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Time of Onset to Changes in Skin Condition During Exposure to Synthetic Urine

A Prospective Study

Phipps, LeeAnn; Gray, Mikel; Call, Evan

Journal of Wound Ostomy & Continence Nursing: July/August 2019 - Volume 46 - Issue 4 - p 315–320
doi: 10.1097/WON.0000000000000549
Continence Care

PURPOSE: The purpose of this study was to evaluate the impact of incontinence on epithelial-moisture barrier function and the subsequent risk for incontinence-associated dermatitis by exposing healthy volunteers to a premium incontinence pad wet with synthetic urine.

DESIGN: Prospective, single-group study.

PARTICIPANTS AND SETTING: Thirty women 65 years or older participated in the study. Participants had healthy skin of the buttocks, perineal, and perigenital areas and were not incontinent of urine or stool. The study was conducted at a contracted clinical research facility in Southeastern United States.

METHODS: Four hundred milliliters of synthetic urine was distributed across the width of a premium incontinence pad with wicking technology containing a superabsorbent polymer core. Participants laid supine for a total of 4 hours, with the wet pad under the buttocks. Skin assessments were conducted at baseline prior to contact with the wet pad, at 15 minutes, 30 minutes, and 1, 2, and 4 hours after exposure to the synthetic urine. Outcome measures were skin moisture content, cutaneous pH, transepidermal water loss (TEWL), mean coefficient of friction values (static and dynamic), and tolerability evaluations (expert clinical grader–assessed erythema and participant-assessed discomfort).

RESULTS: Mean moisture content of the skin increased from 46.19 ± 22.1 to 1845.28 ± 542.7 micro-Siemens (μS) after just 15 minutes of exposure and was significantly increased at all time points compared to baseline (P < .001). Cutaneous pH increased from 5.67 ± 0.5 to 6.25 ± 0.1 after 15 minutes; pH was higher at all time points compared to baseline (P < .001). Passive transfer of water through the stratum corneum (TEWL) showed an increase from 9.02 ± 2.2 g/m2/h at baseline to 16.83 ± 5.2 g/m2/h at 4 hours (P < .001). There was a significant increase from baseline to 4 hours in mean coefficient of static friction (0.32 ± 0.01 vs 0.47 ± 0.03; P < .00001) as well as mean coefficient of dynamic friction (0.29 ± 0.01 vs 0.42 ± 0.02; P < .00001). There was a significant increase in erythema and an increase in participant-assessed discomfort at all time points (P < .005).

CONCLUSIONS: Our findings suggest that impairment of the skin's epithelial-moisture barrier function associated with inflammation and development of incontinence-associated dermatitis begins rapidly after an incontinence event, even with the use of a premium pad with wicking technology. Study findings also suggest that prompt attention to incontinence events is needed to prevent moisture-associated skin damage (incontinence-associated dermatitis) even when absorbent pads are used.

LeeAnn Phipps, PhD, Hillrom Inc, Chicago, Illinois.

Mikel Gray, PhD, APRN, FNP-BC, PNP-BC, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, Charlottesville.

Evan Call, MS, CSM-NRM, Weber State University, Ogden, Utah.

Correspondence: LeeAnn Phipps, PhD, Hillrom Inc, 130 E Randolph St, Ste 1000, Chicago, IL 60601 (

Disclosure: LeeAnn Phipps, Mikel Gray, and Evan Call are clinical consultants of Hillrom.

© 2019 by the Wound, Ostomy and Continence Nurses Society.