Prevalence Of Incontinence-associated Dermatitis Research Articles

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.

Prevalence of incontinence-associated dermatitis and associated factors in intensive care patients

Objective: To determine the prevalence of incontinence-associated dermatitis (IAD) and factors associated with its occurrence in adult patients admitted to intensive care units (ICUs). Method: This is an observational, epidemiological, cross-sectional, point-prevalence study conducted in ICUs with a sample of 40 patients. The following statistical tests were applied: Fisher’s exact test, Student’s t-test, Mann-Whitney test, and logistic regression. Results: The prevalence of IAD was found to be 22.5%. After univariate and bivariate analysis of associated factors, logistic regression was performed on variables with a p-value less than 0.20. Only the variable “sedated patient” was found to be statistically significant, which means that a sedated patient is 5.4-fold more likely to develop IAD compared to the population without IAD. Conclusion: The prevalence of IAD found in this study may assist in the planning of healthcare resources, interventions, and prevention strategies, as well as help institutions compare IAD indicators in similar populations. In addition, the finding that sedated ICU patients were 5.4-fold more likely to develop IAD may be useful in developing targeted prevention strategies for this population.

Selective detection of urease-producing bacteria on the genital skin surface in patients with incontinence-associated dermatitis.

We aimed to investigate the association between the presence of cutaneous urease-producing bacteria and the development of incontinence-associated dermatitis (IAD) using an original urea agar medium as a step toward developing advanced preventive measures. In previous clinical assessments, we developed an original urea agar medium to detect urease-producing bacteria via the medium's colour changes. In a cross-sectional study, specimens were collected via the swabbing technique at genital skin sites in 52 stroke patients hospitalised in a university hospital. The primary objective was to compare the presence of urease-producing bacteria between the IAD and no-IAD groups. Determining the bacterial count was the secondary objective. The prevalence of IAD was 48%. A significantly higher detection rate of urease-producing bacteria was observed in the IAD group than in the no-IAD group (P = .002) despite the total number of bacteria being equivalent between them. In conclusion, we discovered that there was a significant association between the presence of urease-producing bacteria and IAD development in hospitalised stroke patients.

Incontinence-Associated Dermatitis: Prevalence in Intensive Care Units and Knowledge, Attitudes, and Practices of Nurses.

Incontinence-associated dermatitis (IAD) is a major concern among hospitals, especially in intensive care units (ICUs). To describe ICU nurses' knowledge, attitudes, and practices of IAD and to examine the relationships with IAD prevalence in the ICU setting. A descriptive correlational design was used including the Knowledge, Attitudes and Practices of Incontinence-Associated Dermatitis Questionnaire and 1-month IAD prevalence data. The prevalence of IAD in ICUs was 6.89%. A positive correlation was found between IAD prevalence and nurses' IAD knowledge and attitudes. Nurses working in the ICU for more than 7 years, caring for patients at high risk for or having IAD, and thinking IAD-related nursing practices were sufficient had significantly higher IAD knowledge, attitudes, and practices. Findings indicate that ICU nurses learned about IAD through clinical experience and have inadequate training on IAD. A standardized evidence-based care protocol for IAD should be developed.

Characteristics of Fecal Incontinence

Objectives The aim of conducting this study was to investigate the relations between different characteristics of fecal incontinence (FI) and incontinence-associated dermatitis (IAD), placing a focus on stool consistency. Methods This is a secondary data analysis of data from cross-sectional studies. We merged data from the years 2014, 2015, and 2016. Results Of all participating persons, 1.9% were only fecal incontinent and 8.6% lost both urine and fecal material, of which 28.8% lost liquid fecal material and 71.2% lost solid stool. The prevalence of IAD among persons with FI was 5.6%. Persons with liquid FI had a 2.786-time higher risk of developing an IAD than persons with solid stool. Conclusion Because of the higher risk of developing an IAD, persons with liquid FI should be analyzed in further studies by applying the definition of FI from the International Continence Society and referring to the Bristol stool chart.

Comparison of two skin protection regimes for the Prevention of Incontinence-associated Dermatitis in geriatric care (PID): a study protocol for an exploratory randomised controlled pragmatic trial

IntroductionThe majority of aged long-term care receivers and patients in geriatric acute care are affected by some form of incontinence. These individuals are at risk of developing incontinence-associated dermatitis (IAD),...

