Incontinence-associated Dermatitis Research Articles

Perineal Assessment Tool (PAT-C): Validation of a Chinese Language Version and Identification of a Clinically Validated Cut Point Using ROC Curve Analysis.

The purpose of this study was to evaluate content validity and feasibility of the Chinese language perineal assessment tool (PAT-C), to assess its use in the clinical setting, and establish an optimal cut point for identifying patients at high risk for incontinence-associated dermatitis (IAD). Psychometric evaluation of existing instrument. The sample comprised 440 patients managed in intensive care units of 3 hospitals across the island of Taiwan and an affiliated home care service. One hundred three nurses practicing throughout Taiwan participated in the workshops in the third phase of the experiment. The content validity of the PAT-C was evaluated by 3 experienced nurses using the content validity index statistic. We calculated a receiver operating characteristics (ROC) curve to determine a cut point of high-risk IAD. The curve was based on assessment of patients from receiving care from the intensive care unit and home care service of Cathay General Hospital (located in Taipei, New Paipei and Hsinchu). Nurse perceptions on the feasibility of PAT-C were assessed using an investigator-developed survey. Three experienced nurses rated the PAT-C and gave a robust overall content validity index score of 97.22%. The cut point for identifying patients at high risk for developing IAD via ROC curve analysis of 440 patients was 7.5 (sensitivity: 0.85; specificity: 0.79, area under curve: 0.82, P value < .001). One hundred three enrolled nurses attended the workshops and evaluated the feasibility using the PAT-C. Most of the participants considered the PAT-C as necessary (97.90%), 49.7% of participants suggested IAD risk assessment should be implemented by first-line (generalist) nurses, and 40% of participants recommended assessment on a daily basis. Study findings indicate robust content validity, and results of the investigator survey of nurse perceptions of the PAT-C indicate the potential for its widespread use in the clinical setting. We found that a cut point score 8 or more indicates a high risk for developing IAD.

Gaps in nursing care for people with urinary incontinence

Objective: To survey in the literature the role of the nurse in the care of people with urinary incontinence (UI). Methods: Integrative literature review from the publications within the period of 2013 in the databases: BDENF, LILACS, Web of Science, PubMed and SciELO, in the Portuguese, English and Spanish languages. The sample consisted of 11 publications, most of them in English. Results: The data were categorized into three dimensions of care: educational (three articles), care (eight articles) and management (an article, which was also categorized as care). Educational: although nurses presented superficial and incomplete knowledge about incontinence, playful strategies were used for teaching. Assistance: the use of superabsorbent diapers and pads, 3% dimethicone impregnated wipes, spray for the formation of polymer film for incontinence-associated dermatitis, pelvic musculature, urethral massage, bladder training, and eating habits modification were recommended. Gerencial: the quality of nursing care for the elderly with UI was evaluated through protocols, standards and Standard Operational Procedures (SOPs). Conclusion: There is a shortage of studies on the subject and it was evidenced that the nurse assumes an assistance role in urinary incontinence, although its knowledge is incipient.

Nursing interventions in children with diaper dermatitis (incontinence-associated dermatitis)—a systematic review

