Incontinence-associated Dermatitis Research Articles

Incontinence-Associated Dermatitis-Like Skin Changes Induced by the Application of Absorbent Pads Containing Bacteria and Artificial Urine in Rats.

Incontinence-associated dermatitis (IAD) is one of the most serious complications in older people with incontinence. Controlling urine property in absorbent pads could be effective for preventing IAD caused by bacterial urine. However, no animal model has been established to evaluate their effectiveness. This study aimed to induce IAD-like skin changes using absorbent pads containing bacterial urine and to confirm their pathophysiology in rats. Hairless Wistar Yagi rats were divided into the bacteria-containing urine (BU) and the bacteria-free urine (U) groups. A 10-h-attachment of absorbent pads containing artificial urine with/without bacteria to the skin pretreated with sodium lauryl sulfate was performed repeatedly for 5 days. Macroscopic findings and skin barrier function were examined every day, and histological changes, inflammatory responses and bacterial quantification in tissue samples were examined on Day 5. The BU group exhibited significant skin redness from Day 3, significant elevation of transepidermal water loss from Day 1, and histological changes, including significantly thickened epidermis, abnormal keratinocyte differentiation and erythrocyte leakage. Inflammation, confirmed by higher myeloperoxidase-positive cells, elevated tumour necrosis factor-α expression, and vascular endothelial damage, indicated by CD31 and pentraxin 3-positive cells, were observed in the BU group. The bacterial quantification showed no significant difference between the groups. IAD-like skin changes including histological changes and inflammation were suggested to be caused by urine properties altered by bacteria. This study proposed a new animal model for evaluating the effectiveness of absorbent pads in controlling the urine properties of bacterial urine on preventing IAD.

Implementing a Hospital-Wide Programme Using iPARiHS to Prevent and Manage Incontinence-Associated Dermatitis and Improve Hospital-Acquired Pressure Injuries.

To outline the implementation of a hospital-wide programme using the Integrated Promoting Action on Research Implementation in Health Services framework to prevent and manage incontinence-associated dermatitis and improve hospital-acquired pressure injuries. This is an empirical research study using mixed methods. The study, conducted across surgical, medical and critical care wards between June and October 2023, aimed to address knowledge gaps, enhance clinical practice and evaluate the effectiveness of interventions. The implementation strategy included education modules, engagement of staff through focus groups and targeted interventions such as individualised toileting plans and structured skin care regimens. Data collection involved audits, incident reporting and clinician knowledge surveys. Findings indicate a reduction in hospital-acquired incontinence-associated dermatitis and pressure injuries postimplementation, with observed improvements in clinician knowledge. However, challenges including workload, skill mix and resource limitations were identified as barriers to implementation. The sustainability and scalability of the programme were emphasised, with ongoing monitoring and evaluation essential for long-term success. This study underscores the importance of evidence-based interventions, interdisciplinary collaboration and leadership support in improving patient outcomes and reducing healthcare costs associated with preventable skin injuries. Further research is needed to assess implementation in community settings and scale up interventions across healthcare networks. Analysing a hospital-wide programme using the Integrated Promoting Action on Research Implementation in Health Service framework to prevent and manage incontinence-associated dermatitis and improve hospital-acquired pressure injuries, could help identify the challenges for delivering patient-centred care. No patient or public involvement. To describe the implementation study, we referred to the StaRI Guideline. This intervention study was applied to the whole population and was therefore not a trial and did not require trial registration. The study was considered low risk and the Human Research Ethics Application (HREA) was approved.

EFFECT OF TWO DIFFERENT CARE PRODUCTS ON PREVENTION OF INCONTINENCE-ASSOCIATED DERMATITIS IN PATIENTS

EFFECT OF TWO DIFFERENT CARE PRODUCTS ON PREVENTION OF INCONTINENCE-ASSOCIATED DERMATITIS IN PATIENTS

Prevention and management of urinary incontinence-associated dermatitis: A systematic review

