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Tülü B, Üzen Cura Ş. Factors affecting the development of incontinence dermatitis among patients in intensive care unit. J Tissue Viability 2024; 33:357-361. [PMID: 38632012 DOI: 10.1016/j.jtv.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/18/2024] [Accepted: 03/31/2024] [Indexed: 04/19/2024]
Abstract
AIM This research was conducted to determine the factors affecting the development of incontinence-associated dermatitis in intensive care patients. METHODS The sample of the study consisted of 114 intensive care patients who developed incontinence-associated dermatitis. Patients were followed for a minimum of 8 days. The 'Patient Information Form' and the 'Incontinence-Associated Dermatitis and Severity Instrument (IADSI)' were used for data collection. The data were collected between February and May 2022. Ethics committee approval was obtained for the research. In the evaluation of the data, SPSS for Windows (Version 24.0, Statistical Package for Social Sciences) program was used. RESULTS It was determined that there was a statistically significant difference in the mean IADSI score between day 1 (17.79 ± 6.06) and day 8 (27.35 ± 9.55). Statistically significant differences were found between mean IADSI score and gender, status of smoking and alcohol use, chronic disease status, regular medication use, type and level of nutrition, defecation characteristics and number, presence of infection, presence of urinary and fecal incontinence, mobility and sweating status, body and defecation hygiene, age and BMI (p < 0.05). CONCLUSION The day 8 IADSI scores are considered to be evidence of the rapid progress of IAD after its development. It is important to know the risk factors associated with IAD in order to recognize the risk factors before IAD develops and to take possible precautions for these risk factors.
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Affiliation(s)
- Burcu Tülü
- Çanakkale Onsekiz Mart University School of Graduate Studies, Department of Nursing, Çanakkale, Türkiye.
| | - Şengül Üzen Cura
- Canakkale Onsekiz Mart University, Faculty of Health Sciences, Department of Fundamental Nursing, Canakkale, Türkiye.
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Wang G, Wang X, Wang H, Wang L, Li W. Risk Factors for Incontinence-Associated Dermatitis in Critically Ill Patients with Incontinence: A Systematic Review and Meta-analysis. J Wound Ostomy Continence Nurs 2024; 51:313-323. [PMID: 39037164 DOI: 10.1097/won.0000000000001090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
PURPOSE This systematic review analyzed evidence related to risk factors for Incontinence Associated Dermatitis (IAD) in critically ill incontinent patients. METHOD Systematic review and meta-analysis. SEARCH STRATEGY 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. FINDINGS 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). IMPLICATIONS 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.
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Affiliation(s)
- Guandong Wang
- Guandong Wang, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Xueying Wang, The College of Nursing and Health of Zhengzhou University, Zhengzhou, Henan, China
- Haibo Wang, BS, Head nurse, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Liang Wang, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Wenjuan Li, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Xueying Wang
- Guandong Wang, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Xueying Wang, The College of Nursing and Health of Zhengzhou University, Zhengzhou, Henan, China
- Haibo Wang, BS, Head nurse, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Liang Wang, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Wenjuan Li, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Haibo Wang
- Guandong Wang, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Xueying Wang, The College of Nursing and Health of Zhengzhou University, Zhengzhou, Henan, China
- Haibo Wang, BS, Head nurse, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Liang Wang, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Wenjuan Li, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Liang Wang
- Guandong Wang, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Xueying Wang, The College of Nursing and Health of Zhengzhou University, Zhengzhou, Henan, China
- Haibo Wang, BS, Head nurse, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Liang Wang, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Wenjuan Li, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Wenjuan Li
- Guandong Wang, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Xueying Wang, The College of Nursing and Health of Zhengzhou University, Zhengzhou, Henan, China
- Haibo Wang, BS, Head nurse, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Liang Wang, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Wenjuan Li, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
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Duncan I, Stocking A, Fitzner K, Ahmed T, Huynh N. The Prevalence of Incontinence and Its Association With Urinary Tract Infections, Dermatitis, Slips and Falls, and Behavioral Disturbances Among Older Adults in Medicare Fee-for-Service. J Wound Ostomy Continence Nurs 2024; 51:138-145. [PMID: 38527324 PMCID: PMC11008436 DOI: 10.1097/won.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
PURPOSE The purpose of this study was to examine the prevalence of urinary (UI), fecal (FI), and dual incontinence (DI) in older adults and their association with urinary tract infections, dermatitis, slips and falls, and behavioral disturbances based on Medicare fee-for-service (FFS) claims data. DESIGN Retrospective analysis. SUBJECTS AND SETTINGS Data from administrative claims from the CMS Medicare Limited Data Set (5% sample) for all months in 2018 were reviewed. The analysis was limited to FFS Medicare beneficiaries, with minimum of 3-month enrollment in Parts A and B who were at least 65 years old. This cohort included 1.2 million beneficiaries in the United States. METHODS We used diagnosis codes to identify members with incontinence and grouped these members into 3 categories (UI only, FI only, and DI). We also divided claims based on 4 sites of care (nursing home, skilled nursing facility, home health, and self- or family care). We then determined the prevalence of (1) urinary tract infections (UTIs), (2) dermatitis, (3) slips and falls, and (4) behavioral disturbances for each type of incontinence. RESULTS We found that 11.2% of Medicare members had a claims-based diagnosis of incontinence in 2018. On average, those diagnosed with incontinence experienced 5 times more UTIs, 2 times as many dermatitis events, more than twice as many slips and falls, and 2.8 times more behavior disturbances compared to those without an incontinence diagnosis. For those with DI, the prevalence of the 4 outcomes was significantly higher (between 22% and 185%) compared to those with UI only. CONCLUSIONS Findings show that Medicare beneficiaries diagnosed as incontinent experience a much higher prevalence of UTIs, dermatitis, slips and falls, and behavioral disturbances compared to those without a diagnosis of incontinence. Our results suggest that incontinence may be an important indicator diagnosis for multiple other conditions and, if not well-managed, may challenge the desire for those who are incontinent to age at home.
