Incontinence-associated Dermatitis Severity Research Articles

Incontinence-associated dermatitis: who is affected?

Intensive care unit (ICU) patients possess multiple risk factors for developing loss of skin integrity, particularly incontinence-associated dermatitis (IAD). IAD is an inflammatory skin condition resulting from repeated and prolonged contact with urine, faeces or both. This study aimed to measure the incidence and clinical characteristics of adult ICU patients with IAD. This was a prospective observational study conducted over three months in an adult ICU. Included patients were ≥18 years who experienced faecal incontinence during their intensive care admission. Patients were excluded if they had an ileostomy or colostomy, had IAD on admission, or were continent of urine and faeces. Skin inspections were performed every second day on all recruited patients by trained research nurses. Other data were collected from patient medical records. A total of 37 patients took part in the study. Incidence of IAD was 35.1%; 13 patients who had incontinence developed IAD. The mean time to onset of IAD was 3.69 days, median 3 days (SD: 1.8, range: 2-8 days). Of the 13 patients who developed IAD, 12 (92.3%) patients were initially assessed as having category 1 IAD and one (7.7%) patient was initially assessed with category 2 IAD. Of the patients with category 1 IAD, one patient (7.7%) progressed to category 2 IAD severity. A larger sample is recommended to fully explore ICU patient characteristics and IAD development. The incidence of IAD in ICU patients was high at 35%, indicating this condition requires due consideration in ICU patients.

Construction and application of digital protection system for incontinence-associated dermatitis based on earlier prevention

Objective To establish a digital protection system for incontinence-associated dermatitis based on earlier prevention to reduce the incidence of incontinence-associated dermatitis. Methods Based on the informationization of nursing platform, we run the digital protection system module of incontinence-related dermatitis based on the forward moving of the prevention gateway in Zhejiang Provincial People's Hospital. Through comparative study, 108 patients with incontinence and incontinence-related dermatitis from January to March 2018 were randomly selected as the pre-operation data, and 108 patients with incontinence and incontinence-related dermatitis from January to March 2019 as the post-operation data. The nurses of the two groups were observed and compared in terms of their assessment accuracy in patients' incontinence risk, position and Incontinence Associated Dermatitis Severity (IADS) , clinical staging, and implementation of prevention strategies. Meanwhile, the incidence of incontinence-related dermatitis among all inpatients in the hospital from January to March in 2018 was compared with the same period of 2019. Results After the operation of the digital protection system for incontinence-related dermatitis based on earlier prevention, the nursing staff's accuracy rate in the risk assessment of incontinence (χ2=38.095, P<0.01) , IADS (χ2=64.901, P<0.01) , clinical staging accuracy (χ2=42.424, P<0.01) and the implementation of protective measures (χ2=50.000, P<0.01) had significant statistical differences. The incidence of incontinence-related dermatitis in hospitalized patients decreased from 0.35% before operation to 0.06% after operation with statistical significance (χ2=41.031, P<0.01) . Conclusions The operation of the digital protection system for incontinence-associated dermatitis based on earlier prevention can reduce the incidence of incontinence-associated dermatitis and improve the prevention and management competence of nursing staff. Key words: Incontinence-associated dermatitis; Digitization; Prevention system; Earlier prevention; Specialty of wound, stoma and incontinence; Assessment; Prevention

Evaluation of Validity and Reliability of a Revised Incontinence-Associated Skin Damage Severity Instrument (IASD.D.2) by 3 Groups of Nursing Staff.