BackgroundTo prevent incontinence-associated dermatitis (IAD) and manage the treatment, the cause of IAD must be determined correctly and distinguished from other skin problems. IAD can be prevented with professional care. AimThis systematic review aims to systematically examine the methods used in the prevention and treatment of urinary incontinence-associated dermatitis. Materials and methodsThe PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) criteria were taken as the basis for creating the systematic review protocol and writing the article. In this systematic review, the scans are combinations of words and word groups determined by the MeSH (Medical Subject Headings) terms “incontinence”, “incontinence-associated dermatitis”, “prevention of urinary incontinence”, “treatment of urinary incontinence” and “randomized controlled”. Studies conducted in the last eight years were examined in the PubMed, Cochrane Library, Web of Science, and Scopus databases between January and March 2024. Studies were selected by determining inclusion and exclusion criteria according to the PICOS method and these studies included in the review were evaluated according to the Joanna Briggs Institute (JBI) critical evaluation lists according to their types. ResultsFive randomized controlled trials with a total of 644 participants were included in this systematic review. In all five studies included in the review, it was determined that pharmacological and non-pharmacological methods significantly reduced dermatitis associated with urinary incontinence. ConclusionIn the reviewed studies, it was observed that pharmacological and non-pharmacological methods had a positive effect on dermatitis in individuals with IAD. It is recommended to conduct more studies of high methodological quality, using larger sample groups, with different interventions and randomization and blinding methods, and examining the effectiveness of pharmacological and non-pharmacological methods in individuals with urinary incontinence-associated dermatitis.

Decreasing the rate of incontinence-associated dermatitis in intensive care units: A quality improvement project

PurposePatients in the intensive care unit (ICU) are at a high risk of developing incontinence-associated dermatitis (IAD), the incidence and severity of which are positively related to pressure injuries, thus affecting nursing quality indicators. This quality improvement project aimed to decrease the severity and incidence of IAD, with a focus on enhancing awareness among nursing staff. DesignThis 36-month project was implemented via the Plan-Do-Study-Act (PDSA) model. Subjectsand setting: Included staff members worked in the ICUs (central and emergency ICUs) at a Grade A tertiary hospital in Suzhou (South of Jiangsu), China. MethodsThe quality improvement project included three main procedures: (1) formulating and implementing a modified prevention and treatment nursing protocol for early structured skin care with perineum ventilation, formulating a guidance sheet for incontinence nursing care; (2) organizing training and assessments of theories and skills, including three special sections on incontinence care training (theoretical knowledge, project process, video watching), skills training for nursing staff, and an incontinence nursing workshop to engage and evaluate all staff; (3) annual analysis and discussion of nursing quality control. ResultsFollowing project completion, there was a decrease in the overall incidence of IAD. Moreover, ICU nurses may attach more importance/awareness to IAD. ConclusionsThis project successfully reduced the incidence of IAD among ICU patients.

Incontinence-associated dermatitis: a frequent and overlooked problem in older people

Incontinence-associated dermatitis: a frequent and overlooked problem in older people

Evaluating Intensive Care Nurses' Knowledge of Incontinence-Associated Dermatitis: A Multicenter Cross-sectional Study.

To determine the knowledge levels of nurses working in the ICU about incontinence-associated dermatitis (IAD). A descriptive cross-sectional study was conducted in adult ICUs at two private and three public hospitals in a province in Turkey. The study included 296 nurses who agreed to participate in the research. Researchers used the "Nurse Identification Form" and the "IAD Knowledge Test" to collect data on nurses' IAD knowledge. Data analysis included the use of percentage distribution and the Mann-Whitney U, Kruskal-Wallis, and Spearman correlation tests. The mean age of the nurses was 26.55 ± 3.89 years (range, 20-47 years), and the duration of working in the ICU was 2.71 ± 2.55 years (range, 1-22 years). Of the nurses, 183 (61.8%) worked in general ICUs. Of those, 69 (23.3%) received IAD training. Nurses achieved a 49.8% correct response rate on the IAD knowledge test. Nurses working in tertiary and general ICUs demonstrated higher IAD knowledge levels (Ps = .003 and .047, respectively). There were no relationships between age, career length, institution, ICU type, and IAD knowledge level. Nurses' knowledge level of IAD was low in intensive care. To remedy this, IAD should be added to intensive care nursing certificate programs as content, and the use of IAD risk assessment and diagnosis scales in ICUs should be expanded.

2143 Minimal ingredient wipes for geriatric care

Abstract Introduction Wipes are a practical solution for cleansing skin and widely used in children, neonates, and in geriatric care. Effective cleansing requires low liquid surface tension (<40 mN/m), and many wipes contain surfactants to achieve this [1, 2]. However, these compounds may cause dryness, itching, irritation, and inflammation [1]. Age-related degeneration in skin suppleness decreases skin viability, often leading to irritation and incontinence-associated dermatitis, especially in frail nursing home residents [3]. By utilising purification technology, it is possible to lower liquid surface tension for cleansing and mitigate negative skin reactions caused by surfactants and additives. One minimal ingredient surfactant-free wipe (SF-wipe) achieves a solution surface tension of <35 mN/m, facilitating effective cleansing without surfactants [2]. These SF-wipes demonstrated superior results in a prospective study where neonates experienced significantly fewer days of clinically significant irritant diaper dermatitis [4]. The aim of this exploratory study was to understand current behaviours around personal hygiene and attitude towards SF-wipes in nursing homes. Method Four nursing care homes (n = 71 residents) received SF-wipes to trial. Feedback on effects and usability was gathered through interviews and reported qualitatively. Results Nursing staff indicated that the SF-wipes were soft, non-drying, non-abrasive, and facilitated faster in-bed bathing versus previous methods. Using SF-wipes did not lead to skin irritation in most residents, though some experienced transient skin coldness after use. Conclusions The high prevalence of skin conditions like incontinence-associated dermatitis in nursing home residents [5] means SF-wipes may prove beneficial versus surfactant-containing wipes, mirroring findings in neonates. Further studies are needed to prove this.

