The skin performs a variety of important physiologic roles including protection from environmental exposure, preservation of internal homeostasis and thermoregulation amongst others. [Gray, 2011]
Moisture-associated skin damage (MASD) pathophysiology is related to both recurrent chemical and physical irritation to the skin barrier, triggering inflammation and subsequent skin damage. Multiple factors have a negative impact on the skin barrier function, including chemical irritants in urine and feces, changes in
skin surface pH, associated microorganisms, repeated skin cleansing activities, an occlusive perineal environment (due to the use of incontinence pads), and mechanical factors such as friction.
Exposure to moisture affects the integrity of the outermost layer of the skin which makes the skin more vulnerable to friction and skin tears. [Bostan, 2019]
Prevention and treatment of MASD include the removal of occlusive conditions, gentle skin cleansing, skin protection, and the application of therapeutic ointments. [Collier, 2016; Lumbers, 2019] However, moisture management at the skin cushion interface should not only focus on personal hygiene but also on moving moisture away from the skin cushion interface. This is due to the fact that support surfaces with a microclimate management function show significantly lower skin hydration levels. [Denzinger, 2020]
Vicair O2 cushions, which have a perforated liner, are effective in moving away moisture from the skin cushion interface. This effect becomes even more apparent when a top cover is used. The dissipation of moisture by the Vicair O2 cushions is so effective, that within 1hr, wet spots appeared on the surface underneath the cushion. [Call, 2016 (unpublished)]
Wheelchair cushions are often covered with incontinence covers to protect the cushion against moisture. However, prolonged exposure to moisture makes the skin more vulnerable for MASD and pressure injury development. Therefore, the focus should be shifted from protecting the cushion against moisture to protecting the wheelchair user against moisture to prevent MASD and pressure injury development.