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Affiliation(s)
- Ian Duncan
- Correspondence: Ian Duncan, PhD, FSA, MAAA, Department of Statistics and Applied Probability, University of California, Santa Barbara, South Hall 5518, Santa Barbara, CA 93106 ()
| | - Andrew Stocking
- Ian Duncan, PhD, FSA, MAAA, Department of Statistics and Applied Probability, University of California, Santa Barbara
- Andrew Stocking, PhD, Principle Business Enterprises Inc, Dunbridge, Ohio
- Karen Fitzner, PhD, Santa Barbara Actuaries Inc, Santa Barbara, California
- Tamim Ahmed, PhD, MBA, Santa Barbara Actuaries Inc, Santa Barbara, California
- Nhan Huynh, PhD, Santa Barbara Actuaries Inc, Santa Barbara, California
| | - Karen Fitzner
- Ian Duncan, PhD, FSA, MAAA, Department of Statistics and Applied Probability, University of California, Santa Barbara
- Andrew Stocking, PhD, Principle Business Enterprises Inc, Dunbridge, Ohio
- Karen Fitzner, PhD, Santa Barbara Actuaries Inc, Santa Barbara, California
- Tamim Ahmed, PhD, MBA, Santa Barbara Actuaries Inc, Santa Barbara, California
- Nhan Huynh, PhD, Santa Barbara Actuaries Inc, Santa Barbara, California
| | - Tamim Ahmed
- Ian Duncan, PhD, FSA, MAAA, Department of Statistics and Applied Probability, University of California, Santa Barbara
- Andrew Stocking, PhD, Principle Business Enterprises Inc, Dunbridge, Ohio
- Karen Fitzner, PhD, Santa Barbara Actuaries Inc, Santa Barbara, California
- Tamim Ahmed, PhD, MBA, Santa Barbara Actuaries Inc, Santa Barbara, California
- Nhan Huynh, PhD, Santa Barbara Actuaries Inc, Santa Barbara, California
| | - Nhan Huynh
- Ian Duncan, PhD, FSA, MAAA, Department of Statistics and Applied Probability, University of California, Santa Barbara
- Andrew Stocking, PhD, Principle Business Enterprises Inc, Dunbridge, Ohio
- Karen Fitzner, PhD, Santa Barbara Actuaries Inc, Santa Barbara, California
- Tamim Ahmed, PhD, MBA, Santa Barbara Actuaries Inc, Santa Barbara, California
- Nhan Huynh, PhD, Santa Barbara Actuaries Inc, Santa Barbara, California
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Jiang H, Shen J, Lin H, Xu Q, Li Y, Chen L. Risk factors of incontinence-associated dermatitis among critically ill patients: A systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1146697. [PMID: 37113614 PMCID: PMC10126239 DOI: 10.3389/fmed.2023.1146697] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
Objectives Incontinence-associated dermatitis (IAD) is increasingly found among critically ill patients, but the risk factors for IAD in these patients are currently unclear. The purpose of this meta-analysis was to identify the risk factors of IAD in critically ill patients. Methods Web of Science, PubMed, EMBASE, and Cochrane Library were systemically searched until July 2022. The studies were selected based on inclusion criteria, and data were independently extracted by two researchers. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. Odds ratios (ORs) and their associated 95% confidence intervals (CIs) were used to identify significant differences in the risk factors. The I 2 test was used to estimate the heterogeneity of studies, and Egger's test was used to assess the potential publication bias. Results A total of 7 studies enrolling 1,238 recipients were included in the meta-analysis. Age ≥ 60 (OR = 2.18, 95% CI: 1.38~3.42), female sex (OR = 1.76, 95% CI: 1.32~2.34), dialysis (OR = 2.67, 95% CI: 1.51~4.73), fever (OR = 1.55, 95% CI: 1.03~2.33), vasoactive agent (OR = 2.35, 95% CI: 1.45~3.80), PAT score ≥ 7 (OR = 5.23, 95% CI: 3.15~8.99), frequency of bowel movement > 3times/d (OR = 5.33, 95% CI: 3.19~8.93), and liquid stool (OR = 2.61, 95% CI: 1.56~4.38) were the risk factors of IAD among critically ill patients. Conclusions Many risk factors are related to IAD among critically ill patients. Nursing staff should pay more attention to evaluating the risk of IAD and enhance the care of high-risk groups.
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Affiliation(s)
- Hongzhan Jiang
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jiali Shen
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Huihui Lin
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Qiuqin Xu
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yuanchan Li
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Lijuan Chen
- Department of General Surgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen, China
- *Correspondence: Lijuan Chen
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El Genedy-Kalyoncu M, Fastner A, Völzer B, Raeder K, Neumann K, Lahmann NA, Kottner J. 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. BMJ Open 2022; 12:e065909. [PMID: 36175092 PMCID: PMC9528637 DOI: 10.1136/bmjopen-2022-065909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION The 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), a common type of irritant contact dermatitis caused by repeated and prolonged direct contact of the skin with urine and stool. The prevalence of IAD in these settings is high. Preventive measures include mild skin cleansing and the application of skin protecting leave-on products. Available evidence is weak regarding the comparative performance of different skin protection strategies and products due to a lack of confirmatory trials using relevant comparators and endpoints. Therefore, the overall aim of this exploratory trial is to compare the effects of three skin protection strategies to estimate effect sizes of the recently published core outcomes in IAD research. METHODS AND ANALYSIS A pragmatic three-arm, assessor-blinded, randomised controlled, exploratory trial with parallel group design will be performed, comparing film-forming and lipophilic skin protecting leave-on products for IAD prevention with standard incontinence care alone. The trial will be conducted in geriatric nursing homes and geriatric acute care settings in the federal state of Berlin, Germany. A total of n=210 participants being incontinent of urine and stool will be included. Outcomes include IAD incidence, erythema, erosion, maceration, IAD-related pain, patient satisfaction, safety, feasibility and compliance. IAD incidence of the control and intervention groups will be compared to estimate effect sizes, and the procedural feasibility of the intervention will be tested to plan a possible subsequent confirmatory randomised controlled trial. ETHICS AND DISSEMINATION The study received the approval of the ethics committee of Charité-Universitätsmedizin Berlin (EA4/043/22). Results will be disseminated through peer-reviewed open-access journals and international conferences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT05403762) and German Clinical Trials Register (Deutsches Register Klinischer Studien, or DRKS) (DRKS00028954).
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Affiliation(s)
| | - Alexandra Fastner
- Institute of Clinical Nursing Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Bettina Völzer
- Institute of Clinical Nursing Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kathrin Raeder
- Department of Geriatrics and Medical Gerontology, Research Group Geriatrics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Konrad Neumann
- Department of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nils Axel Lahmann
- Department of Geriatrics and Medical Gerontology, Research Group Geriatrics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Kottner
- Institute of Clinical Nursing Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Zhang Q, Li X, Zhang K, Lv L, Jin Y. Psychometric properties of the Chinese version of the knowledge, attitudes and practices of the incontinence‐associated dermatitis questionnaire (C‐KAP‐IAD‐Q) used with Chinese nurses. Int J Nurs Pract 2022:e13107. [DOI: 10.1111/ijn.13107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Qi Zhang
- School of Nursing Peking University Beijing China
| | - Xintong Li
- Faculty of Nursing Fenyang College of Shanxi Medical University Lvliang China
| | - Ke Zhang
- Faculty of Education Science and Technology Shanxi Datong University Datong China
| | - Lijun Lv
- Department of Nursing The Affiliated Hospital of Changzhi Chinese Medicine Research Institute Changzhi China
| | - Yi Jin
- Department of Nursing Tianjin Huanhu Hospital Tianjin China
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Gray M, Bliss DZ, McNichol L. Moisture-Associated Skin Damage: Expanding and Updating Practice Based on the Newest ICD-10-CM Codes. J Wound Ostomy Continence Nurs 2022; 49:143-151. [PMID: 35255065 DOI: 10.1097/won.0000000000000865] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Moisture-associated skin damage (MASD) occurs when skin is repeatedly exposed to various sources of bodily secretions or effluents, often leading to irritant contact dermatitis with inflammation, with or without denudation of affected skin. In 2020, the Wound, Ostomy and Continence Nurses Society took an initiative that led to the addition of multiple International Classification for Diseases codes for irritant contract dermatitis caused by various forms of MASD for use in the United States (ICD-10-CM). In the last issue of the Journal of Wound, Ostomy and Continence Nursing, a clinical practice alert identifying the various new codes was published that summarized each of the new codes and provided highlights of the descriptions of each of the these codes. This is the first in a series of 2 articles providing a more detailed description of the newest irritant contact dermatitis codes linked to MASD. Specifically, this article reviews the clinical manifestations and assessment, pathophysiology, epidemiology, prevention, and management of irritant contact dermatitis due to saliva, respiratory secretions, and fecal or urinary incontinence.