Silicone dressing combined with topical oxygen therapy alleviates incontinence-associated dermatitis via NF-κB p65/STAT1 signaling pathway.

Incontinence-associated dermatitis (IAD) is a tough problem in clinical settings, not only increasing the risk of complications like catheter-related urinary tract infections and pressure ulcers in elderly and critically ill patients, but also prolonging hospital stays, raising hospital costs, and possibly leading to medical disputes. This study is aimed to evaluate the therapeutic effect of silicone dressing combined with topical oxygen therapy on IAD in a rat model. An IAD rat model induced by synthetic urine with trypsin was established. Hematoxylin & eosin staining was carried out to examine skin histology. Using immunofluorescence, the microvessel density in the affected skin tissues was determined. ELISA was performed to measure the concentrations of inflammatory cytokines and angiogenic factors in serum. The mRNA expression of EGF, PDGF, and VEGF was detected via qRT-PCR. Western blotting was employed to determine NF-κB p65/STAT1 pathway-related protein levels. Compared to single therapy, silicone dressing combined with topical oxygen therapy could significantly reduce the severity of IAD, improve skin histology, inhibit inflammation, and promote angiogenesis in IAD rat models. Additionally, the results showed that relatively speaking, the combined therapy suppressed the NF-κB p65/STAT1 signaling pathway more effectively. These findings indicated that silicone dressing combined with topical oxygen therapy can alleviate IAD through promoting wound healing and inhibiting inflammation via NF-κB p65/STAT1 signaling pathway in a rat model, which provided a theoretical basis for the prevention and treatment of IAD in clinic.

Patients' experience of incontinence and incontinence-associated dermatitis in hospital settings: a qualitative study.

To explore the experience of patients with incontinence and incontinence-associated dermatitis (IAD) in acute care hospitals and their family caregivers, including their perceptions and management, as well as the impact on their wellbeing. A qualitative exploratory study design was employed in 18 wards across six acute/subacute hospitals in New South Wales, Australia. Patients with incontinence (with or without IAD) were invited to participate. Where interviews were not possible with the patient, their family caregiver was invited to participate. Semi-structured interviews were conducted. There were 45 interviewees in the study; 41 were patients with incontinence (11 of whom had IAD) and four were family caregivers. The experience of incontinence was captured by three themes: 'incontinence interrupts every aspect of my life'; 'actively concealing and cloaking'; and 'perceived as irreversible'. Incontinence was expected by the patients at their age and did not come as a surprise. It was normalised and approached with stoicism. As such, patients self-managed their incontinence by developing strategies to ensure they avoided episodes of incontinence during their stay. Incontinence left patients feeling anxious, embarrassed and with a sense of shame, and they did not communicate these feelings, or engage with health professionals about their incontinence, nor did health professionals discuss their incontinence with them. There was a strong sense of resignation that incontinence was irreversible and nothing could be done to improve it. All participants displayed little knowledge of IAD. The experience of having IAD was characterised by the theme 'debilitating and desperate for relief' and was experienced as a particularly painful, itching and burning condition that left patients distressed and irritable. Patients with incontinence in acute settings required further education from health professionals to reduce the stigma of incontinence, and provide further support to manage their incontinence. Health professionals can also play a key role in educating patients about the risks of developing IAD and how it can be prevented.

Implementation of an external female urinary catheter strategy on prevention of skin breakdown in acute care: A quality improvement study.

