Urinary incontinence is a global health problem that is estimated to affect 14 million people of all ages in the UK while one in 10 of the UK population is thought to experience faecal incontinence (NHS England, 2018). Incontinence-associated dermatitis (IAD) occurs when the skin is exposed to urine and/or faeces (Beeckman et al, 2015).

People with IAD suffer from discomfort, pain, itching and a reduced quality of life (Ousey and O’Connor, 2017) and for clinicians and carers, IAD is challenging and time consuming to treat (Beeckman, 2017).

A structured skin care regimen is a fundamental part of caring for patients with IAD (Woo et al, 2017), and products that reduce the suffering of patients and simplify care are advantageous.
 

What is PROSHIELD◊ Skin Care?

PROSHIELD◊ Skin Care consists of two skin care products that are formulated for the prevention and management of IAD on both intact and injured skin (Meuleneire, 2010; Flynn and Williams, 2011; Maxwell and Sinclair, 2012; Wall and Vernon, 2016). PROSHIELD◊ Foam and Spray Skin Cleanser is used to remove urine and/or faeces from the skin, while PROSHIELD◊ Plus Skin Protectant protects the skin from injury, and restores moisture. Together, they fulfil the aims of an evidence-based skin care regimen — to cleanse, protect and restore (Beeckman et al, 2015).
 

1. PROSHIELD◊ Foam and Spray Skin Cleanser

The most important function of the skin is to act as a barrier to the external environment (Flanagan, 2020). The skin does this by maintaining a slightly acidic pH which deters micro-organisms from establishing infection and by producing natural oils that keep the skin healthy and supple so that it can function as an effective waterproof barrier (Beeckman et al, 2015). This finely balanced environment can be disrupted, however, by the use of some traditional soap products that alter the skin pH and strip it of essential oils resulting in dryness and irritation.
PROSHIELD◊ Foam and Spray Skin Cleanser has been formulated to be pH balanced and so maintains normal skin pH during use (Smith & Nephew, 2019a).

Traditional soap and some cleansers require water to rinse but PROSHIELD◊ Foam and Spray Skin Cleanser requires no rinsing (Flynn and Williams, 2011; Ling, 2011; Wall and Vernon, 2016) or the use of a separate moisturiser when used with PROSHIELD◊ PLUS Skin Protectant and therefore has the potential to reduce the number of steps needed in the skin care regimen of a person with incontinence.
PROSHIELD◊ Foam and Spray Skin Cleanser has both a foam and spray mode:
  • The foam helps to gently break down dried stool or hard to remove debris and is formulated to eliminate odour (Ling, 2011). Traditional soap and water can require vigorous rubbing, in order to remove dried stool and debris and this has the potential to further damage vulnerable skin (Beeckman et al, 2015). With PROSHIELD◊ Foam and Spray Skin Cleanser vigorous rubbing is not necessary
  • The spray is used to gently clean the affected area and is a no rinse formulation, which is considered best practice when managing incontinence (Beeckman et al, 2015).
Proshield product image

2. PROSHIELD◊ PLUS Skin Protectant

Following skin cleansing it is important to protect the skin from further damage and restore it to a healthy, balanced condition where injury has occured. Achieving these goals by using just one product is considered to be best practice for patients who are at high risk of, or have, IAD (Beeckman et al, 2015).

Skin care products are known to commonly cause an allergic or immune response, and it is usually ingredients such as perfumes and preservatives that are the cause (Penzer et al, 2012). PROSHIELD◊ PLUS Skin Protectant is a smooth, transparent*, viscous and fragrance-free ointment that does not contain any of the common allergens. Its transparency* is beneficial since it allows for skin observation and assessment (Smith & Nephew, 2019b,c,d).

An important consideration when selecting a skin protectant for patients with IAD is the effect it may have on the absorbency of continence products, such as pads. Dimethicone-containing products, such as PROSHIELD◊ PLUS Skin Protectant, are non-occlusive and so do not affect absorbency (Flynn and Williams, 2011; Ling, 2011; Meuleneire, 2011; Beeckman et al, 2015; Wall, 2016).

When PROSHIELD◊ Foam and Spray Skin Cleanser and PROSHIELD◊ PLUS Skin Protectant are used together they can help to prevent and protect the skin from IAD and moisture lesions and reduce the incidence of moisture lesions in people with IAD (Meuleneire, 2010; Flynn and Williams, 2011; Ling, 2011; Maxwell and Sinclair, 2012; Wall and Vernon, 2016).  

In the management of heavily exuding wounds, PROSHIELD◊ PLUS Skin Protectant can be used around the periwound area to help prevent skin damage (Hoggarth et al, 2005; Meuleneire, 2010; Flynn and Williams, 2011; Ling, 2011; Maxwell and Sinclair, 2012).  
 

How will PROSHIELD◊ Skin Care benefit me and my patients?

In summary, the main advantages of PROSHIELD◊ Foam and Spray Skin Cleanser and PROSHIELD◊ PLUS Skin Protectant are:
 
1. For the healthcare professional or carer:
  • A reduced number of steps in the skin-care regimen of a patient following an episode of incontinence
  • Transparent* ointment allowing skin observation and assessment
  • Potential for reduced numbers of moisture lesions in people with IAD
  • It can be used to help prevent peri-wound damage resulting from a high volume of exudate.
 
2. For the patient:
  • A reduction in pain and discomfort that is achieved by maintaining skin pH (Smith and Nephew, 2019a) and moisture barrier function (Shah et al, 1995)
  • Gentle cleansing that eliminates the need for vigorous rubbing.
 