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Affiliation(s)
- Mikel Gray
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, Charlottesville
- Donna Z. Bliss, PhD, RN, FGSA, FAAN, University of Minnesota School of Nursing, Minneapolis
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, FAAN, WOC Nurse, Cone Health, Greensboro, North Carolina
| | - Donna Z Bliss
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, Charlottesville
- Donna Z. Bliss, PhD, RN, FGSA, FAAN, University of Minnesota School of Nursing, Minneapolis
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, FAAN, WOC Nurse, Cone Health, Greensboro, North Carolina
| | - Laurie McNichol
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, Charlottesville
- Donna Z. Bliss, PhD, RN, FGSA, FAAN, University of Minnesota School of Nursing, Minneapolis
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, FAAN, WOC Nurse, Cone Health, Greensboro, North Carolina
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Mugita Y, Minematsu T, Nakagami G, Sanada H. Promoting effect of acylated homoserine lactone on the healing of tissue damage in model rats with incontinence-associated dermatitis. J Wound Care 2021; 30:XIi-XIxi. [PMID: 34597169 DOI: 10.12968/jowc.2021.30.sup9a.xi] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE One of the most common complications in patients with incontinence is incontinence-associated dermatitis (IAD). This study was conducted to determine the pathophysiology of the healing process of IAD and to develop an effective therapeutic approach according to its pathophysiology. METHOD IAD was reproduced on a dorsal rat skin by applying agarose gel containing water and enzymes, and inoculating it with bacteria. Examination of the IAD healing process suggested that the promotion of keratinocyte migration and improvement of basement membrane enhance keratinocyte layer elongations, which contribute to IAD healing. A therapeutic approach using N-(3-oxotetradecanoyl)-L-homoserine lactone, which is one of the acylated homoserine lactones (AHLs) and can promote keratinocyte migration in vitro, was applied on the IAD area in rats. RESULTS AHL treatment after IAD development resulted in an earlier tipping point for recovery than the vehicle treatment. Histological and immunohistological analyses revealed that the tissue surface was already covered by the epidermis, indicating the results of elongation of the keratinocyte layer from hair follicles. The characteristics of the alignment of basal keratinocytes, the existence of stratum corneum, and the membrane-like distribution of the components of basement membrane were similar to those of a normal epidermis. CONCLUSION These results suggested that AHL application possibly contributed to earlier IAD healing before progressing to a severe state. Although elongation of the keratinocyte layer was observed in both the AHL and vehicle groups, the possibility that AHL application promotes IAD healing was suggested. The new concept of the enhancement of keratinocyte migration as a therapeutic approach for IAD would change the skin care strategy for IAD in the healthcare setting.
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Affiliation(s)
- Yuko Mugita
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Takeo Minematsu
- Department of Skincare Science, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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Pflegerische Interventionen bei Kindern mit Windeldermatitis (inkontinenzassoziierter Dermatitis) – ein systematisches Review. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-019-0648-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Conceptual Framework for Incontinence-Associated Dermatitis Based on Scoping Review and Expert Consensus Process. J Wound Ostomy Continence Nurs 2021; 48:239-250. [PMID: 33951713 DOI: 10.1097/won.0000000000000754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Incontinence-associated dermatitis (IAD) has been studied over the last decades, but gaps in the knowledge related to its identification, etiological agents, and risk factors remain. We carried out a scoping review about IAD that included systematic reviews, experimental, and observational studies about IAD and its potential risk factors. We retrieved 24 articles that described 100 potential risk factors and which were synthesized by the authors and proposed to a panel of experts. Panelists used a structured process of consensus development to create a conceptual framework of factors associated with IAD. This framework proposes that liquid fecal material, when combined with exposure to urine and stool, and bacterial contaminated urine are etiological factors for development of IAD. The framework also proposes 2 pathophysiological mechanisms and 8 main risk factors for IAD development. The proposed model could improve the quality of care for patients with or at risk of IAD, assisting healthcare professionals to identify at-risk patients, diagnose the type of lesion, and establish adequate and effective prevention and treatment measures.
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Mugita Y, Nakagami G, Minematsu T, Kitamura A, Sanada H. Combination of urease inhibitor and antiseptic inhibits urea decomposition-induced ammonia production by Proteus mirabilis. Int Wound J 2020; 17:1558-1565. [PMID: 32851777 DOI: 10.1111/iwj.13422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/30/2022] Open
Abstract
The decomposition of urea into ammonia by urease-producing bacterium shows an elevation in the pH level, which can lead to incontinence-associated dermatitis (IAD). This study aimed to examine the efficacy of a combination of antiseptic and urease inhibitor in inhibiting the decomposition of urea by the urease-producing bacterium Proteus mirabilis. We performed in vitro assays to compare the effects of a combination of antiseptic and urease inhibitor, antiseptic only, urease inhibitor only, and an untreated control with the effects of a urea-containing solution. Cultured P. mirabilis was mixed with urea-containing solution, followed by the addition of antiseptic and/or urease inhibitor. The main outcome used to assess the efficacy of the different treatments was ammonia concentration at 4-hours post-treatment initiation, and multiple comparison analysis was performed using Dunnett's test to compare the results between groups. Ammonia concentrations in samples treated with either antiseptic or urease inhibitor were lower than those in the untreated control, while the combination of antiseptic and urease inhibitor resulted in decreased ammonia concentrations compared with either treatment alone. Therefore, the application of both urease inhibitor and antiseptic is more effective for the inhibition of urea decomposition by urease-producing bacteria. Novel preventive strategies using these reagents may be effective for preventing IAD.
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Affiliation(s)
- Yuko Mugita
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeo Minematsu
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Skincare Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Aya Kitamura
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Tay C, Yuh AS, Sheau Lan EL, Ong CE, Aloweni F, Lopez V. Development and validation of the incontinence associated dermatitis knowledge, attitude and practice questionnaire. J Tissue Viability 2020; 29:244-251. [PMID: 32773358 DOI: 10.1016/j.jtv.2020.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 05/04/2020] [Accepted: 06/23/2020] [Indexed: 01/04/2023]
Abstract
AIM This study aimed to develop and test the validity and reliability of the Knowledge, Attitudes and Practices of Incontinence-associated Dermatitis Questionnaire (KAP-IAD-Q) for Nurses. METHODS A psychometric validation design was employed. Phase I of the study entailed the development of items through an extensive literature review and a double Delphi procedure with 11 experts specialised in wound, ostomy and continence to examine content validity of the KAP-IAD-Q. Phase II involved administering the KAP-IAD-Q to a convenience sample of 263 Registered Nurses from a public hospital in Singapore to evaluate its construct validity, internal consistency and test-retest reliability. RESULTS The instrument showed acceptable content validity (S-CVI = 0.85). Exploratory factor analysis showed all 22 items demonstrated strong factor loadings >0.4 and the four factors KAP-IAD-Q explained 58.1% of total variance. The four factors were☹1) knowledge om IAD aetiology and identification, (2) knowledge on IAD risk factors; (3) attitudes, and (4) practices. The overall internal consistency was excellent (Cronbach's α = 0.913). The KAP-IAD-Q showed good overall test-retest reliability as well (ICC = 0.89 (95% CI 0.69-0.96, p < 0.001). CONCLUSION The KAP-IAD-Q demonstrated good psychometric properties and is effective in measuring levels of IAD-related KAP among nurses. Further confirmation of the proposed factor structure is recommended. Future research should explore determinants of nurses' KAP and associations between IAD knowledge, attitudes and practices.