Zur Pflege der Windeldermatitis (inkontinenzassoziierten Dermatitis, IAD) bei Kindern werden verschiedene Produkte mit teils unklarer Wirkung eingesetzt. Untersuchung der Wirksamkeit pflegerischer Interventionen zur Therapie der IAD bei Kindern. Die systematische Recherche erfolgte von Oktober 2017 bis Marz 2018 mit den Suchbegriffen „diaper rash“, „diaper dermatitis“, „nappy rash“ oder „nappy dermatitis“ und Verknupfung mit „nursing“, „intervention“, „treatment“ und „therapy“ in MEDLINE, Cochrane Library (CENTRAL und CDSR), CINAHL und Embase. Nach der Studienauswahl wurden Studienmerkmale extrahiert, Verzerrungsrisiken eingeschatzt und Effektmase berechnet. Insgesamt wurden 20 Primarstudien (Grose der Stichprobe n = 3801 Kinder mit IAD) mit teils hohem Verzerrungsrisiko eingeschlossen. Zinkoxid/Lebertran ist wirksamer als lokal aufgetragene Muttermilch (Relatives Risiko [RR]: 1,57 [95 %-Konfidenzinterval [KI]: 1,15; 2,12]), Tonerde verbessert die Heilung im Vergleich zu Calendula (RR: 1,95 [95 %-KI: 1,40; 2,72]), und die Supplementation von Magnesium in Calendula verkurzt die Heilung um mehr als eineinhalb Tage (Mittelwertsdifferenz [MD]: −1,75 [95 %-KI: −2,04; −1,46]). Desinfizierende Wirkstoffe reduzieren gegenuber Barrierecremes die IAD starker (Eosin RR: 2,75 [95 %-KI: 1,07; 7,04]; Oxychinolin RR: 6,50 [95 %-KI: 1,72; 24,53]; Sudocrem® (vermutlich Allergan, Dublin, Irland) MD: −2,50 [95 %-KI: −3,11; −1,89]). Windeln mit Superabsorbern sowie die Anwendung von 3‑in-1-Tuchern haben einen kleinen gunstigen Heilungseffekt auf die IAD. Es konnte keine Uberlegenheit eines Wirk- oder Tragerstoffs als Pflegemasnahme identifiziert werden. Nur wenige Studien mit niedriger Evidenz empfehlen, Schutz- und Barriereprodukte mit desinfizierenden Wirkstoffen zu kombinieren.

PROTECT - Trial: A cluster RCT to study the effectiveness of a repositioning aid and tailored repositioning to increase repositioning compliance.

To study the effectiveness of tailored repositioning and a turning and repositioning system on: (a) nurses' compliance to repositioning frequencies; (b) body posture of patients after repositioning; (c) incidence of pressure ulcers and incontinence-associated dermatitis; (d) nurses' and patients' preferences, comfort and acceptability; and (e) budget impact. Patient-tailored systematic repositioning is key in pressure ulcer prevention. To date, a clinical decision-making tool is lacking and compliance to pressure ulcer prevention guidelines is low. Research concerning commercially available turning and repositioning systems is lacking. Multicentre, cluster, three-arm, randomized, controlled pragmatic trial. Two hundred and twenty-seven patients at risk of pressure ulcer development were recruited at 29 wards in 16 hospitals between February 2016 and December 2017. Wards were randomly assigned to two experimental groups and one control group. Nurses' compliance to repositioning frequencies increased significantly in the experimental groups when patients were cared for in bed (94.6% vs. 69% and 84.9% vs. 71.4%). Applying the turning and repositioning system was associated with significantly more correctly positioned patients (30-45° tilted side-lying position) (69.6% vs. 34.6%). Few pressure ulcers and incontinence-associated dermatitis incidents occurred. Both patients and nurses were positive about the intervention. Higher labour costs related to repositioning in bed were found in the control group. This was the first study investigating the effect of tailored repositioning and the use of a repositioning aid to increase nurses' compliance to repositioning. The results were in favour of the interventions yet demonstrating the importance of follow-up and education. This study is registered at https://clinicaltrials.gov/NCT02690753;NCT02690753.

Prevention and management of moisture-associated skin damage

The harmful effects of excessive moisture on a patient's skin are well known. While traditionally considered an issue only encountered in continence care and older people, it is now recognised that the harmful effects of excessive moisture can occur across the lifespan and in various patient groups. The term 'moisture-associated skin damage' describes the spectrum of inflammatory damage that occurs in response to the prolonged exposure of a patient's skin to perspiration, urine, faeces or wound exudate. It is generally accepted that moisture-associated skin damage consists of four conditions: incontinence-associated dermatitis, intertrigo, peristomal moisture-associated dermatitis, and periwound moisture-associated dermatitis. This article describes the aetiologies of each of the different types of moisture-associated skin damage, and outlines the nursing interventions required for their prevention and management.