The purpose of this study was to evaluate a revised version of the Incontinence-Associated Skin Damage Severity instrument (IASD.D.2) using 3 different groups of nursing staff. Revisions to the instrument included renumbering 1 body area where incontinence-associated dermatitis (IAD) occurs into 2 areas (right and left), which raised the total possible score from 52 to 56, and defining the borders of the body areas. Observational, evaluative design. Five clinical experts certified in wound, ostomy, and/or continence (WOC) nursing evaluated content validity. Evaluators were attendees at the WOC Nurses (WOCN) Society 2014 conference, hospital nurses, and nursing staff at a nursing home. Evaluators were attendees at the WOCN Society's 2014 National Conference, hospital nurses at a community hospital with Magnet designation, and nursing staff at a skilled nursing home in the Midwestern United States. The evaluator group comprised 198 conference attendees (all nurses; age 53 ± 8.2 years, mean ± SD), 67 hospital nurses (age 37 ± 11 years), and 34 nursing home nursing staff (age 45 ±13.8 years). The majority of evaluators (>75%) in each of the groups were female. Clinical experts evaluated the content validity of the revised instrument. Evaluators scored 5 to 9 photographic cases using the revised instrument. Four of the cases were scored by all evaluators. The agreement of case scores among all evaluators was analyzed to assess interrater reliability. The scores of evaluators grouped by evaluators' self-identified skin color or nursing experience (<10 years vs ≥10 years) were also tested for differences. To provide evidence for criterion validity, the agreement of evaluators' scores with experts' scores (considered a "gold standard" in this study) was analyzed. The agreement of the IASD.D.2 scores among all evaluators within each group ranged from 0.74 to 0.79, suggesting good interrater reliability. The agreement of each group of evaluators with the experts for all case scores ranged from 0.82 to 0.85, suggesting good criterion validity. There was no significant difference in scores by evaluators' skin color or nursing experience. The revised IASD.D.2 has good content and criterion validity and interrater reliability. The instrument has potential to standardize reporting of IAD severity in research and clinical practice and assist communication about IAD among nursing staff.

Chinese localization and test on reliability and validity of Skin Condition Assessment Tool

Objective To localize Skin Condition Assessment Tool (SAT) in Chinese and test on the reliability and validity of scales. Methods Totally 50 incontinence associated dermatitis (IAD) patients who were admitted to Tianjin Medical University General Hospital between July and September 2016 were investigated and assessed in terms of their SAT reliability and validity. Results The validity of SAT re-test was 0.775; the correlation coefficient within the group was 0.977 (P<0.01) ; the Cronbach′sα coefficient which stands for internal consistency was 0.836; the content validity index (CVI) was 0.93; there was one common factor in factor analysis; and the accumulated variance contribution rate was 78.561%. Conclusions The Chinese version of SAT has less entries and is easy to use. Its result has sound reliability and validity, hence applicable to the assessment of IAD severity. Key words: Skin Condition Assessment Tool; Reliability; Validity; Incontinence associated dermatitis

Independent risk factors for the development of skin erosion due to incontinence (incontinence-associated dermatitis category 2) in nursing home residents: results from a multivariate binary regression analysis.

The aim of this study was to identify characteristics independently associated with a higher risk of developing skin damage because of incontinence [incontinence-associated dermatitis (IAD) category 2] in nursing home residents. As part of a larger randomised controlled trial, IAD incidence was monitored for 1 month in a sample of 381 incontinent residents using a validated IAD Severity Categorisation Tool. Data on demographical, physical, functional and psychological characteristics were collected. The overall IAD incidence (category 1-2) was 30·0%, and 6% of the participants developed skin damage (IAD category 2). Residents who developed IAD category 2 were less mobile [odds ratio (OR) 2·72, 95% confidence interval (CI) 1·06-6·94], had more friction and shear issues (OR 2·54; 95% CI 1·02-6·33) and had more erythema due to incontinence (OR 3·02; 95% CI 1·04-8·73) before IAD category 2 occurrence. Care providers should give full attention to risk factors to both detect residents at risk for IAD development and to start prevention in time.

The feasibility of integrating an evidence-based clinical guideline and the nursing information system for incontinence associated dermatitis patients in ICUs