What is the supporting clinical evidence for using PROSHIELD◊ Skin Care?

PROSHIELD◊ Foam and Spray Skin Cleanser and PROSHIELD◊ PLUS Skin Protectant adhere to best practice recommendations both in formulation and when used as part of a structured skin care regimen (Beeckman et al, 2015). A Cochrane review also found the management of IAD using a skin care product was more effective than not using one (Beeckman et al, 2016).
 
A number of studies have evaluated the use of PROSHIELD◊ Skin Care in clinical practice.
The efficacy of PROSHIELD◊ Skin Care when used on intact or injured skin was confirmed in an audit of ten patients with moisture lesions due to IAD (Meuleneire, 2010). The clinicians found it very easy to remove the ointment with PROSHIELD◊ Foam and Spray Skin Cleanser.

Flynn and Williams (2011) undertook a small user evaluation in an elderly group of patients who had skin damage following incontinence. They found using PROSHIELD◊ Skin Care in conjunction with effective pressure ulcer prevention and management resulted in improved skin condition.

Ling (2011) found in a small evaluation of nine patients that the use of PROSHIELD◊ Skin Care led to a rapid improvement in skin condition, a reduction in odour and patient reported pain and general improvement in the patient’s quality of life.    
      
Howers and Boyett (2012) undertook a large audit in 56 nursing homes over a three-month period. Before the evaluation started the staff took part in an education programme and product training. Ninety evaluation forms were analysed, and the authors concluded that following the use of PROSHIELD◊ Skin Care and in conjunction with education and product training, the products were easy to apply and remove, and led to positive patient feedback and a number of skin care benefits.

Wall and Vernon (2016) found a 26% reduction in pressure ulcers and/or IAD following a three-month evaluation of PROSHIELD◊ Skin Care when it was used as part of a skin care regimen and following a programme of education.
 
Further information and guidance
For further information and guidance on PROSHIELD◊ Skin Care, we can arrange for a Smith+Nephew representative to contact you. follow the following link:
www.smith-nephew.com/key-products/advanced-wound-management/proshield-skin-care/proshield-contact-us
*as demonstrated in vitro

References

Beeckman D, Campbell J, Campbell K, et al (2015) Proceedings of the Global IAD expert panel. Incontinence Associated Dermatitis: moving prevention forward. Wounds International, London. Available online www.woundsinternational.com  

Beeckman D, Van Damme N, Schoonhoven L, et al (2016) Interventions for preventing and treating incontinence-associated dermatitis in adults. Cochrane Database of Systematic Reviews, Issue 11. Art. No.: CD011627. DOI: 10.1002/14651858.CD011627.pub2  

Beeckman D (2017) A decade of research on incontinence-associated dermatitis: Evidence, knowledge gaps and next steps. J Tissue Viability 26(1): 47–56

Flanagan M (2020) Incontinence-associated dermatitis 2: assessment, diagnosis and management. Nurs Times [online] 116(4): 40-44

Flynn D, Williams S (2011) Barrier creams for skin breakdown. Nurs Residential Care 13(11): 553–8 

Hoggarth A, Waring M, Alexander J, Greenwood A, Callaghan T (2005) A Controlled, Three-Part Trial to Investigate the Barrier Function and Skin Hydration Properties of Six Skin Protectants. Ostomy Wound Manage 51(12): 30-42

Howers L, Boyett F (2012) Evaluation of Proshield Plus in nursing homes for inclusion onto formulary in a healthcare trust. Wounds UK poster presentation. Harrogate, UK

Ling L (2011) Proshield skin care protective system: A sequence of evaluations. Wounds UK poster presentation. Harrogate, UK

Maxwell J, Sinclair D (2012) Treatment of Moisture Lesions in Children. Paper presented at: European Wound Management Association; Vienna, Austria

Meuleneire F (2010) A new solution in the treatment of moisture lesions. European Pressure Ulcer Advisory Panel (EPUAP) poster presentation. Birmingham, UK: 1-3 September

NHS England (2018) Excellence in continence care: Practical guidance for commissioners, and leaders in health and social care. Available online: https://www.england.nhs.uk/wp-content/uploads/2018/07/excellence-in-continence-care.pdf  

Ousey K, O’Connor L (2017) Incontinence Associated Dermatitis Made Easy. Wounds UK 13(1): 1–6

Penzer R, et al (2012) Best practice in emollient therapy. A statement for healthcare professionals. Dermatological Nurs 11(4): S1-S19  

Shah S, Cornell M, Ward AJ (1995) Evaluation of moisture through skin protectant barriers by paper chromatography. Adv Skin Wound Care 8(4): 20–27

Smith & Nephew (2019a) Review of Certificate of Analysis for Proshield Foam & Spray Incontinence Cleanser. RD/19/024

Smith and Nephew (2019b) Verification Testing Report of Usability and Transparency for PROSHIELD PLUS Skin Protectant. U/064/R3

Smith & Nephew (2019c) Verification Testing Report of Usability and Transparency for PROSHIELD Plus Skin Protectant. U/064/R1

Smith & Nephew (2019d) Review of Certificate of Analysis for PROSHIELD Plus Skin Protectant. RD.19.016

Wall L, Vernon T (2016) Launch of a skin care regime to reduce the incidence of moisture associated skin damage. Poster presentation, Tissue Viability Society (TVS) conference, UK

Woo K, Beeckman D, Chakravarthy D (2017) Management of moisture-associated skin damage: A scoping review. Adv Skin Wound Care 30(11): 494-501

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