title: Non-rinse skin cleansers: the way forward in preventing incontinence related moisture lesions?
abstract: OBJECTIVE
  The use of non-rinse skin cleansers in the care of patients who are at risk of tissue breakdown is not new within the National Health Service (NHS). Back to the Floor Continence Care Rounds (introduced in 2012 to facilitate bedside continence care education) at University Hospitals Birmingham had identified that in the current climate of austerity and efficiency savings, the use of non-rinse cleanser was being randomly rationed. Our objective was to determine whether the introduction of a smaller tube of non-rinse cleanser with targeted education would improve usage and ultimately improve the skin of incontinent patients.
  
  
  METHODS
  There were five clinical areas randomised into two groups. In group 1 three clinical areas were provided with targeted education and new sizes of tubes of non-rinse skin cleanser. In group 2, the two remaining clinical areas acted as control groups, one receiving targeted education only and the remaining had no education or new sized tubes. The incidence of incontinence associated moisture lesions from each clinical area was monitored for 13 weeks pre and post study period.
  
  
  RESULTS
  The in-depth study undertaken at University Hospitals Birmingham, over a 6-month period, confirmed a trend in staff committing to the ethos of prudency, and in turn compromising the use of the most effective treatment and prevention of incontinence associated moisture lesions. The ability of the Trust staff to recognise and respond to a change in practice and the responsiveness of a commercial provider to the proposed new methodology has resulted in a significant reduction in incontinence associated moisture lesions across the trust. The clinical areas included in the study demonstrated a 70-76.9% reduction in moisture lesion incidence compared to an 8.3-13.6% reduction in the control groups.
  
  
  CONCLUSIONS
  The results strongly suggest that a reduction in incontinence associated moisture lesions can be achieved by a simple change in nursing regime. The combination of solid education provision, alongside a more appropriate size of product, has demonstrated significant patient benefit, greater adherence in practice and a reduction in waste. The integrity of the patients' tissue was preserved and staff were satisfied with their input and the patients' progress. The outcomes of this study will have an impact on patient benefit and on the efficiency for trusts resulting in greater patient satisfaction and a more appropriate use of limited resources.
  
  
  BACKGROUND
  SCA provided 20ml tubes of TENA Wash Cream free of charge and the TENA Nurse Advisor for support during the education provision element of the study.
authors.affiliation: University Hospitals Birmingham NHS Foundation Trust.
authors.forename: F J
authors.initials: FJ
authors.lastname: Harries
authors.affiliation: University Hospitals Birmingham NHS Foundation Trust.|Professor and Honorary Research Fellow, The Royal Orthopaedic Hospital Birmingham NHS Foundation Trust.
authors.forename: P A
authors.initials: PA
authors.lastname: Begg
mesh_terms: D003879:Dermatologic Agents / Q000627:therapeutic use*; D003902:Detergents / Q000627:therapeutic use*; D005242:Fecal Incontinence / Q000150:complications; D006801:Humans; D017592:Skin Care / Q000379:methods*; D012871:Skin Diseases / Q000209:etiology / Q000517:prevention & control*; D012883:Skin Ulcer / Q000209:etiology / Q000517:prevention & control*; D014549:Urinary Incontinence / Q000150:complications
chemical_list: D003879:Dermatologic Agents; D003902:Detergents
keywords: education; incontinence; incontinence associated moisture lesions; non-rinse skin cleaners; pressure ulcers