Background: Incontinence associated dermatitis (IAD) occurs when urine or stool comes into contact with perineal or perigenital skin. IAD is a challenge for ICU nurses. There are several IAD care guidelines in the literature, but still remained in the paper stage. Objective: The aim of this study was to pilot test the feasibility of implementing the IAD clinical guidelines into the nursing information system (NIS) to improve prevention and care of IAD for ICU patients. Methods: A three stage designed research was conducted, in the first stage a systematic review was performed in accordance with the PRISMA and PICO guidelines to develop an evidence-based clinical guideline for IAD patients in ICU. Seven electronic databases were searched for clinical studies and guidelines, and the quality of included study was assessed using the Joanna Briggs Institutes’ appraisal tools. In the second stage, the research and nursing informatics team was formed and a computerized nursing record system was designed to integrate the guideline knowledge and NIS. In the third stage, evaluate the feasibility of the computerized nursing record system using a self-developed questionnaires based on the technology acceptance model for evaluating the nurses’ perception of the system, content validity was examined, and the reliability of the instrument was tested, and patients’ IAD prevalence rates was monitored. The participants in this stage were 4 adult ICU patients and nurses. Results: In stage one, 35 articles were reviewed by two independent reviewers, 12 articles met the inclusion criteria; 2 clinical guidelines, 4 randomized controlled trials, and 6 systematic reviews, data was extracted and synthesized by a research team. Based on the evidence combined with 2 stoma care experts’ opinions the draft recommendations and accompanying guideline was proposed. The draft document was reviewed and confirmed at 3 consensus meetings attended by 21 senior nurses from 4 ICUs. In this guideline included 4 domains that provided information about general information, assessment tools, severity, preventive and treatment strategies for IAD. In stage two, the system requirement analysis and design the IAD care flow based on the 5 steps of nursing process mainly included: (1) Perineal Risk Assessment Tool was used in the assessment stage (2) Incontinence Associated Dermatitis Severity (IADS) was used to analyse the IAD severity. (3) The linkage of severity stage in accordance with nursing care plan. (4) The preventive and treatment interventions in IAD nursing care plan were classified based on severity stages. (5) The outcome was evaluated using IADS. In stage three, after IRB approved, 63 ICU patients were recruited in this study, the prevalence rate was 17.4%. The nurses’ perception of the system was evaluated in 3 directions: (1) 79% nurses’ perceived the system were ease of use. (2) 85% nurses’ perceived the system were useful. (3) 88% nurses’ perceived the system were fit the task. Discussion/Conclusion: According to the results of this study, implementing the IAD clinical guidelines into (NIS) was practical to simplifying clinic working procedure and effective in communicating and documenting IAD nursing care information.

Clinical study of three kinds of nursing interventions for prevention of incontinence associated dermatitis in critically ill patients

Objective To study the effect of skin protective membrane, semi-transparent dressing and combination of the two in critically ill patients with incontinence associated dermatitis (IAD) skin protection. Methods A total of 114 patients who were admitted into ICU and NICU of Hebei Xingtai People's Hospital from December 2013 to November 2014 were selected. These subjects were divided into 3 groups randomly. All three groups received routine skin care, on this basis, skin protective membrane group (34 cases) used skin protective membrane for skin protection, semi-transparent dressing group (40 cases) adopted semi-permeable dressing for skin protection, while the combination group (40 cases) used skin protective membrane combined with semi-transparent dressing for skin protection. The incidence, occurrence and severity of IAD in the three groups were compared. Results The incidence rate of IAD in the combination group was 20.0% (8/40), 20.6% (7/34) in the skin protective membrane group, and significantly lower than 47.5% (19/40) in the semi-transparent dressing group, the difference was significant (χ2=9.201, P < 0.05). The occurrence time of IAD in the combination group was (4.75±0.46) days, which was significantly longer than those of the skin protective membrane group [(3.86±1.35) days] and the semi-transparent dressing group [(2.74±0.73) days], the difference was significant (F=17.120, P < 0.05). The IAD severity of the combination group scored 3.63 ±0.92, which was significantly lower than those of the skin protective membrane group (5.29±1.11) and the semi-transparent dressing group (6.74±1.79), the difference was significant (F=12.240, P <0.05). Conclusions Skin protective membrane combined with semi-transparent dressing have priority in decreasing IAD incidence rate, and delaying the occurrence time of IAD, and relieving the severity of IAD, which is better than either of the two. Key words: Nursing care, critically-ill patients; Incontinence associated dermatitis; Skin protective membrane; Semi-transparent dressing

Construction and application of nursing process preventing critical patients fromincontinence-associated dermatitis

Objective To construct nursing process for critically ill preventing incontinence-associated dermatitis(IAD), and provide theoretical basis for clinical nurses to prevent arising of IAD. Methods In basis of nursing procedure, preliminaryframework and entry pool of IAD-preventing nursing process were formed through evidence-based systematic evaluation and expert consulting, and a final content of the process was determined by a survey of 22 nursing specialists in Nantong with 2 rounds of expert consulting. The formatted process was applied in 88 hospitalized critically ill to prevent IAD from July to December in 2014. Results Nursing Process of IAD prevention for Critically ill patients was formatted, including 3 aspects: risk assessment of IAD, nursing management for IAD prevention and IAD severity assessing. IAD occurred to 4 out of 88 patients, of which the occurrence rate was 4.5%, which was lower than 25.7% of that before performing of the process. Conclusions The construction of nursing process preventing intensive care unit from Incontinence-associated dermatitis provides a relatively standardized theoretical basis for clinical nursing workers scientifically, feasibly and practicably. Key words: Incontinence-associated dermatitis; Critically ill patients; Prevention; Nursing process; Construction