Incontinence and Incontinence-Associated Dermatitis in Acute Care: A Retrospective Analysis of Total Cost of Care and Patient Outcomes From the Premier Healthcare Database.

PURPOSE:To evaluate the prevalence of incontinence and treatment of incontinence-associated dermatitis (IAD) and associations with outcomes including total cost of care, length of stay (LOS), 30-day readmission, sacral area pressure injuries present on admission and hospital acquired pressure injuries, and progression of all sacral area pressure injuries to a higher stage.DESIGN:Retrospective analysis.SUBJECTS AND SETTINGS:Data were retrieved from the Premier Healthcare Database and comprised more than 15 million unique adult patient admissions from 937 hospitals. Patients were 18 years or older and admitted to a participating hospital between January 1, 2016, and December 31, 2019.METHODS:Given the absence of an IAD International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code, we categorized patients treated for IAD by selecting patients with a documented incontinence ICD-10-CM code and a documented charge for dermatology products used to treat IAD. The t test and χ2 tests determined whether incontinence and treatment for IAD were associated with outcomes.RESULTS:Incontinence prevalence was 1.5% for the entire sample; prevalence rate for IAD among incontinent patients was 0.7%. As compared to continent patients, incontinent patients had longer LOS (6.4 days versus 4.4 days), were 1.4 times more likely to be readmitted, 4.7 times more likely to have a sacral pressure injury upon admission pressure injury, 5.1 times more likely to have a sacral hospital-acquired pressure injury, and 5.8 times more likely to have a sacral pressure injury progress to a severe stage. As compared to incontinent patients without IAD treatment, those with IAD treatment had longer LOS (9.7 days versus 6.4 days), were 1.3 times more likely to be readmitted, and were 2.0 times more likely to have a sacral hospital-acquired pressure injury. Total index hospital costs were 1.2 times higher for incontinent patients and 1.3 times higher for patients with IAD treatment.CONCLUSIONS:Incontinence and IAD prevalence are substantially lower than past research due to underreporting of incontinence. The lack of an ICD-10-CM code for IAD further exacerbates the underreporting of IAD. Despite low prevalence numbers, our results show higher health care costs and worse outcomes for incontinent patients and patients with IAD treatment.

The Prevalence of Incontinence-Associated Dermatitis in Hospitalized Patients in China: A Systematic Review and Meta-Analysis.

To determine the prevalence and characteristics of incontinence-associated dermatitis (IAD) among hospitalized Chinese patients. Authors searched Chinese (China National Knowledge Infrastructure, Wanfang Data, VIP Data, Chinese Biomedicine) and English (PubMed, Web of Science) electronic databases for articles published from 1987 through February 2019. The preliminary search identified 558 studies. After removal of duplicates (n = 202), application of exclusion criteria, and screening titles and abstracts (n = 346), 10 studies met the inclusion criteria. A standardized form was constructed to extract data from eligible studies, and this information was extracted by two independent authors. A pooled analysis of the 10 studies (total sample size, 40,039) showed the prevalence of IAD in hospitalized Chinese patients was 1.44% (95% confidence interval, 1.10%-1.79%). Subgroup analysis indicated no significant association between sex and IAD. Patients older than 90 years had the highest incidence of IAD (8.64%). The most common type was mild IAD (1.00%). Fecal incontinence (48.02%) led to more cases of IAD than urinary incontinence (11.35%) or both (25.78%). The most common types of IAD were perineal (0.92%) and perianal (0.90%). Incontinence-associated dermatitis is a global health problem that requires more attention. Understanding the prevalence and characteristics of IAD is helpful in the formulation of IAD prevention and treatment programs in China.

Exploring Incontinence-Associated Dermatitis in a Single Center Intensive Care Unit: A Longitudinal Point Prevalence Survey.