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Affiliation(s)
- Cheryl Tay
- National University of Singapore, Yong Loo Lin School of Medicine, Alice Lee Centre for Nursing Studies, Singapore.
| | - Ang Shin Yuh
- Singapore General Hospital, Nursing Department, Singapore.
| | | | - Choo Eng Ong
- Singapore General Hospital, Nursing Department, Singapore
| | - Fazila Aloweni
- Singapore General Hospital, Nursing Department, Singapore.
| | - Violeta Lopez
- National University of Singapore, Yong Loo Lin School of Medicine, Alice Lee Centre for Nursing Studies, Singapore; School of Nursing, Hubei University of Medicine, Shiyan, China.
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A Survey of Turkish Nurses' Knowledge of Incontinence-Associated Dermatitis. J Wound Ostomy Continence Nurs 2020; 46:434-440. [PMID: 31513132 DOI: 10.1097/won.0000000000000567] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to determine the knowledge of incontinence-associated dermatitis (IAD) among nurses working in intensive care units. DESIGN Descriptive study. SUBJECTS AND SETTING The study was conducted in 6 intensive care units of a 550-bed academic research hospital in Turkey. Licensed practical and registered nurses with a minimum of a Bachelor of Science in Nursing degree employed full-time on these units were invited to participate. METHODS The survey consisted of statements that examined the demographic characteristics (14 questions) and knowledge levels (59 statements) of the nurses. For each statement, nurses were required to mark only one of the following options: "correct," "incorrect," or "no knowledge." Data were collected from July to September 2016. The Shapiro-Wilk test, Mann-Whitney U test, Kruskal-Wallis H test, post hoc multiple comparison test, and Spearman's correlation coefficient were used to analyze the data. RESULTS Of the 126 RNs who participated in the study, 46.83% (n = 59) had an undergraduate degree in nursing. The majority (29.37%) practiced in gastroenterology surgery and urology intensive care units. The mean knowledge score was 33.05 ± 10.16 (min = 0, max = 59). The most correctly answered statement (94.44%; n = 119) was "The pH of the skin plays a role in skin barrier function." The statement with the most incorrect or "no knowledge" answers (96.03%; n = 120) was "The natural moisturizing factor found in the structure of corneocytes helps the skin to maintain its oil levels." Based on correctly answered statements, we found knowledge levels of the prevention and treatment of IAD were higher among nurses with a master of science degree in nursing (40.67 ± 4.32) and lower among licensed practical nursing (29.12 ± 10.08) (P < .05). CONCLUSION In this study, knowledge of the nurses on identification, prevention, and treatment of IAD was low. Comprehensive basic nursing education and in-service training programs on IAD are recommended.
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Examining Prevalence and Risk Factors of Incontinence-Associated Dermatitis Using the International Pressure Ulcer Prevalence Survey. J Wound Ostomy Continence Nurs 2020; 46:285-290. [PMID: 31276451 PMCID: PMC6716554 DOI: 10.1097/won.0000000000000548] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Bebiş H, Moorhead S, Gençbaş D, Özdemir S, Seven M. NOC/NIC Linkages to NANDA-I for Continence Care of Elderly People with Urinary Incontinence in Nursing Homes: A Systematic Review. Florence Nightingale Hemsire Derg 2019; 27:284-303. [PMID: 34267982 DOI: 10.26650/fnjn386150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/17/2019] [Indexed: 11/20/2022] Open
Abstract
Aim The aim of this study was to review interventional studies conducted by nurses about elderly people with urinary incontinence in nursing homes and to match the results to standardized nursing terminology using the Nursing Interventions Classification and the Nursing Outcomes Classification Linkages to the NANDA-I diagnoses guidelines. Method A systematic review of quantitative intervention studies was conducted using the PRISMA statement as a guide. The interventional research in English was scanned using the MEDLINE and CINAHL databases from January 2005 to May 2015. Fourteen studies that had at least one nurse researcher were conducted in nursing homes, excluding surgical and pharmacological interventions. The Nursing Outcome Classification and Nursing Intervention Classification Linkages to NANDA-I diagnoses and the Clinical Conditions Part II-U List were used as a guide to select North American Nursing Diagnosis Association International nursing diagnoses, Nursing Outcome Classification Scales, and Nursing Interventions from the data. Results We found the frequency of use of various NANDA-I diagnoses, Nursing Interventions, and Nursing Outcomes based on the Nursing Outcomes Classification and Nursing Interventions Classification Linkages to NANDA-I diagnoses and the Clinical Conditions List for incontinence. Conclusion Using the Nursing Outcomes Classification and Nursing Interventions Classification Linkages to NANDA-I diagnoses guide may provide new nursing perspectives on non-standardized research. In future studies, this may allow a comparison of data worldwide, enabling nurses to use the results in evidence-based practices.
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Affiliation(s)
- Hatice Bebiş
- Department of Public Health Nursing, Near East University, Nicosia, Cyprus
| | - Sue Moorhead
- The University of Iowa College of Nursing, Iowa City, Iowa, USA
| | - Dercan Gençbaş
- Department of Nursing, Atılım University Faculty of Health Sciences, Ankara, Turkey
| | - Serpil Özdemir
- Department of Public Health Nursing, Gülhane Faculty of Nursing Health Science University, Ankara, Turkey
| | - Memnun Seven
- Department of Obstetric and Gynecologic Nursing, Koç University, İstanbul, Turkey
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Hälleberg Nyman M, Forsman H, Wallin L, Ostaszkiewicz J, Hommel A, Eldh AC. Promoting evidence-based urinary incontinence management in acute nursing and rehabilitation care-A process evaluation of an implementation intervention in the orthopaedic context. J Eval Clin Pract 2019; 25:282-289. [PMID: 29411463 DOI: 10.1111/jep.12879] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The risk of developing urinary incontinence (UI) is associated with older age and hip surgery. There has been limited focus on factors that promote evidence-based UI practice in the orthopaedic context. The aim of this study was to evaluate an implementation intervention to support evidence-based practice for UI in patients aged 65 or older undergoing hip surgery. METHODS A 3-month intervention was delivered in 2014 to facilitate the implementation of UI knowledge in orthopaedic units in 2 hospitals in Sweden. Each unit appointed a multidisciplinary team of nurses and physiotherapists or occupational therapists to facilitate the implementation. The teams were supported by external facilitators who shared knowledge about UI and implementation science. Interviews, nonparticipant observations, and audits of patient records were performed. RESULTS Prior to the intervention, there was no use of guidelines regarding UI. The intervention raised the internal facilitators' awareness of UI risks associated with hip surgery. As internal facilitators shared this information with their peers, staff awareness of UI increased. The teams of internal facilitators described needing additional time and support from managers to implement evidence-based UI care. A management initiative triggered by the intervention increased the documentation of UI and urinary problems in 1 unit. CONCLUSION To promote evidence-based practice related to safe procedures for older people in hospital care, there is a need to better understand strategies that successfully facilitate knowledge implementation. This study suggests that a multiprofessional team approach is promising for instigating a process towards evidence-based management of UI.