Reliability and validity of the Chinese version of Incontinence-Associated Dermatitis Severity Instrument

Objective To translate the English version of Incontinence-Associated Dermatitis Severity Instrument (IADS ) into Chinese and to test its reliability and validity. Methods The IADS was introduced and localized with the permission by the author. A total of 60 patients who had IAD in the Affiliated Hospital of Nantong University from June to August 2012 were investigated. The internal consistency reliability, inter-rater reliability and content validity were used to evaluate the scale. Results The reliability and validity of IAD severity scale showed that Cronbach' α coefficient was 0.72; inter-rater correlation coefficient was 0.82, P<0.01; content validity ratio was 0.91. Conclusions The Chinese version of IADS was proved to be reliable and valid. It can be used to identify IAD and its severity and provide the basis for clinical intervention and dynamic assessment. Key words: Dermatitis; Incontinence; Severity; Reliability; Validity

Is it Feasible to Use Incontinence-Associated Dermatitis Assessment Tools in Routine Clinical Practice in the Long-term Care Setting?

To investigate the feasibility of using incontinence-associated dermatitis (IAD) tools in routine clinical practice by asking nursing home staff (RNs and non-RN caregivers) and tissue viability specialty (TVS) nurses to evaluate 3 instruments and a 4-point severity scoring system for describing and grading IAD examples captured in photographs of skin underneath absorptive pads in nursing home patients. Feasibility study. Twelve female nursing home residents whose incontinence was managed with pads and who had previously been identified as experiencing IAD were recruited, along with 16 nursing home staff (6 RNs and 10 non-RNs) and 10 TVS nurses. Weekly high-quality photographs were taken of the skin beneath absorptive pads of nursing home residents for 8 weeks yielding a library of 78 photographs. A subset of 10 representative photographs was chosen. The 16 nursing home staff and 10 TVS nurses were then asked to describe and grade the IAD in the 10 photographs using 3 IAD instruments and simple severity scoring system (SSS) developed for this study. Particular attention was paid to identifying any practical challenges staff encountered in conducting their task. The TVS nurses were able to use all 3 IAD instruments and the SSS and reported that they could incorporate them into their clinical practice with relative ease. Although the RNs were able to use the 3 instruments adequately with some initial assistance, they generally felt that they were too busy to complete them. By contrast, they reported that they found the SSS simple and quick enough to incorporate into their routine practice. The caregivers had difficulty with the text-based instruments, especially if English was not their first language, and they were only able to use the SSS. The caregivers' SSS scores for a given photograph varied more than TVS nurse scores, but the correlation between the mean TVS scores, which were operationally defined as the gold standard for purposes of this study, and the mean RN and caregiver scores (R = 0.811) were fairly high. Existing IAD instruments are too time-consuming and linguistically complex for use in routine clinical practice in nursing homes. We found that staff generally found the SSS easy to judge IAD severity based on pictures used in the study. This finding suggests that the SSS could be improved by adding reference photographs of skin illustrating each of the 4 points on the scale. Such an instrument could be designed and validated with an emphasis on integration into current clinical practice pathways.

Incontinence-Associated Dermatitis in Community-Dwelling Individuals With Fecal Incontinence

To describe the occurrence and severity of incontinence-associated dermatitis among community-dwelling individuals with fecal incontinence. Descriptive and comparative secondary data analysis. One hundred eighty-nine community-dwelling individuals with fecal incontinence who participated in a study comparing the effects of dietary fiber on fecal incontinence. A survey on the use of absorbent products that contained questions about subjects' history of skin damage was administered at the start of the study. Incontinence-associated dermatitis occurred in 52.5% of the community-living individuals with fecal incontinence. The severity of incontinence-associated dermatitis was mostly mild to moderate and occurred periodically. Redness without broken skin was the most common manifestation (68%). Most individuals (95%) reported the location of skin damage to be the anal/rectal area. Those with double incontinence also reported dermatitis around the vagina or penis. Individuals with a greater severity of fecal incontinence had a greater severity of incontinence-associated dermatitis (r = 0.27, P = .000). Both the frequency of incontinence (r = 0.23, P < .002) and the amount of feces leaked (r = 0.23, P < .002) had a significant correlation with incontinence-associated dermatitis severity. There were no significant differences in the occurrence or severity of incontinence-associated dermatitis by sex, age, or presence of double incontinence. A high percentage of individuals in the community with fecal incontinence suffer from incontinence-associated dermatitis at times. This population may benefit from consultation with a WOC nurse about prevention and management of incontinence-associated dermatitis.