The purpose of this study was to provide longitudinal prevalence rates of incontinence-associated dermatitis (IAD) in patients in an intensive care unit (ICU) and to identify patient characteristics associated with IAD development. Prospective observational. The sample comprised 351 patients aged 18 years and older in a major metropolitan public hospital ICU in Queensland, Australia. All consenting, eligible participants at risk of developing IAD underwent weekly skin inspections to determine the presence of IAD. Data were collected weekly for 52 consecutive weeks. Descriptive statistics described the study sample and logistic regression analysis was used to identify patient characteristics associated with development of IAD. The weekly IAD prevalence ranged between 0% and 70%, with IAD developing in 17% (n = 59/351) of ICU patients. The odds of IAD developing increased statistically significantly with increasing age (odds ratio [OR]: 1.029, 95% confidence interval [CI]: 1.005-1.054, P = .016), time in the ICU (OR = 1.104; 95% CI: 1.063-1.147, P < .001), and Bristol Stool chart score (OR = 4.363, 95% CI: 2.091-9.106, P < .001). Patients with respiratory (OR = 3.657, 95% CI: 1.399-9.563, P = .008) and sepsis (OR = 3.230, 95% CI: 1.281-8.146, P = .013) diagnoses had increased odds of developing IAD. These data show the high variability of IAD prevalence over a 1-year period. Characteristics associated with the development of IAD in patients in the ICU included older age, longer lengths of ICU stay, incontinent of liquid feces, and having respiratory or sepsis diagnoses.

Examining Prevalence and Risk Factors of Incontinence-Associated Dermatitis Using the International Pressure Ulcer Prevalence Survey.

PURPOSE:To evaluate prevalence and risk factors of incontinence-associated dermatitis (IAD).DESIGN:Retrospective analysis of 2016 International Pressure Ulcer Prevalence survey data.SUBJECTS AND SETTING:Adult patients who were in acute care, long-term acute care, long-term care, and rehabilitation facilities in the United States and Canada.METHODS:IAD prevalence was calculated among all patients surveyed, among the incontinent patients only, across multiple care settings, and by incontinence type. A logistic regression examined risk factors for IAD in the incontinent population.RESULTS:Nearly 1 in 5 incontinent patients had IAD documented. Incontinence-associated dermatitis prevalence in the entire patient population was 4.3% while incontinence prevalence was 18%. Of incontinent patients, prevalence of IAD ranged from 8.4% in long-term care facilities to 19% in acute care facilities. Facilities with higher rates of incontinence did not necessarily have higher prevalence of IAD. Incontinence-associated dermatitis prevalence by incontinence type ranged from 12% for patients with urinary incontinence to 26% for patients with fecal management systems. Regression results support the association of the following factors with an increased likelihood of IAD documented: all types of incontinence, fecal management systems, higher body weight, diminished mobility, additional linen layers, longer length of stay, and lower Braden Scale scores.CONCLUSIONS:Incontinence-associated dermatitis remains a concern in acute care settings. Risk factors associated with IAD were similar to risk factors previously reported for hospital-acquired pressure injuries, such as limited mobility, longer lengths of stay, and additional linen layers. By consistently documenting IAD as well as pressure injury prevalence, facilities may benchmark overall skin prevention models.

Epidemiology of Incontinence-Associated Dermatitis and Intertriginous Dermatitis (Intertrigo) in an Acute Care Facility.