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Affiliation(s)
- Maria Hälleberg Nyman
- School of Health Sciences, Örebro University, Örebro, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Henrietta Forsman
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Lars Wallin
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joan Ostaszkiewicz
- Centre for Quality and Patient Safety Research, Barwon Partnership, School of Nursing and Midwifery, Deakin University, Melbourne, Australia
| | - Ami Hommel
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.,Department of Orthopaedics, Skaane University Hospital, Lund, Sweden
| | - Ann Catrine Eldh
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Van den Bussche K, Verhaeghe S, Van Hecke A, Beeckman D. Minimum Data Set for Incontinence-Associated Dermatitis (MDS-IAD) in adults: Design and pilot study in nursing home residents. J Tissue Viability 2018; 27:191-198. [DOI: 10.1016/j.jtv.2018.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 11/25/2022]
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19
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Katoh N, Tennstedt D, Abellan van Kan G, Saint Aroman M, Loir A, Bacqueville D, Duprat L, Guiraud B, Bessou-Touya S, Duplan H. Gerontodermatology: the fragility of the epidermis in older adults. J Eur Acad Dermatol Venereol 2018; 32 Suppl 4:1-20. [DOI: 10.1111/jdv.15253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 09/18/2018] [Indexed: 12/15/2022]
Affiliation(s)
- N. Katoh
- Department of Dermatology; Graduate School of Medical Science; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - D. Tennstedt
- Department of Dermatology; Saint-Luc University Clinics; Brussels Belgium
| | - G. Abellan van Kan
- Gérontopôle; Department of Internal Medicine and Geriatrics; Toulouse University Hospital; Toulouse France
| | | | - A. Loir
- Pierre Fabre Dermo-Cosmétique; Lavaur France
| | - D. Bacqueville
- Pharmacology Division; Pierre Fabre Dermo-Cosmétique; Toulouse France
| | - L. Duprat
- Pharmacology Division; Pierre Fabre Dermo-Cosmétique; Toulouse France
| | - B. Guiraud
- Pharmacology Division; Pierre Fabre Dermo-Cosmétique; Toulouse France
| | - S. Bessou-Touya
- Pharmacology Division; Pierre Fabre Dermo-Cosmétique; Toulouse France
| | - H. Duplan
- Pharmacology Division; Pierre Fabre Dermo-Cosmétique; Toulouse France
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20
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The Impact of Microclimate on Skin Health With Absorbent Incontinence Product Use. J Wound Ostomy Continence Nurs 2018; 45:341-348. [DOI: 10.1097/won.0000000000000449] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Incontinence, Incontinence-Associated Dermatitis, and Pressure Injuries in a Health District in Australia. J Wound Ostomy Continence Nurs 2018; 45:349-355. [DOI: 10.1097/won.0000000000000446] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Mugita Y, Minematsu T, Nakagami G, Sanada H. Influence of digestive enzymes on development of incontinence-associated dermatitis: Inner tissue damage and skin barrier impairment caused by lipidolytic enzymes and proteases in rat macerated skin. Int Wound J 2018; 15:623-632. [PMID: 29877066 DOI: 10.1111/iwj.12906] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 12/16/2022] Open
Abstract
One of the most common complications in patients with incontinence is incontinence-associated dermatitis. This study aimed to examine the influences of lipidolytic enzymes and/or proteases on skin barrier and tissue structure on the development of incontinence-associated dermatitis. Two animal experiments, ex vivo and in vivo, were performed using rats to examine the influences of 3 factors (maceration, proteases, and lipidolytic enzymes) alone or in various combinations on the barrier function and histology of the skin. As a result, skin treatments, including both of the skin maceration and proteases application, caused erythrocyte leakage from the blood vessels in the dermis. The erythrocyte leakage was observed in a larger area in the skin treated with proteases and lipidolytic enzymes with maceration than in the skin treated with proteases with maceration, that is, the addition of lipidolytic enzymes to skin maceration with proteases enhanced erythrocyte leakage. Lipidolytic enzymes in macerated skin are factors that accelerate tissue damage via skin barrier impairment, and proteases are the factors that trigger the development of incontinence-associated dermatitis via tissue damage. Advanced nursing care of perineal skin in patients with faecal incontinence is required because of the deleterious influence of lipidolytic enzymes and proteases.
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Affiliation(s)
- Yuko Mugita
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeo Minematsu
- Department of Skincare Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Global Nursinc Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Global Nursinc Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Global Nursinc Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Van Damme N, Clays E, Verhaeghe S, Van Hecke A, Beeckman D. Independent risk factors for the development of incontinence-associated dermatitis (category 2) in critically ill patients with fecal incontinence: A cross-sectional observational study in 48 ICU units. Int J Nurs Stud 2018; 81:30-39. [PMID: 29428583 DOI: 10.1016/j.ijnurstu.2018.01.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/16/2018] [Accepted: 01/27/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Critically ill patients suffering from fecal incontinence have a major risk of developing incontinence-associated dermatitis (IAD). The presence of moisture and digestive enzymes (lipase, protease) negatively influences skin barrier function. Additional risk factors will make some patients even more vulnerable than others. In order to provide (cost) effective prevention, this specific patient population should be identified timely. OBJECTIVES To identify independent risk factors for the development of IAD category 2 (skin loss) in critically ill patients with fecal incontinence. DESIGN A cross-sectional observational study. SETTING AND PARTICIPANTS The study was performed in 48 ICU wards from 27 Belgian hospitals. Patients of 18 years or older, with fecal incontinence at the moment of data collection, were eligible to participate. Patients with persistent skin redness due to incontinence (IAD category 1) were excluded. METHODS Potential risk factors were carefully determined based on literature and expert consultations. Data were collected over a period of eight months by trained researchers using patient records and observation of skin care practices. At the time a patient was included in the study, all relevant data from the past six days, or since admission at the ICU, were recorded. Simultaneously, direct skin observations were performed and high definition photographs were ratified by an expert IAD researcher. A multiple binary logistic regression model was composed to identify independent risk factors. Variables with P < .25 in single binary logistic regression analyses were added to the multiple model using a forward procedure. A cut-off value of P < .1 was established to retain variables in the final model. Nagelkerke's R2 and Hosmer-Lemeshow statistic were calculated as measures of model fit. RESULTS The sample comprised of 206 patients, of which 95 presented with IAD category 2, and 111 were free of IAD. Seven independent risk factors were identified: liquid stool [odds ratio (OR) 4.69; 95% confidence interval (CI) 2.28-9.62], diabetes (OR 2.89; 95% CI 1.34-6.27), age (OR 1.05; 95% CI 1.02-1.08), smoking (OR 2.67; 95% CI 1.21-5.91), non-use of diapers (OR 2.97; 95% CI 1.39-6.33), fever (OR 2.60; 95% CI 1.23-5.53), and low oxygen saturation (OR 2.15; 95% CI 1.03-4.48). Nagelkerke's R2 was 0.377. The Hosmer-Lemeshow statistic indicated no significant difference between the observed and expected values (p = .301). CONCLUSIONS Liquid stool, diabetes, age, smoking, non-use of diapers, fever, and low oxygen saturation were independently associated with IAD category 2 in critically ill patients with fecal incontinence.
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Affiliation(s)
- Nele Van Damme
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, UZ Gent, 5K3, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Els Clays
- Epidemiology and Prevention Unit, Department of Public Health, Ghent University, UZ Gent, 5K3, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Sofie Verhaeghe
- University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, UZ Gent, 5K3, Corneel Heymanslaan 10, B-9000 Ghent, Belgium; Department Health Care, VIVES University College, Wilgenstraat 32, B-8800 Roeselare, Belgium
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, UZ Gent, 5K3, Corneel Heymanslaan 10, B-9000 Ghent, Belgium; Nursing Department, Ghent University Hospital, UZ Gent, 11K12, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, UZ Gent, 5K3, Corneel Heymanslaan 10, B-9000 Ghent, Belgium; School of Health Sciences, University of Surrey, Guilford, UK; School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland.