Development of a New Incontinence Containment Product and an Investigation of Its Effect on Perineal Dermatitis in Patients With Fecal Incontinence: A Pilot Study in Women

The purpose of this 2-part study was to 1) develop a new incontinence containment product for fecal incontinence and 2) examine the effect of this new product on the occurrence of incontinence-associated dermatitis (IAD). In part 1, a new incontinence containment product was designed, developed, and trialed among 10 healthy female volunteers. The product was comprised of a double layer of polypropylene nonwoven fabric and 100% cotton interlock fabric with a 3-ply 100% cotton interlock fabric added into the perianal section. Participants wore the product for 8 hours and were asked to defecate into the product and evaluate its comfort, ability to contain liquids and protect privacy, any personal allergic reaction, and air permeability. In part 2, after any product modifications, 12 bedridden women treated in the neurology unit of a hospital in western Turkey who had an indwelling urinary catheter and fecal incontinence and who did not have diabetes mellitus, a darkly pigmented area in the perianal area, pressure injury, or erythema were randomized to 2 groups (study product and control, a premium adult diaper) and monitored for 8 days for the development and severity of perineal dermatitis (scored from 0 [no erythema] to 4 [broken, abraded skin]) using a skin assessment tool. Any type of erythema was considered IAD. Skin care (cleansing with a washcloth and water) was provided daily and after each defecation to all study participants. Data were collected via paper-and-pencil completion of the perineal skin integrity assessment and patient observation forms and entered into and analyzed by a computerized statistical program. Fisher's exact test and the chi-squared test were used to analyze the difference in IAD incidence and severity between the 2 groups, and the Mann Whitney U test was used to detect differences in the number and consistency of defecations. No statistically significant differences were noted among the characteristics of the 12 participants (6 in each group) except for age; patients in the study product group were significantly older (70.66 ± 10.36 vs 52.20 ± 16.78 years; P <.05. Four (4) patients in the study group exhibited 13 areas of perineal dermatitis (degree 1 = 6 areas; degree 2 = 6 areas; degree 3 = 1 area; and degree 4 = 0); 1 patient in the control group had 4 areas with degree 1. This prototype product is not sufficient to be used in clinical practice in patients with fecal incontinence, but further study in a larger population is warranted..

Preventing and treating incontinence-associated dermatitis in adults.

Preventing and treating incontinence-associated dermatitis in adults.

Prevention and Management of Incontinence-Associated Dermatitis in the Pediatric Population: An Integrative Review.

An integrative review was conducted to synthesize evidence on prevention and management of incontinence-associated dermatitis (IAD) in the pediatric population. A 5-step integrative process was used to guide the review. Articles published from January 2000 to April 6, 2017, were identified and retrieved from CINAHL, PubMed, ProQuest (MEDLINE), and Scopus; key terms were associated with IAD, pediatric, prevention, and management. Supplemental and manual searches were carried out to identify other relevant studies. The studies' findings were extracted and summarized in a table of evidence, with their quality evaluated using the Joanna Briggs Institute's Critical Appraisal Checklist. Sixteen articles were included in the review. Articles explored prevention and management strategies including skin cleansing technique, diaper selection, and the application of topical skin care products. Inconsistent and limited evidence was found regarding the benefits of using disposable wipes in preference to water-moistened washcloths in the cleansing process and on the use of superabsorbent polymer diapers with breathable outer lining in IAD prevention. Findings were inconclusive with regard to the best topical skin care product for IAD care. However, the application of skin protectants was encouraged by the authors, as well as promoted in various clinical guidelines. The development of a structured skin care regimen supplemented by a comprehensive patient education program was advised to enhance the prevention and management of IAD.

Skuteczność miejscowego stosowania oleju kamforowego u pacjentów opieki długoterminowej z zapaleniem skóry związanym z nietrzymaniem moczu