The purpose of this study was to measure the prevalence of incontinence-associated dermatitis (IAD) and intertriginous dermatitis (ITD) upon admission, and the incidence of hospital-acquired IAD and ITD in a sample of acutely ill adults. This was a descriptive, retrospective-cohort observational study. The sample comprised 417 adults admitted to an urban community hospital licensed for 249 acute and 52 acute rehabilitation beds in Charleston, South Carolina, and referred to WOC nurses for evaluation and treatment. Prevalence and incidence rates were calculated from data previously collected for quality improvement purposes from January 1, 2014, to December 31, 2016, by the WOC nurses and documented in a secure, password-protected electronic spreadsheet. The prevalence of IAD/ITD was calculated as the proportion of patients diagnosed with IAD/ITD on admission to our facility. The incidence of IAD and ITD was calculated as percentage of patients who developed IAD/ITD during the course of their hospital stay. All units in the hospital were included. The mean prevalence of IAD present on admission was 16%; the prevalence decreased over the data collection period; it was 21% in 2014, 15% in 2015, and 13% in 2016. The mean incidence of hospital-acquired IAD during the data collection period was 23%; the highest rate (26%) occurred in 2016. Patients classified as normal weight from their body mass index and patients 60 years and older had the highest incidence of hospital-acquired IAD. The mean prevalence of ITD for patients admitted to the hospital was 40% for the 3-year time; annual rates varied from a low of 36% in 2015 to a high of 42% in 2016. The mean incidence of hospital-acquired ITD was 33% over the data collection period; mean incidence rates were 32% in 2014, 39% in 2015, and 29% in 2016. The incidence of ITD was higher in patients classified as obese based on body mass index in patients 60 years and older. The most common location was the gluteal cleft. The prevalence of IAD fell within the range of prior epidemiologic studies, but the facility-acquired IAD incidence rates were higher than other studies based in the acute care setting. The prevalence of ITD was higher than rates reported in prior studies; we searched the literature and found no previous reports of ITD occurrences over the course of a hospital stay. Additional research regarding IAD prevention and ITD in the gluteal cleft is needed. Data collection regarding IAD and ITD prevalence and incidence could be incorporated into the data collection tool used for pressure injury data collection for the National Database of Nursing Sensitive Indicators.

Clinical utility of the German Ghent Global IAD Categorization tool including incontinence‐associated dermatitis prevalence and categories

Is the German pilot version of the Ghent Global IAD Categorization (GLOBIAD) tool a clinical useful tool from the users' perspective and what are the incontinence‐associated dermatitis (IAD) prevalence and categories in the hospital and geriatric settings? Before evaluating the psychometric properties of an instrument, it is recommended to carry out a pre‐test with target users. Recent research on IAD has focused on the design and evaluation of the psychometric properties of the English GLOBIAD. In 2017, the annual, multicentre, cross‐sectional survey was conducted. This survey includes the German pilot version of the GLOBIAD tool as well as the Staff View Assessment Instrument, a questionnaire distributed to evaluate the clinical utility of the German pilot version of the GLOBIAD tool. The majority of the patients in both types of institutions were female with average ages of 66 years (hospital setting) and 82 years (geriatric setting). Patients in the geriatric institution (N = 634) were statistically significantly more care dependent compared to hospital patients (N = 2955). Patients in the geriatric institutions suffered statistically significantly more often from urinary, faecal and double (UI, FI, DI) incontinence than hospital patients. More than 75% of the ward nurses agreed that the German pilot version of the GLOBIAD tool was useful. The highest IAD prevalence was observed in the DI hospital patients, who were statistically significantly more often affected by IAD than geriatric patients. Due to the high level of agreement regarding the clinical utility of this tool, we can recommend it to clinicians. As this was a pilot version of the tool, further testing of the psychometric properties of this version in hospital and geriatric settings is warranted.

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).

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, Incontinence-Associated Dermatitis, and Pressure Injuries in a Health District in Australia: A Mixed-Methods Study.

This purpose of this study was to measure the prevalence of incontinence, incontinence-associated dermatitis (IAD), and pressure injuries (PIs) in a local health district in Australia. We also aimed to determine associated evidence-into-practice gaps. Multisite mixed-methods study. The sample comprised 250 adult patients in 12 units across 4 hospitals; their mean age was 73 years. Nurses caring for the patient at the time of the audit were questioned on nursing practice for patients with incontinence. A 2-page audit tool was developed and used to capture demographic data, continence and mobility status, IAD and PI, incontinence products, nursing practice observations, and nurses' comments. Each patient was assessed by 2 senior nurses. Quantitative analysis included descriptive statistics and bivariate analysis using a χ test to examine the association between mobility and incontinence and a Fisher exact test to examine the association between IAD and PI. Content analysis was used to analyze qualitative data and develop themes. Almost half of patients had incontinence (n = 111/250), 20.7% of patients with incontinence (n = 23/111) had IAD, and 6.3% (n = 7/111) had hospital-acquired PI. There was a significant association between incontinence and mobility, and between IAD and PIs. In addition, 22.3% of patients who were continent (31/139) were wearing an incontinence product. Analysis of qualitative data found that both incontinence management and language used to refer to incontinence pads were incompatible with current best practices. The prevalence of incontinence among patients observed in this study was similar to rates reported internationally, but the prevalence of IAD was slightly lower. The association between IAD and PIs, as well as incontinence and mobility, was statistically and clinically significant. Nurses commonly used interventions with little or no evidence. Hospitals should put measures in place to improve nurses' knowledge of incontinence, IAD, and PI practices.