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Coyer F, Campbell J. Incontinence-associated dermatitis in the critically ill patient: an intensive care perspective. Nurs Crit Care 2017; 23:198-206. [PMID: 29266568 DOI: 10.1111/nicc.12331] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/29/2017] [Accepted: 11/14/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Incontinence-associated dermatitis is a skin disorder evident as a complication of incontinence. It is characterized by perineal, buttock and groin erythema and skin breakdown. Incontinence-associated dermatitis is a ubiquitous, nosocomial condition commonly present in critically ill patients in the intensive care unit. Critically ill patients, by the nature of their critical illness and therapies used to treat their presenting condition, are commonly predisposed to faecal incontinence and are consequently at high risk of developing incontinence-associated dermatitis. However, this condition is under-explored and under-reported in the intensive care literature. OBJECTIVE The aim of this paper is to provide a review of the literature relating to incontinence-associated dermatitis from the critically ill patients in the intensive care setting. DISCUSSION There is a paucity of literature addressing this condition in the intensive care context, with only 11 studies identified. This paper will provide an overview of the definitions, prevalence and incidence of incontinence-associated dermatitis. Furthermore, an exposition of incontinence-associated dermatitis from the critically ill patient and intensive care nursing perspectives will be presented through a review of the skin barrier function, clinical presentation, risk factors, clinical assessment and severity categorization, prevention and management of incontinence-associated dermatitis. CONCLUSION It is imperative that critical care nurses have an appreciation of incontinence-associated dermatitis as a common, yet preventable condition, and are equipped with knowledge to appropriately prevent and manage this common complication.
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Affiliation(s)
- Fiona Coyer
- School of Nursing, Queensland University of Technology and Intensive Care Services, Royal Brisbane and Women's Hospital, Metro North Hospital Health Service, Herston, Queensland 4006, Australia.,Visiting Professor, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
| | - Jill Campbell
- Skin Integrity Services, Royal Brisbane and Women's Hospital, Metro North Hospital Health Service, Herston, Queensland 4006, Australia
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Clinical Evaluation of a Skin Protectant for the Management of Incontinence-Associated Dermatitis: An Open-Label, Nonrandomized, Prospective Study. J Wound Ostomy Continence Nurs 2017; 44:172-180. [PMID: 28267125 PMCID: PMC5344181 DOI: 10.1097/won.0000000000000307] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE: The purpose of this study was to evaluate the efficacy of an investigational skin protectant product at managing severe skin breakdown associated with incontinence. DESIGN: Open-label, nonrandomized, prospective study. SUBJECTS AND SETTING: The sample comprised 16 patients; inclusion criteria were: patients older than 18 years, cared for in the intensive care unit of a level I trauma center hospital or in long-term care facilities in the northeast region of the United States, and had incontinence-associated dermatitis (IAD). Twelve of the patients had epidermal skin loss and 4 had severe redness. METHODS: The investigational product is a formulation based on acrylate chemistry. The skin protectant application schedule was twice weekly for up to 3 weeks for a maximum of 6 applications during the study period. The skin was evaluated via a skin assessment instrument specifically designed for use in this study; this instrument has not undergone validation studies. The main outcome measure was changes in the instrument score over time. In addition, complete reepithelialization was recorded when observed, and pain scores (associated with IAD) were noted in participants who were able to report pain. RESULTS: The IAD score improved in 13 of 16 patients, remained unchanged in 1 patient, and deteriorated in 2 patients. The median percent improvement in the skin assessment instrument was 96% (P = .013). Four of the patients with epidermal skin loss had complete reepithelialization of the skin surface with 4 to 6 applications of the skin protectant, and 5 had substantial improvement. The 4 patients with severe red skin returned to healthy normal skin with 2 to 4 skin protectant applications. Substantial pain reduction was reported by all 9 patients who reported pain at enrollment. No adverse events associated with the skin protectant application were reported during data collection. CONCLUSION: Results of this study suggest that an acrylate-based product, evaluated here for the first time in patients, may be effective as a protective barrier in the presence of continued incontinence. Additional research is needed to confirm these findings.
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Bliss DZ, Mathiason MA, Gurvich O, Savik K, Eberly LE, Fisher J, Wiltzen KR, Akermark H, Hildebrandt A, Jacobson M, Funk T, Beckman A, Larson R. Incidence and Predictors of Incontinence-Associated Skin Damage in Nursing Home Residents With New-Onset Incontinence. J Wound Ostomy Continence Nurs 2017; 44:165-171. [PMID: 28267124 DOI: 10.1097/won.0000000000000313] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to determine the incidence and predictors of incontinence-associated dermatitis (IAD) in nursing home residents. METHODS Records of a cohort of 10,713 elderly (≥65 years) newly incontinent nursing home residents in 448 nursing homes in 28 states free of IAD were followed up for IAD development. Potential multilevel predictors of IAD were identified in 4 national datasets containing information about the characteristics of individual nursing home residents, nursing home care environment, and communities in which the nursing homes were located. A unique set of health practitioner orders provided information about IAD and the predictors of IAD prevention and pressure injuries in the extended perineal area. Analysis was based on hierarchical logistical regression. RESULTS The incidence of IAD was 5.5%. Significant predictors of IAD were not receiving preventive interventions for IAD, presence of a perineal pressure injury, having greater functional limitations in activities of daily living, more perfusion problems, and lesser cognitive deficits. CONCLUSION Findings highlight the importance of prevention of IAD and treatment/prevention of pressure injuries. A WOC nurse offers expertise in these interventions and can educate staff about IAD predictors, which can improve resident outcomes. Other recommendations include implementing plans of care to improve functional status, treat perfusion problems, and provide assistance with incontinence and skin care to residents with milder as well as greater cognitive deficits.
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Affiliation(s)
- Donna Z Bliss
- Donna Z. Bliss, PhD, RN, FAAN, FGSA, University of Minnesota School of Nursing, Minneapolis, Minnesota. Michelle A. Mathiason, MS, University of Minnesota School of Nursing, Minneapolis, Minnesota. Olga Gurvich, MS, University of Minnesota School of Nursing, Minneapolis, Minnesota. Kay Savik, MS, University of Minnesota School of Nursing, Minneapolis, Minnesota. Lynn E. Eberly, PhD, School of Public Health Division of Biostatistics, Minneapolis, Minnesota. Jessica Fisher, BSN, RN, University of Minnesota School of Nursing, Minneapolis, Minnesota. Kjerstie R. Wiltzen, BSN, BA, RN, University of Minnesota School of Nursing, Minneapolis, Minnesota. Haley Akermark, BSN, RN, University of Minnesota School of Nursing, Minneapolis, Minnesota. Amanda Hildebrandt, BA, University of Minnesota School of Nursing, Minneapolis, Minnesota. Megan Jacobson, BSN, RN, University of Minnesota School of Nursing, Minneapolis, Minnesota. Taylor Funk, BSN, RN, University of Minnesota School of Nursing, Minneapolis, Minnesota. Amanda Beckman, BSN, RN, University of Minnesota School of Nursing, Minneapolis, Minnesota. Reed Larson, BSN, RN, University of Minnesota School of Nursing, Minneapolis, Minnesota
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Bliss DZ, Bland P, Wiltzen K, Gannon A, Wilhems A, Mathiason MA, Turnbaugh R. Incontinence Briefs Containing Spiral-Shaped Fiber Acidify Skin pH of Older Nursing Home Residents at Risk for Incontinence-Associated Dermatitis. J Wound Ostomy Continence Nurs 2017; 44:475-480. [PMID: 28877114 DOI: 10.1097/won.0000000000000362] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The study's purpose was to assess the pH of the skin of older (aged ≥75 years) incontinent nursing home residents after exposure to an incontinence brief containing spiral-shaped fiber wet with an alkaline solution mimicking urine or fecal pH and compared to skin pH after exposure to an industry standard brief wet with the same solution and various controls. DESIGN The design was experimental, as conditions were applied to skin and skin pH was measured in random order, and subjects served as their own controls. SETTING AND SUBJECTS The setting was a Midwestern nonprofit nursing home. The sample was 26 nursing home residents; their mean age was 87 years (SD = 6 years); 77% were female. Most (69%) had urinary incontinence alone, and 31% had dual urinary and fecal incontinence. METHODS Skin pH was measured in duplicate on 6 areas of the inner thighs and 6 areas of the volar surface of the forearms. Each area was exposed to 1 of 6 conditions applied in random order: an incontinence brief containing spiral-shaped fiber wet with an alkaline solution and one that was dry; a standard incontinence brief (without spiral-shaped fiber) wet with the same alkaline solution and one that was dry; the alkaline solution alone; and normal skin. RESULTS On both the thighs and the forearms, skin pH was significantly lower (more acidic) after exposure to the incontinence brief containing spiral-shaped fiber wet with an alkaline solution compared to the wet standard brief and all other control conditions (P < .001). On thighs, the mean skin pH was 5.7 (SD = 0.5) after exposure to the wet brief with spiral-shaped fiber versus 6.4 (SD = 0.5) after exposure to the wet standard brief. On forearms, the mean skin pH was 5.3 (SD = 0.4) after exposure to the wet brief with spiral-shaped fiber versus 6.0 (SD = 0.4) after exposure to the wet standard brief. CONCLUSIONS Incontinence briefs containing a spiral-shaped fiber significantly acidify the pH of the skin exposed to an alkaline solution, while industry standard briefs do not. Since alkaline skin pH is a risk factor for incontinence-associated dermatitis (IAD), results suggest that briefs with spiral-shaped fiber may help prevent IAD. Findings encourage further research.