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Kohut I, Galnykina S. The efficacy of topical camphorated oil in long-term care of residents with incontinence-associated dermatitis. Dermatology Review/PrzeglÄ d Dermatologiczny. 2019;106(6):683-686. doi:10.5114/dr.2019.92742. APA Kohut, I., & Galnykina, S. (2019). The efficacy of topical camphorated oil in long-term care of residents with incontinence-associated dermatitis. Dermatology Review/PrzeglÄ d Dermatologiczny, 106(6), 683-686. https://doi.org/10.5114/dr.2019.92742 Chicago Kohut, Ihor, and Svitlana Galnykina. 2019. "The efficacy of topical camphorated oil in long-term care of residents with incontinence-associated dermatitis". Dermatology Review/PrzeglÄ d Dermatologiczny 106 (6): 683-686. doi:10.5114/dr.2019.92742. Harvard Kohut, I., and Galnykina, S. (2019). The efficacy of topical camphorated oil in long-term care of residents with incontinence-associated dermatitis. Dermatology Review/PrzeglÄ d Dermatologiczny, 106(6), pp.683-686. https://doi.org/10.5114/dr.2019.92742 MLA Kohut, Ihor et al. "The efficacy of topical camphorated oil in long-term care of residents with incontinence-associated dermatitis." Dermatology Review/PrzeglÄ d Dermatologiczny, vol. 106, no. 6, 2019, pp. 683-686. doi:10.5114/dr.2019.92742. Vancouver Kohut I, Galnykina S. The efficacy of topical camphorated oil in long-term care of residents with incontinence-associated dermatitis. Dermatology Review/PrzeglÄ d Dermatologiczny. 2019;106(6):683-686. doi:10.5114/dr.2019.92742.

Prevention and Management of Incontinence-Associated Dermatitis in the Pediatric Population

Journal of Wound, Ostomy and Continence Nursing 46(1):p E1, January/February 2019. | DOI: 10.1097/WON.0000000000000507

Turkish Adaptation and Validity and Verification Percentages Study of the Incontinence-Associated Dermatitis and Its Severity Instrument

Turkish Adaptation and Validity and Verification Percentages Study of the Incontinence-Associated Dermatitis and Its Severity Instrument

Prevalence of Moisture-Associated Skin Damage in an Acute Care Setting

Moisture-associated skin damage (MASD) is characterized by inflammation of the skin with or without erosion of the skin caused by prolonged exposure to various sources of moisture including urine or stool, perspiration, wound exudate, or mucus. The purpose of this quality improvement project was to determine the prevalence of MASD at a teaching hospital in the Midwestern United States. Data were collected quarterly over a period of 12 months concurrently with the quarterly Pressure Ulcer Prevalence Survey (PUPS). The PUPS team comprises 40 RNs; 20 of whom are Skin Care Champions with training in skin care and pressure injury prevention. Patients' skin was assessed from head to toe; in addition to assessing for pressure injuries, a data collection form developed by WOC nurse was also filled out by the PUPS team nurses for patients identified as having MASD. We assessed anatomic location of MASD and treatment in use at the time of assessment. The prevalence of MASD was 4.34% (62 out of 1427 patients), and the prevalence of incontinence-associated dermatitis was 1.54% (22 out of 1427 patients).

Design and psychometric testing of the attitude towards the prevention of incontinence-associated dermatitis instrument (APrIAD).

Despite the availability of a range of skin care products for the prevention of incontinence-associated dermatitis (IAD), prevalence remains high. Nurses' attitude is an important determinant to take into account in quality improvement projects. This study aimed to design a psychometrically test the attitude towards the prevention of incontinence-associated dermatitis instrument (APrIAD). A prospective psychometric instrument validation study was performed in a convenience sample of 217 Belgian nurses. Construct validity and reliability (internal consistency, stability) were tested. The exploratory factor analysis demonstrated a model consisting of four factors and 14 items: (a) beliefs about the impact of IAD on patients, (b) beliefs about team responsibility to prevent IAD, (c) beliefs about personal responsibility to prevent IAD, and (d) beliefs about the effectiveness of IAD prevention products and procedures. Cronbach's α was 0.72 for factor 1, 0.65 for factor 2, 0.63 for factor 3, and 0.47 for factor 4. The intra-class correlation coefficient was 0.689 (95% confidence interval [CI] 0.477-0.825) for the total instrument, 0.591 (95% CI 0.388-0.764) for factor 1, 0.387 (95% CI 0.080-0.626) for factor 2, 0.640 (95% CI 0.406-0.795) for factor 3, and 0.768 (95% CI 0.597-0.872) for factor 4. Psychometric testing of the APrIAD demonstrated adequate validity and reliability measures.

Report of the proceedings of a UK skin safety advisory group.

Moisture-associated skin damage, especially incontinence-associated dermatitis, continues to present significant health challenges and requires multidisciplinary input to provide effective prevention and treatment. In the absence of mandatory reporting such damage is under- or wrongfully reported, resulting in a lack of accurate data on prevalence and costs of associated care. In March this year, a multidisciplinary team of experts met in the UK to seek to determine measures to improve patient skin care. They aimed to identify activities to increase awareness and education, collect data, and improve prevention and treatment regimes. This article describes that discussion and the conclusions made by the group, such as the key actions required to effect policy changes.

