Friction Between Human Skin and Incontinence Pads in the Presence of Topical Barrier Protection Treatments

This research project investigated skin friction in relation to skin damage in the skin-pad interface, which is relevant to those living with incontinence, as well as professionals in the medical community who seek to treat the condition. This is a common and debilitating skin condition, and the tribological behaviours of skin treatments for this condition are not well understood. An initial experimental study focussed on developing protocols to understand the properties of skin in an untreated and treated state. The results gave insights into skin hydration, roughness, deformation, and friction. This study evidenced the suitability of the protocols for in vivo testing, and highlighted relationships between skin moisture and stratum corneum roughness, moisture and friction, and deformation and friction. With the addition of skin treatments, it was found that glycerol and Vaseline both considerably increased the friction coefficient, whereas Cavilon did not. Cavilon also produced a more consistent friction response across all participants. In addition, it identified that Cavilon, an advanced formulation developed specifically to protect skin of those with incontinence, performed differently to glycerol and Vaseline. To put the experimental studies into context an online questionnaire was designed to reach a community of people living with incontinence to learn about their experiences of incontinence-associated dermatitis (IAD). Knowledge was gained into various management techniques, including choice of treatments and absorbent products. User-defined data about the skin-pad interface was collected, such as incontinence severity, symptoms of IAD, and bodily locations affected. The dataset helped to establish factors that impacted the severity levels of IAD, which aided in the development of a new question based diagnostic tool to categorise people according to the severity of IAD that they experienced. If made available for public use in the future, it could play a role in the early stages of diagnosis. The protocol from the first experimental study was adapted to assess tribological interactions in the skin-pad interface, with IAD specific skin treatments and different wetness conditions. In a wet-pad state Cavilon reduced friction, and had much lower dynamic and static coefficients of friction than the other barrier treatments (Sorbaderm Barrier Cream and the barrier spray). Cavilon provided stable friction coefficients in reciprocating sliding, whereas the other treatments, and untreated skin, did not display this unique characteristic. The barrier spray gave rise to high static friction coefficients, and exhibited the most stick-slip. Cavilon, Sorbaderm, and the barrier spray were all found to reduce directional differences in the static coefficient of friction; indicative of reduced shear loading. A number of strategies were identified by which skin protection can be realised. Recommendations applicable for use by clinicians and those living with incontinence to form part of a preventative management regime for IAD, with the hope of improving the lives of those living with incontinence