceration.
Moisture lesions are also known as
incontinence-associated dermatitis.
Moisture lesions exhibit an
erosion of the epidermis and
maceration develops on the
surrounding skin. This is due to
the skin’s prolonged exposure
to excessive fluid because of
urinary incontinence and/or faecal
incontinence, perfuse sweating or
wound exudate (Maklebust and
Sieggreen, 1995).
Moisture lesions can easily be
mistaken for pressure ulcers and