Methods of Bowel Management in Critical Care

The purpose of this study was to compare 3 methods of bowel management to control fecal incontinence in adult critical care patients and their effect on incontinence-associated dermatitis, pressure ulcer prevalence, and clinician satisfaction. Fifty-nine adult patients in critical care with liquid fecal incontinence were recruited from 6 critical care units in a large Midwest healthcare system. Subjects were randomly assigned to 1 of 3 groups: bowel management system catheter, rectal/nasopharyngeal trumpet, or usual care. Subjects were assessed daily for incontinence-associated dermatitis, pressure ulcer prevalence, and other clinical data. Direct care nurse satisfaction with each method was evaluated by self-administered survey. Incontinence-associated dermatitis severity and pressure ulcer prevalence did not differ across groups at baseline. Over time, the change in incontinence-associated dermatitis severity score was significantly different across groups (P < .001). There were no significant differences in proportion of patients experiencing pressure ulcers during the study among groups. Clinicians reported significantly greater satisfaction with the bowel management system (P = .007) and rectal trumpet (P = .001) as compared to usual care. In addition, economic and safety benefits were identified with use of internal fecal devices. Specifically, an economic savings of $3100 to $3400 per 29 days of care was identified. Subjects experienced no adverse side effects when internal devices were used. Results of this randomized controlled trial provide new information for the care of patients with fecal incontinence in the critical care setting. Incontinence-associated dermatitis severity scores differed across groups over time, pressure ulcer prevalence did not differ across groups over time, use of an internal device or bowel management system improved clinician satisfaction, and the use of internal fecal methods was more cost-effective than usual care.

A 3-in-1 Perineal Care Washcloth Impregnated With Dimethicone 3% Versus Water and pH Neutral Soap to Prevent and Treat Incontinence-Associated Dermatitis

We compared the effectiveness of a 3-in-1 perineal care washcloth versus standard of care (water and pH neutral soap) to prevent and treat incontinence-associated dermatitis (IAD). The product under study was a soft, premoistened washcloth, including a 3% dimethicone formula, with cleansing, moisturizing, and barrier protection properties. Randomized, controlled clinical trial. The study sample comprised a random sample of 11 nursing home wards (6 experimental and 5 control) in a convenience sample of 4 nursing homes in Belgium. The sample included nursing home residents at risk for and/or affected by IAD defined as incontinent of urine, feces, urine/feces, and/or having erythema of the perineal skin (not caused by pressure/shear), and/or having an edematous skin in the genital area. Participants in the experimental group were treated according to a standardized protocol, including the use of a 3-in-1 perineal care washcloth impregnated with a 3% dimethicone skin protectant. Participants in the control group received perineal skin care with water and pH neutral soap, the standard of care in Belgian nursing homes. The study period was 120 days. Data were collected between February and May 2010. Incontinence-associated dermatitis prevalence and severity were assessed using the IAD Skin Condition Assessment Tool. The surface (cm), redness, and depth of the perineal lesion were assessed daily by the nurses. This tool generates a cumulative severity score (maximum score = 10) based on area of skin affected, degree of redness, and depth of erosion. Four hundred sixty-four nursing home residents were assessed and 32.9% (n = 141) met the criteria for inclusion, including 73 subjects in the experimental group and 68 in the control group. Baseline IAD prevalence was comparable in both groups (experimental: 22.3% vs control: 22.8%, P = .76). Baseline IAD severity was 6.9/10 in the experimental group and 7.3/10 in the control group. A significant intervention effect on IAD prevalence was found (experimental: 8.1% vs control: 27.1%, F = 3.1, P = .003). A nonsignificant effect on IAD severity could be determined (experimental: 3.8/10 vs control: 6.9/10, F = 0.8, P = .06). The use of a 3-in-1 washcloth, impregnated with a 3% dimethicone formula, resulted in a significantly reduced prevalence of IAD and a trend toward less severe lesions. These findings provide indicative evidence for the use of 3-in-1 perineal care washcloth as an effective intervention against the use of water and a pH neutral soap to prevent and/or treat IAD.