To evaluate the incidence of skin-related complications attributable to incontinence-associated dermatitis (IAD) using an external female urinary catheter device strategy for urinary incontinent (UI) patients in acute care. Multicenter quality improvement study. Randomized allocation of two commercially available external female urinary catheter devices was used in hospitalized UI female patients. Daily nursing skin assessments were documented in the electronic health record before, during and after external catheter device application. Methods and results were reported following SQUIRE guidelines. Three hundred and eighty-one patients from 57 inpatient care units were included in the analysis. Both catheter devices were associated with an overall low risk (5 %) of new or worsening skin breakdown. The overall benefit of external catheters is most persuasive for skin integrity, rather than infection prevention. Significant negative outcomes are associated with UI patients. External female urinary catheters are a non-invasive alternative strategy to reduce exposure of regional skin to urine contamination and IAD-related skin complications. Use of external female urinary catheters in hospitalized UI female patients offers low risk (5%) of new or worsening overall skin breakdown. Hospitalized UI female patients were screened for external catheter device eligibility by the bedside nurse. The quality improvement review committee waved consent because the intervention was considered standard care.

Risk Factors for Incontinence-Associated Dermatitis in Critically Ill Patients with Incontinence: A Systematic Review and Meta-analysis.

This systematic review analyzed evidence related to risk factors for Incontinence Associated Dermatitis (IAD) in critically ill incontinent patients. Systematic review and meta-analysis. Eight databases, including PubMed, Embase, CINAHL, Cochrane Library, and Web of Science, were searched for studies published in the English language. The China National Knowledge Infrastructure, WanFang Data, and Chinese Scientific Journal Database were also searched for studies evaluating risk of IAD in critically ill incontinent patients published in the Chinese language. Twenty-four studies with moderate-to-high methodological quality were included. Significant risk factors for developing IAD were being older [odds ratio (OR)=1.06, 95% confidence interval (CI): 1.02-1.10, P =.007], fever (OR=2.57, 95% CI: 1.87-3.57, P <.00001), diagnosed with consciousness disorder (OR=5.70, 95% CI: 2.28-14.22, P =.0002), having higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR=1.71, 95% CI: 1.25-2.35, P =.0009), lower Braden score (OR=0.73, 95% CI: 0.56-0.96, P =.02), lower oxygen saturation (OR=2.76, 95% CI: 1.52-5.00, P =.0008), double incontinence (OR=4.10, 95% CI: 2.34-7.17, P <.00001), liquid stool (OR=6.55, 95% CI: 4.12-10.41, P <.00001), frequent incontinence (OR=1.21, 95% CI: 1.03-1.43, P =.02), and higher perineal assessment tool (PAT) score (OR=3.18, 95% CI: 1.76-5.76, P =.0001). Findings of this systematic review and meta-analysis suggest that healthcare providers should consider risk factors such as older age, fever, consciousness disorder, higher APACHE II score, lower Braden score and double incontinence matter when developing strategies for the prevention and management of IAD in critically ill incontinent patients.

Risk Factors for Incontinence-Associated Dermatitis in Critically Ill Patients with Incontinence: A Systematic Review and Meta-Analysis.

Risk Factors for Incontinence-Associated Dermatitis in Critically Ill Patients with Incontinence: A Systematic Review and Meta-Analysis.

ERRATUM: Knowledge of nursing staff before and after training on incontinence-associated dermatitis.

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Managing incontinence-associated dermatitis in the community: an overview.

Incontinence-associated dermatitis (IAD) is often treated a hygienic challenge, rather than a serious condition with potentially life-threatening consequences. More appropriate education on the management strategies specific to IAD is required, in order for personalised and effective care that reflects the critical nature of this condition to be provided. Francesca Ramadan provides an overview of the key elements of best practice in IAD management and treatment.

Impact of an evidence-based bundle on incontinence-associated dermatitis prevalence in hospital patients: A quasi-experimental translational study.

The study aimed to evaluate the effect of an intervention on the prevalence and severity of incontinence-associated dermatitis (IAD) in six hospitals in one state in Australia. This quasi-experimental pre-and post-study,conducted in 18 wards, was part of a larger implementation science study on incontinence-associated dermatitis. Skin and incontinence assessments were conducted on patients during February and March 2020 (pre-intervention) and July and August 2021 (post-intervention). The intervention comprised continence assessment and management, an education brochure for patients, family and caregivers on IAD, the Ghent Global IAD Categorisation Tool (GLOBIAD) and a skin care regime with patient skin protection measures (three-in-one barrier cream cloths, minimisation of bed protection layers, use of appropriate continence aid). A total of 1897 patients were assessed (pre-intervention = 964, post-intervention = 933). A total of 343 (35.6%) pre-intervention patients and 351 (37.6%) post-intervention patients had incontinence. The prevalence of hospital-acquired IAD was 6.71% in the pre-intervention group and 4.27% in the post-intervention group; a reduction of 36.3% (p = 0.159) despite higher patient acuity, prevalence of double incontinence and the COVID-19 pandemic in the post-intervention group compared with the pre-intervention group. Our multisite best practice IAD prevention and treatment intervention was able to reduce the prevalence and severity of hospital-acquired IAD, suggesting enduring effectiveness of the intervention.