Incontinence-Associated Dermatitis and Intertriginous Dermatitis as Nurse-Sensitive Quality Indicators: A Delphi Study.

This purpose of this study was to determine whether consensus exists concerning the need to collect epidemiologic data about 2 forms of moisture-associated skin damage, incontinence-associated dermatitis (IAD) and intertriginous dermatitis (ITD), and whether these data should be part of data routinely collected as part of the National Database of Nursing Quality Indicators (NDNQI). Modified Delphi technique. Questionnaires were sent via e-mail to 50 identified experts, with an initial response of 17. Thirteen clinical experts responded to the second round and 11 responded to a third round. Items on the questionnaires were investigator-developed. Consensus was defined as 80% or more agreement. Three rounds of questionnaires were employed to attempt consensus. Descriptive statistics were performed using mean and standard deviation for continuous data and frequencies and percentages for categorical data. Qualitative data were analyzed question by question by the primary researcher using content analysis. Consensus was achieved indicating that individual facilities should regularly collect data about IAD prevalence or incidence. Consensus was not reached about the need to regularly collect data about ITD prevalence or incidence. Panelists also failed to reach consensus that IAD or ITD prevalence or incidence should be incorporated into the NDNQI indicators. Panelists did not reach consensus that IAD or ITD epidemiologic data should be incorporated on the NDNQI. Additional research is needed, particularly in the area of ITD, before benchmarks can be established regarding these data as nurse-sensitive indicators of quality care.

Incontinence-Associated Dermatitis (IAD): Prevalence and Associated Factors in 4 Hospitals in Southeast Norway.

The aim of this study was to investigate the prevalence and severity of incontinence-associated dermatitis (IAD) and associated factors in acute care settings in Southeast Norway. Descriptive, multisite epidemiologic survey. The study setting was 29 wards across 4 hospitals, in a hospital trust in the southeast of Norway. Data were collected from 340 patients (age ≥18 years). More than half (56.2%) were 70 years or older (median age category 70-79 years) and 53.3% were male. Data collection was conducted in parallel with a pressure injury prevalence study undertaken in 2016. A modified Pressure Injury Prevalence Minimum Data Set, including documentation of fecal or urinary incontinence, use of indwelling fecal collection system or urinary catheter, and presence of IAD, was completed. RNs participating in the study were trained by the researchers on skin assessment and data extraction from the electronic medical record. Descriptive statistics were used for prevalence figures; the Kruskal-Wallis and χ tests were used to determine associated factors. Analysis revealed that 16.5% (56 out of 340) of the sample were incontinent. The prevalence of IAD in the total population was 7.6% (26 out of 340). The prevalence of IAD was 29% (16 out of 56) among patients with urinary or fecal incontinence. Of those identified with IAD, 5.2% (18 out of 340) had category 1 (red intact skin) and 2.4% (8 of 340) had category 2 (red skin with breakdown). Bivariate analysis revealed that fecal incontinence (P < .001), immobility (P < .01), and 70 years or older (P < .03) were associated with IAD. The overall prevalence (patients with and without incontinence) of IAD was lower than reported in prior studies; frequent use of indwelling urinary catheters and a relatively low prevalence of incontinence may explain this finding. Similar to prior studies, almost 1 in 3 patients who were incontinent suffered from IAD, showing a need for evidence-based guidelines to prevent IAD in hospitalized patients. Findings suggest that particular attention should be given to prevent IAD among patients with fecal incontinence patients, 70 years and older, and those with immobility.

Incontinence-Associated Dermatitis, Characteristics and Relationship to Pressure Injury: A Multisite Epidemiologic Analysis.

