Ask the treatment expert: support for "open system" treatment of incontinent patients

Share this content:
Ask the treatment expert
Ask the treatment expert
Is leaving denuded skin or rash on the buttocks or perineal area “open to air” at night found to be helpful for healing among incontinent residents?

Clinical experience supports the “open system” for incontinence management while in bed or at night.
Studies have found that incontinence-related skin breakdown develops with prolonged exposure of the skin to perspiration, urine, stool or wound exudate. Absorptive containment devices such as an incontinence brief or pad create an occlusive, humid environment that raises the pH of the underlying skin and increases production of perspiration.

Normal pH of the skin is 4 – 5.5 (slightly acidic), which provides a protective barrier against external elements and bacteria. Exposure of skin to perspiration under an incontinent brief raises the skin pH to 7.1 (neutral) and exposure to urine or liquid stool increases skin ph to 8 or higher (alkaline). This rise in pH destroys the natural protective barrier of the skin, resulting in skin breakdown and susceptibility to bacterial invasion. Friction created by moving moist or saturated incontinence briefs or clothing over irritated skin also can result in actual skin breakdown.

For some patients, the “open to air” concept may be sufficient to facilitate skin repair. However for patients with extensive breakdown, the addition of topical treatment products such as petroleum, zinc oxide, or ointments with balsam of Peru, castor oil and trypsin also should be utilized.