Senior Baccalaureate Nursing Students’ Knowledge and Visual Differentiation Ability for the Pressure Injury Classification System and Incontinence-associated Dermatitis

Purpose: This study aimed to evaluate senior baccalaureate nursing students’ knowledge and visual differentiation ability for the pressure injury classification system (PICS) and incontinence-associated dermatitis (IAD).Methods: A cross-sectional survey was conducted using a paper-based questionnaire with 120 senior baccalaureate nursing students in South Korea. Data were collected using a knowledge test (KT) and a visual differentiation tool (VDT) based on 21 photographs with clinical information related to PICS and IAD.Results: Students had relatively high KT scores (62.6%), and low VDT scores (35.6%). Critical issues in this study were nursing students’ lack of an adequate visual differentiation ability to accurately assess the stage of pressure injury and IAD and their higher level of confusion in identifying unstageable, deep tissue injuries, and IAD compared to stage 1-4 injuries. Satisfaction with education (r=.20, p&lt;.05) and exposure to various teaching methods (r=.21, p&lt;.05) exhibited significant correlations with higher VDT scores.Conclusion: The findings of this study suggest that increasing students’ satisfaction with their education and applying various teaching methods can contribute to the improvement of visual differentiation ability in PICS.

Incontinence-associated dermatitis in older adults in residential care settings: a point prevalence study.

To identify, for the first time, the proportion of older adults in extended care settings in Ireland affected by IAD. Cross-sectional, multisite, point prevalence survey, across three community extended care settings for older people in Ireland. Two clinical nurse specialists, using the Scottish Excoriation and Moisture Related Skin Damage Tool, identified the presence of IAD through clinical observation and visual skin inspection. IAD prevalence was calculated for the total population and incontinent population sets using percentages and confidence intervals (CI). The prevalence of incontinence was 86.4% (n=165), a significantly higher proportion were female (P=0.003). The point prevalence of IAD across the total population and incontinent population was 11.5% (22/191; 95% CI, 7.4-19.9%) and 13.3% (22/164; 95% CI, 8.5-19.5%), respectively. Being incontinent was associated with being female, more dependent (Barthel), having possible cognitive impairment, poorer mobility (Braden and Waterlow) and a high risk of pressure ulcers (Waterlow). A logistic regression analysis found no predictor variables for IAD among the variables that met the cut-off point for this analysis. The study provides the first point prevalence empirical data on the occurrence of IAD in Ireland. It can inform decision-making on future planning and budgeting of new quality improvement projects and act as a benchmark for ongoing auditing of IAD.

Is the varying management of incontinence-associated dermatitis due to a lack of understanding of etiology?

Incontinence-associated dermatitis, previously and sometimes still referred to as moisture lesions or moisture damage, is a commonly seen contact dermatitis that is a reactive response of the skin to chronic contact to urine and faecal matter. Understanding the etiology is fundamental to creating a skin care plan and successfully prevention. Systemic reviews and studies have shown that the continued variability in management results from a combination of knowledge base, observation, diagnosis, and product selection. This article aims to improve clinicians' understanding of incontinence-associated dermatitis and its management.

Incidencia de dermatitis asociada a la incontinencia en neonatos hospitalizados. Adaptación y validación de una escala de gravedad

IntroductionUp to 60% of hospitalised neonates may develop incontinence-associated dermatitis (IAD). Our aim was to adapt the Clinical Evaluation Scale for Characterization of the Severity of Diaper Dermatitis to the Spanish population and to find out the nationwide frequency of IAD in hospitalized neonates. MethodsCross-cultural adaptation and assessment of content validity of the scale. We carried out a prospective, multicentre observational study of the incidence of nappy rash in postnatal wards and neonatal intensive care units in 6 Spanish hospitals. ResultsWe obtained a content validity index of 0.869 for the total scale (95%CI: 0.742-0.939). The sample included 196 neonates. The cumulative incidence of IAD was 32.1% (9.1% mild-moderate, 8% moderate and 1.6% severe). The incidence rate was 2.2 IAD cases per 100 patient days. A stool pH of less than 5.5, a greater number of bowel movements a day, a greater daily urine output and the use of oral drugs were among the factors associated with the development of IAD. ConclusionThe Spanish version of the Clinical Evaluation Scale for Characterization of the Severity of Diaper Dermatitis had an adequate content validity for the assessment of DAI in the hospitalised neonatal population. Mixed feeding, treatment with oral drugs and the use of medical devices in the perianal area were associated with an increased risk of nappy dermatitis in infants.