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Affiliation(s)
- Donna Z Bliss
- Donna Z. Bliss, PhD, RN, FAAN, FGSA, University of Minnesota School of Nursing, Minneapolis. Peggy Bland, HSD, RN, Presbyterian Manor of Mid-America Nursing Home, Farmington, Missouri. Kjerstie Wiltzen, BA, BSN, RN, CWCN, University of Minnesota School of Nursing, Minneapolis. Alexandra Gannon, BSN, RN, University of Minnesota School of Nursing, Minneapolis. Anna Wilhems, BSN, RN, University of Minnesota School of Nursing, Minneapolis. Michelle A. Mathiason, MS, University of Minnesota School of Nursing, Minneapolis. Robert Turnbaugh, RN, Presbyterian Manor of Mid-America Nursing Home, Farmington, Missouri
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Effects of a Skin Barrier Cream on Management of Incontinence-Associated Dermatitis in Older Women. J Wound Ostomy Continence Nurs 2017; 44:481-486. [DOI: 10.1097/won.0000000000000353] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bliss DZ, Gurvich OV, Eberly LE, Harms S. Time to and predictors of dual incontinence in older nursing home admissions. Neurourol Urodyn 2017; 37:229-236. [PMID: 28407296 DOI: 10.1002/nau.23279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/12/2017] [Indexed: 11/07/2022]
Abstract
AIMS There are few studies of nursing home residents that have investigated the development of dual incontinence, perhaps the most severe type of incontinence as both urinary and fecal incontinence occur. To determine the time to and predictors of dual incontinence in older nursing home residents. METHODS Using a cohort design, records of older nursing home admissions who were continent or had only urinary or only fecal incontinence (n = 39,181) were followed forward for report of dual incontinence. Four national US datasets containing potential predictors at multiple levels describing characteristics of nursing home residents, nursing homes (n = 445), and socioeconomic and sociodemographic status of the community surrounding nursing homes were analyzed. A Cox proportional hazard regression with nursing home-specific random effect was used. RESULTS At 6 months after admission, 28% of nursing home residents developed dual incontinence, at 1 year 42% did so, and at 2 years, 61% had dual incontinence. Significant predictors for time to developing dual incontinence were having urinary incontinence, greater functional or cognitive deficits, more comorbidities, older age, and lesser quality of nursing home care. CONCLUSIONS The development of dual incontinence is a major problem among nursing home residents. Predictors in this study offer guidance in developing interventions to prevent and reduce the time to developing this problem which may improve the quality of life of nursing residents.
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Affiliation(s)
- Donna Z Bliss
- School of Nursing, University of Minnesota, Minneapolis, Minnesota
| | - Olga V Gurvich
- School of Nursing, University of Minnesota, Minneapolis, Minnesota
| | - Lynn E Eberly
- Division of Biostatistics, School of Public Health, Minneapolis, Minnesota
| | - Susan Harms
- School of Nursing, University of Minnesota, Minneapolis, Minnesota.,College of Pharmacy, Minneapolis, Minnesota
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Park KH, Choi H. Prospective study on Incontinence-Associated Dermatitis and its Severity instrument for verifying its ability to predict the development of pressure ulcers in patients with fecal incontinence. Int Wound J 2016; 13 Suppl 1:20-5. [PMID: 26847935 DOI: 10.1111/iwj.12549] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/28/2015] [Accepted: 10/28/2015] [Indexed: 02/06/2023] Open
Abstract
Fecal incontinence with loose stools is a risk factor for skin damage that may develop into a pressure ulcer (PU). The aim of this study was to determine the feasibility of applying the Incontinence-Associated Dermatitis and its Severity (IADS) instrument to patients with fecal incontinence as a tool to predict PU development. This prospective study enrolled 120 intensive care unit patients with bowel incontinence of Bristol Stool type 5, 6, and 7. Trained nurses evaluated IADS scores and the occurrence of PUs daily for 7 days. Patients with higher IADS scores were significantly more likely to develop a PU (odds ratio = 1·22, 95% confidence interval = 1·12-1·33). The receiver operating characteristic curve analysis revealed the area under curve to be 0·790, suggesting that higher IADS scores are associated with an increased likelihood of developing a PU (sensitivity 72·5%, specificity 71·2%, using a cut-off value of 8/9). Our results suggest that the IADS instrument can serve as a tool for predicting the occurrence of PUs in patients with fecal incontinence. Patients with IADS scores that exceed eight points should be classified as being at risk of developing a PU, and placed under intensive care as a proactive measure to prevent PU development.
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Affiliation(s)
- Kyung Hee Park
- Department of Nursing Science, The University of Suwon, Hwaseong-si, South Korea
| | - Heejung Choi
- Department of Nursing, Konkuk University, Chungju-si, South Korea
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Best practice nursing care for ICU patients with incontinence-associated dermatitis and skin complications resulting from faecal incontinence and diarrhoea. INT J EVID-BASED HEA 2016; 14:15-23. [PMID: 26735567 DOI: 10.1097/xeb.0000000000000067] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIMS Incontinence-associated dermatitis (IAD), resulting from diarrhoea and/or faecal incontinence, is a common problem in intensive care, occurring in 7-50% of the patients, with an estimated 10 million dollars spent annually on continence skin care. This project aimed to evaluate and improve the staff knowledge on IAD and also improve practice in the identification, prevention and treatment of IAD in the ICU. METHODS A pre/post-audit framework was used to implement the best practice recommendations between August 2013 and March 2014. Nursing staff were surveyed and a chart review was conducted to audit baselines of knowledge and nursing practice regarding IAD. Education and product standardization were used to implement the best practice recommendations and a post-audit was conducted to evaluate changes in knowledge and practice. RESULTS Thirty-one (pre-implementation) and 27 (post-implementation) nurses were surveyed to evaluate knowledge on IAD identification, care and documentation practices. No IAD policy or IAD-specific skin assessment tool for use existed in the ICU. After implementation, there was a 40% increase in the ability of the staff to distinguish between IAD and pressure injuries, an increase from 87% to 100% in the use of skin-protectant and an improvement from 25 to 66% in the correct application of skin-protectants. An encouraging 70% of the nurses were using a single standard skin-protectant after implementation as opposed to audit 1, where 100% of the nurses were using multiple products before implementation. There was a 16% increase in the staff surveyed post-audit who said they reported on the perineal skin in patients with IAD. However, IAD documentation in both audit 1 and audit 2, as evidenced by chart review, remained poor. CONCLUSION The project had created an awareness of IAD in the ICU. There was clear knowledge improvement and nursing staff were able to differentiate IAD from pressure injuries. The skin cleansing and protection regime is now more clear and consistent, and a single standardized product is being used to prevent and treat IAD. There was a small improvement in consistently documenting the condition of the perineal skin of patients with IAD; however, it was beyond the scope of this project to develop a policy and implement an IAD-specific skin assessment tool in the ICU, as this would have improved documentation of IAD in the ICU.
