What is the treatment for moisture-associated skin damage (MASD) in hospitalized patients?

Treatment of Moisture-Associated Skin Damage (MASD) in Hospitalized Patients

The treatment for moisture-associated skin damage (MASD) in hospitalized patients should focus on a structured skin care regimen that includes gentle cleansing, application of moisture barriers, and addressing the underlying cause of excessive moisture.

Understanding MASD

MASD occurs when skin is exposed to prolonged or excessive moisture, leading to:

• Overhydration of the skin
• Maceration
• Disruption of the skin's protective acid mantle
• Increased vulnerability to irritants and microorganisms

MASD presents in four main forms:

1. Incontinence-associated dermatitis (IAD)
2. Periwound moisture-associated dermatitis
3. Intertriginous dermatitis (skin fold dermatitis)
4. Peristomal moisture-associated dermatitis

Assessment and Identification

Before treatment, proper assessment is essential:

• Identify the source of moisture (urine, stool, wound exudate, perspiration, etc.)
• Document location, extent, and severity of skin damage
• Differentiate MASD from pressure injuries or other skin conditions
• Consider using validated assessment tools like the Skin Moisture Alert Reporting Tool (S.M.A.R.T.) 1

Treatment Protocol

Step 1: Cleansing

• Clean affected skin gently using pH-balanced, non-irritating cleansers
• Use tepid water or saline for irrigation 2
• Pat dry or allow to air dry rather than rubbing 3
• For perineal areas, clean after each incontinent episode 3

Step 2: Protection

• Apply moisture barrier products:
  • Dimethicone-based barriers for mild cases 3
  • Petrolatum-based products (50% white soft paraffin with 50% liquid paraffin) for moderate cases 2
  • Zinc oxide preparations for more severe cases
• Apply barrier products after cleansing and drying the skin 3

Step 3: Management of Specific MASD Types

For incontinence-associated dermatitis:

• Implement a structured continence management plan
• Use absorbent products with wicking properties
• Consider fecal management systems for severe diarrhea

For periwound moisture-associated dermatitis:

• Select appropriate wound dressings that manage exudate effectively
• Apply barrier products to periwound skin
• Consider silver-containing products if signs of infection are present 2

For intertriginous dermatitis:

• Keep skin folds dry with absorbent products or moisture-wicking fabrics
• Consider antimicrobial powders for skin folds
• Avoid occlusive dressings in skin fold areas

For peristomal moisture-associated dermatitis:

• Ensure proper ostomy appliance fit
• Use barrier products around stoma
• Consider pouching system modifications if leakage occurs

Prevention Strategies

• Implement a regular skin inspection schedule
• Maintain optimal skin hydration without excessive moisture
• Use breathable materials for bedding and clothing
• Position patients to minimize skin-on-skin contact in fold areas
• Implement a structured skin care protocol for high-risk patients 1

Special Considerations for Hospitalized Patients

• Place patients on pressure-relieving mattresses to reduce friction and shear 2
• Maintain ambient room temperature between 25°C and 28°C to reduce perspiration 2
• Avoid adhesive dressings directly on fragile skin 2
• Change bed linens promptly when soiled or damp
• Document interventions and skin condition changes in medical records

Monitoring and Follow-up

• Reassess skin condition daily
• Adjust treatment plan based on skin response
• Document improvement or deterioration
• Consider consultation with wound care specialists for severe or non-responsive cases

Potential Complications

• Secondary cutaneous infections
• Pain and discomfort
• Progression to deeper tissue damage
• Decreased quality of life
• Extended hospital stay

By implementing this structured approach to MASD management, healthcare providers can effectively treat existing skin damage and prevent further complications in hospitalized patients 1, 4.