Effects of Kano model on quality of nursing for patients with incontinence-associated dermatitis

Objective To explore the effects of the Kano model on preventing incontinence-associated dermatitis (IAD) in inpatients and to offer reference for nursing management of IAD. Methods Totally 100 inpatients hospitalized in Xinxiang Central Hospital from January 2016 to December 2017 were selected by convenient sampling. Patients admitted from January to December 2016 were divided into the control group (n=50), while patients admitted between January and December 2017 were divided into the observation group (n=50). Patients in the control group received conventional nursing care, while patients in the observation group received targeted and optimal nursing services by investigating the patients' needs with the Kano model on the basis of conventional nursing. The self-designed nursing service satisfaction questionnaire was used to evaluate the patients' satisfaction. The incidence rate of IAD was calculated. Results A total of 49 patients in oberservation group completed the investigation, and 48 in control group completed investigation. The total score of satisfaction and the scores in the patients' satisfaction with nursing attitude, nursing skills, follow-ups and health education were higher in the observation group than in the control group (P<0.05). Only 1 IAD case was found in the 49 patients in the observation group, with an incidence rate of 2.04%; however, totally 9 IAD cases were found in the 48 patients in the control group, with an incidence rate of 18.75% (χ2=5.625, P=0.018). Conclusions The Kano model can improve the inpatients' satisfaction with IAD nursing and reduce the incidence rate of IAD, which is worth promoting in clinical practice. Key words: Nursing care; Kano model; Incontinence-associated dermatitis (IAD); Application

Cultivating Incontinence-associated Dermatitis Prevention Practices in an Australian Local Health District: A Quasi-experimental Study

A 2-part, quasi-experimental, post-test study was conducted to evaluate the impact of prevention initiatives on IAD prevalence and incontinence practices. In part 1, from May 2017 to November 2017, a quasi-experimental post-test study design was conducted in a health district in Australia. Following an audit of IAD prevalence and identification of evidence practice gaps in 4 hospitals in a local health district (12 wards, 250 patients), an implementation science approach was used to implement evidence-based initiatives. An IAD committee was formed, staff were educated about correct incontinence pad sizing, washable and disposable underpads and plastic sheets were removed from the care setting, and barrier cream cloths for cleansing, moisturizing, and protecting skin were introduced. Patients admitted to 1 of the 12 wards who were ≥18 years of age were recruited for participation and evaluation in the post-intervention implementation IAD and incontinence care practices audit. Post-intervention data were entered into a software program and compared to pre-implementation data using descriptive and bivariate statistics. In part 2, nurses from the 12 wards were asked to participate in 1 of 6 focus groups to share their impressions about the barrier cream cloths. Discussions were transcribed verbatim and analyzed using descriptive content analysis. The rate of incontinence among audited patients (N= 259, 132 men, 124 women; mean age 73.2 ± 16.8 years) was 47.2% (119/252) and 2/259 (0.8%) had a pressure injury (PI). IAD prevalence was significantly lower in the post- than in the pre-implementation audit (6/259 vs 23/250, P = .015), as was hospital-acquired pressure injury (9/250 [3.6%] vs 2/259 [0.08%]) and the use of bed protection layers (154/238 vs 6/259; P <.01). The focus groups included 31 nurses (25 women, 6 men). Four (4) themes emerged: 1) benefits to the patient (eg, improved skin condition), 2) usability (eg, fewer steps), 3) problems encountered (eg, not seeing the barrier in place), and 4) related factors. Patient comfort was cited frequently as an important benefit. Evidence-based initiatives led to a significant reduction in IAD prevalence and improved incontinence care practices. .

Incontinence-Associated Dermatitis: State of the Science and Knowledge Translation.

This review of the literature updates and considers the evidence on incontinence-associated dermatitis (IAD). Best practice strategies for the management of skin damage from IAD (both prevention and treatment) are provided. A mnemonic to help clinicians translate IAD evidence into practice is introduced. Workplace experiences supplement this evidence synthesis. Approaches to assist in translation of this knowledge and evidence into practice are also provided.

