59.1 Use of an enzyme enhanced antifungal* to treat damaged and contaminated perineal skin

Ann Marie Brinton, RN, CWOCN, MSN; Laura K.S. Parnell, MS, CWS; Advanced Practice Consultants, El Camino Village, Calif, and Precision Consulting, Missouri City, Tex

Although incontinence induced perineal skin damage is painful and preventable, it is prevalent. ICU patients have complex health issues and skin care is often overlooked. To further complicate matters, little research is available documenting extrinsic factors affecting the skin and optimal treatment in adults.

Seven ICU and medical/surgical patients with urofecal incontinence were evaluated for treatment and management in addition to previous catheterization. Polymicrobic cultures of Candida albicans and Clostridium difficile, VRE, or MRSA were documented for each person. At the first evaluation, the skin was extremely painful, erythematous, and partially denuded. Patients required various potent analgesics prior to cleaning. After each incontinence episode, foam cleanser was used, followed by an application of enzyme-enhanced antifungal*.

Dramatic improvement in skin inflammation, erythema, edema, and pain was seen within 12Ð24 hours of the initial application of enzyme enhanced antifungal*. Analgesic use quickly decreased and patient cooperation increased. Photos show marked improvement in skin condition. Given the tremendous amount of tissue damage, rapid resolution of inflammation was unexpected and unprecedented. Once the skin healed, a barrier product was used for prevention.

These impressive observations may be partially explained by the enzymes inactivating inflammatory mediators, thereby resolving inflammation. Further research comparing the use of enzyme-enhanced antifungal to antifungal is warranted to document the clinical differences including time to resolution as well as analgesic type and usage.

*Trivase, Swiss-American Products Inc., Dallas, Tex