PURPOSE:The purpose of this study was to measure the prevalence of incontinence-associated dermatitis (IAD) among incontinent persons in the acute care setting, characteristics of IAD in this group, and associations among IAD, urinary, fecal, and dual incontinence, immobility, and pressure injury in the sacral area.DESIGN:Descriptive and correlational analysis of data from a large database of IAD, and pressure injuries of sacral area and heels.SUBJECTS AND SETTING:The sample comprised 5342 adult patients in acute care facilities in 36 states representing all regions of the United States. Facilities used a variety of products for prevention of IAD and sacral area pressure injuries.METHODS:Data were collected for use in a national quality improvement study evaluating current practices related to the prevention of IAD and pressure injuries affecting the sacral area and heels. Data were exported to a spreadsheet, and triple checked for accuracy before being imported to a statistical analysis software program. Descriptive statistics were used to describe prevalence rates for incontinence, types of incontinence, IAD, characteristics of IAD, and pressure injuries. Multivariate logistic regression analysis was conducted on the end point of facility-acquired sacral/buttock pressure injury and the risk factors of immobility and type of incontinence.RESULTS:More than one-third of patients (n = 2492 of 5342 patients; 46.6%) were incontinent of urine, stool, or both. The overall prevalence rate of IAD was 21.3% (1140/5342); the prevalence of IAD among patients with incontinence was 45.7% (1140/2492). Slightly more than half of the IAD was categorized as mild (596/1140, 52.3%), 27.9% (318/1140) was categorized as moderate, and 9.2% (105/1140) was deemed severe. In addition, 14.8% (169/1140) of patients with IAD also had a fungal rash. The prevalence of pressure injury in the sacral area among individuals with incontinence was 17.1% (427/2492), and the prevalence of full-thickness pressure injury in this population was 3.8% (95/2492). Multivariate analysis revealed that both presence of IAD (odds ratio [OR], 4.56; 95% confidence interval [CI], 3.68-5.65) and immobility (OR, 3.56; 95% CI, 2.73-4.63) was associated with a significantly increased likelihood of developing a sacral pressure injury. Multivariate analysis also revealed that presence of IAD (OR, 2.65; 95% CI, 1.74-4.03) and immobility (OR, 6.05; 95% CI, 3.14-11.64) was associated with a significantly increased likelihood of developing full-thickness sacral pressure injury.CONCLUSION:Our study findings are consistent with prior research, supporting a clinically relevant association between IAD and pressure injury of the sacral area. This risk persists even after controlling for presence of immobility, suggesting that IAD functions as an independent risk factor for pressure injury occurrence.

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.

Incontinence-Associated Dermatitis in Nursing Homes: Prevalence, Severity, and Risk Factors in Residents With Urinary and/or Fecal Incontinence.

The purpose of this study was to estimate the prevalence and severity of incontinence-associated dermatitis (IAD) in incontinent nursing home residents by using the Incontinence-Associated Dermatitis Intervention Tool-D (IADIT-D) and to identify potential risk factors. From 2012 to 2014, 3 consecutive annual cross-sectional multicenter studies in 5785 residents in 78 German nursing homes were conducted. Secondary data analysis was performed including all incontinent residents with complete data from the German version of the IADIT-D and validated instrument to assess IAD. Logistic regression analysis was used to identify independent variables associated with IAD occurrence. The overall prevalence of any type of incontinence was 68.3%. Of the total sample, 58.8% (n = 3406) were eligible for the study. Estimated point prevalence of IAD was 5.2% (95% confidence interval [CI], 4.5%-6.0%). According to the IADIT-D, the prevalence of patients with high risk for IAD was 25.3%; early IAD, 2.1%; moderate, 2.0%; severe, 0.2%; and fungal-appearing rash, 1.0%. Body mass index (odds ratio [OR], 1.06; 95% CI, 1.03-1.09), fall risk (OR, 0.91; 95% CI, 0.86-0.97), pressure injury (OR, 2.24; 95% CI, 1.24-4.04), and female gender (OR, 0.64; 95% CI, 0.43-0.94) were statistically significantly associated with IAD in residents with urinary and/or fecal incontinence. IAD is prevalent in nursing home residents. Knowledge about potential risk factors, for example higher body mass index, should be enhanced and integrated into planning of nursing interventions especially skin protection measures.