Gerontodermatology: the fragility of the epidermis in older adults.

The proportion of adults over 60years of age is rapidly increasing and is estimated to reach approximately one-sixth of the global population by 2030. An ageing population is a real challenge for healthcare resources, including dermatologists and geriatricians, as age-related changes in skin integrity and barrier function make older adults more susceptible to developing skin pathologies such as pruritus, dermatitis and infections. Fragile skin arises from several interlinked causes, including age-related changes in skin barrier integrity, previous and current lifestyle choices, skin pathologies and medical interventions. Dermo-cosmetics can play a key role in enhancing skin care regimens and preventing pathologies in this age group. In vitro studies, clinical, and in-daily clinical practice studies of dermo-cosmetics have shown them to be effective in many skin conditions in older adults, like xerosis and pruritus. Incontinence-associated dermatitis (IAD), a common condition arising from contact with irritants such as urine and faeces which can significantly impact the quality of life of sufferers, can also be improved with a barrier cream in incontinent patients aged 70years and older. This supplement focuses on the increased fragility of older skin, the development of common skin pathologies and the efficacy and tolerance of dermo-cosmetic products in older adults.

Minimum Data Set for Incontinence-Associated Dermatitis (MDS-IAD) in adults: Design and pilot study in nursing home residents

Study aimThe aim of this study was to develop a Minimum Data Set for Incontinence-Associated Dermatitis (MDS-IAD), to psychometrically evaluate and pilot test the instrument in nursing homes. Comparable to the MDS for pressure ulcers, the MDS-IAD aims to collect epidemiological data and evaluate the quality of care. Materials and methodsAfter designing and content/face validation by experts and clinicians, staff nurses assessed 108 residents (75.9% female, 77.8% double incontinent) in a convenience sample of five wards. A second nurse independently assessed fifteen residents to calculate inter-rater agreement (p0) and reliability [Cohen's Kappa (ĸ)]. ResultsThe ĸ-value for ‘urinary incontinence’ was 0.68 [95% confidence interval (CI) 0.37–0.99] and 0.55 (95% CI 0.27–0.82) for ‘faecal incontinence’. The p0 for severity categorisation according to the Ghent Global IAD Categorisation Tool (GLOBIAD) was 0.60. IAD was diagnosed in 21.3% of the residents. IAD management mainly involved the application of a leave-on product (66.7%), no-rinse foams (49.1%), toilet paper (47.9%), and water and soap (38.8%). Fully adequate prevention or treatment was provided to respectively 3.6% and 8.7% of the residents. ConclusionThis instrument provides valuable insights in IAD prevalence at organisational level, will allow benchmarking between organisations, and will support policy makers. Future testing in other healthcare settings is recommended.

GLOBIAD categorisation tool for monitoring of Incontinence-associated dermatitis

Objective — to determine the categories of GLOBIAD in patients with incontinence­associated dermatitis (IAD) and to evaluate the effectiveness of topical use of camphor racemic solution in concentration of 0.1 g in 1 ml of sunflower oil.Materials and methods. Camphor racemic solution in concentration 0.1 g in 1 ml of sunflower oil was used in 104 patients with IAD to clean and protect the skin from urine and/or stool. Category evaluation of IAD wasmade by GLOBIAD categorisation tool. In 30 patients of the control group, routine skin care products were used. The comparison was performed before the start of treatment and in one month of treatment.Results and discussion. Topical application of the medication under study in patients with IAD resulted in significant decrease of the number of patients with 2B category — from 30 (28.8 %) to 16 (15.4 %) persons (χ2 = 22.1; p < 0.001) and in increase of the number of patients with 1A category — from 29 (27.9 %) to 52 (50.0 %) patients (χ2 = 21.0; p < 0.001). These results show similar efficacy of the test drug and of routine care regimen in both mild IAD (category 1A) and severe IAD with infection complications (category 2B).Conclusions. Topical application of camphor racemic solution to provide skin care stages in patients with IAD contributed to an improvement in the course of the disease by reducing the number of cases of patients with category 2B GLOBIAD and increasing the number of patients with category 1A, which reflected healing of erosion and eradication of concomitant local infection.