The purpose of this nursing study is to examine the association between transepidermal water loss (TEWL) and skin surface pH in the development of perineal dermatitis in the elderly and to conduct a pilot intervention study to prevent perineal dermatitis. This study will answer the following research questions: (1) Is there a statistically significant difference in transepidermal water loss and skin surface pH levels between continent and incontinent elders? (2) Is there a statistically significant difference in transepidermal water loss and pH levels in urofecal incontinent elders versus elders with isolated incontinence? (3) Is there a statistically significant difference in the rate of developing perineal dermatitis for urofecal incontinent elders versus elders with isolated incontinence (urinary or fecal)? (4) Is there a statistically significant difference in the rate of developing perineal dermatitis depending on age, gender, length of time adult disposable briefs are worn per 24 hour period, number of incontinent episodes, number of times adult briefs are checked and changes, stool consistency, and role of the patient in reporting incontinence? (5) Does treating the skin with an acidic acid solution maintain the skin's pH at an acidic level (less than pH of 5.9), thus preventing perineal dermatitis in the elderly? A two phase prospective longitudinal clinical study will be conducted. In Phase I, both a between subjects (continent vs incontinent) and within subjects design (urinary, fecal, and urofecal incontinent) will be used. Two hundred and twenty subjects will be obtained using a consecutive series design at an urban medical center. Of the 220 subjects, 100 will be continent elders who will provide baseline data on transepidermal water loss and skin surface pH levels. The remaining subjects (120) will be incontinent and meet the general inclusion criteria. Perineal assessment and various skin measurements will be obtained three times per week. Descriptive statistics, three-way analysis of variance, and Cox regression analysis are planned to analyze the data in this phase. In Phase II a repeated measures double blind design will be conducted at an urban medical center. Sixty incontinent subjects will be obtained using a consecutive series design. After meeting the inclusion criteria, each subject will be randomly assigned to either the control group or the experimental group. The experimental group will receive an acidic acid skin wash rather than water prior to applying a moisturizer and moisture repellant. Each subject will be assessed five times a week for the development of perineal dermatitis. Only the principal investigator will know which subjects are receiving the acidic acid wash. Descriptive statistics and one-way analysis of variance will be used on this phase of the study. Results of this study are expected to provide valuable data on the pathogenesis and treatment of perineal dermatitis in the elderly. This study will also provide information to guide further intervention studies in an often-ignored problem in health care.