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Van Damme N, Van den Bussche K, De Meyer D, Van Hecke A, Verhaeghe S, Beeckman D. Independent risk factors for the development of skin erosion due to incontinence (incontinence-associated dermatitis category 2) in nursing home residents: results from a multivariate binary regression analysis. Int Wound J 2016; 14:801-810. [PMID: 27933731 DOI: 10.1111/iwj.12699] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/17/2016] [Accepted: 11/06/2016] [Indexed: 12/01/2022] Open
Abstract
The aim of this study was to identify characteristics independently associated with a higher risk of developing skin damage because of incontinence [incontinence-associated dermatitis (IAD) category 2] in nursing home residents. As part of a larger randomised controlled trial, IAD incidence was monitored for 1 month in a sample of 381 incontinent residents using a validated IAD Severity Categorisation Tool. Data on demographical, physical, functional and psychological characteristics were collected. The overall IAD incidence (category 1-2) was 30·0%, and 6% of the participants developed skin damage (IAD category 2). Residents who developed IAD category 2 were less mobile [odds ratio (OR) 2·72, 95% confidence interval (CI) 1·06-6·94], had more friction and shear issues (OR 2·54; 95% CI 1·02-6·33) and had more erythema due to incontinence (OR 3·02; 95% CI 1·04-8·73) before IAD category 2 occurrence. Care providers should give full attention to risk factors to both detect residents at risk for IAD development and to start prevention in time.
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Affiliation(s)
- Nele Van Damme
- University Centre for Nursing and Midwifery - Department of Public Health, Ghent University, Ghent, Belgium
| | - Karen Van den Bussche
- University Centre for Nursing and Midwifery - Department of Public Health, Ghent University, Ghent, Belgium
| | - Dorien De Meyer
- University Centre for Nursing and Midwifery - Department of Public Health, Ghent University, Ghent, Belgium
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery - Department of Public Health, Ghent University, Ghent, Belgium
| | - Sofie Verhaeghe
- University Centre for Nursing and Midwifery - Department of Public Health, Ghent University, Ghent, Belgium
| | - Dimitri Beeckman
- University Centre for Nursing and Midwifery - Department of Public Health, Ghent University, Ghent, Belgium
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Matar H, Larner J, Viegas V, Kansagra S, Atkinson KL, Shetage S, Skamarauskas JT, Theivendran B, Goldman VS, Chilcott RP. Evaluation of a new topical skin protectant (RD1433) for the prevention and treatment of incontinence-associated dermatitis. Cutan Ocul Toxicol 2016; 36:211-219. [PMID: 27817210 DOI: 10.1080/15569527.2016.1257637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Context Incontinence-associated dermatitis (IAD) is a type of moisture-associated dermatitis caused by repeated skin exposure to urine or stool. A product that could mitigate such symptoms would have a significant impact on cost of care and patients' quality of life. Objective This study compared the clinical efficacy of RD1433 and a comparator product (Vaseline®) in preventing and treating experimental IAD skin lesions. Materials and methods For the "prevention" part of the study, skin sites in eight human volunteers were treated daily for 5 d with either RD1433 or Vaseline® immediately prior to synthetic urine exposure. In the "treatment" part, exposure to synthetic urine was substituted for Vaseline® or RD1433 application on the first 2 d to promote the development of skin lesions prior to the application of the products from day three. Product efficacy was quantified by visual scoring and an array of biophysical instruments. Results Both RD1433 and Vaseline® significantly reduced lesion progression when applied as a prophylactic. When applied as a treatment (following establishment of skin lesions), RD1433 demonstrated a statistically significant improvement in several measures of skin function whereas there was no statistically significant improvement following treatment with Vaseline®. Conclusions The findings of this study suggest that RD1433 may be superior to Vaseline® in the prevention and treatment of experimental IAD lesions. Clearly, further work is required to establish the efficacy of RD1433 with patients in a clinical environment.
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Affiliation(s)
- Hazem Matar
- a Research Centre for Transdermal Drug Delivery and Toxicology, Department of Pharmacy, University of Hertfordshire , Hatfield , Hertfordshire , UK and
| | - Joanne Larner
- a Research Centre for Transdermal Drug Delivery and Toxicology, Department of Pharmacy, University of Hertfordshire , Hatfield , Hertfordshire , UK and
| | - Vanessa Viegas
- a Research Centre for Transdermal Drug Delivery and Toxicology, Department of Pharmacy, University of Hertfordshire , Hatfield , Hertfordshire , UK and
| | - Sneha Kansagra
- a Research Centre for Transdermal Drug Delivery and Toxicology, Department of Pharmacy, University of Hertfordshire , Hatfield , Hertfordshire , UK and
| | - Karen L Atkinson
- a Research Centre for Transdermal Drug Delivery and Toxicology, Department of Pharmacy, University of Hertfordshire , Hatfield , Hertfordshire , UK and
| | - Satyajit Shetage
- a Research Centre for Transdermal Drug Delivery and Toxicology, Department of Pharmacy, University of Hertfordshire , Hatfield , Hertfordshire , UK and
| | - John T Skamarauskas
- a Research Centre for Transdermal Drug Delivery and Toxicology, Department of Pharmacy, University of Hertfordshire , Hatfield , Hertfordshire , UK and
| | - Baveetharan Theivendran
- a Research Centre for Transdermal Drug Delivery and Toxicology, Department of Pharmacy, University of Hertfordshire , Hatfield , Hertfordshire , UK and
| | - Virginia S Goldman
- b Protective Products Division, Bracco Diagnostics Inc. , Princeton , NJ , USA
| | - Robert P Chilcott
- a Research Centre for Transdermal Drug Delivery and Toxicology, Department of Pharmacy, University of Hertfordshire , Hatfield , Hertfordshire , UK and
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Bliss DZ, Gurvich OV, Mathiason MA, Eberly LE, Savik K, Harms S, Mueller C, Wyman JF, Virnig B. Prevention of Incontinence-Associated Skin Damage in Nursing Homes. West J Nurs Res 2016; 39:643-659. [PMID: 27586441 DOI: 10.1177/0193945916666065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Racial/ethnic disparities in preventing health problems have been reported in nursing homes. Incontinence is common among nursing home residents and can result in inflammatory-type skin damage, referred to as incontinence-associated skin damage (IASD). Little is known about the prevention of IASD and whether there are racial/ethnic disparities in its prevention. This study assessed the proportion of older nursing home residents receiving IASD prevention after developing incontinence after admission ( n = 10,713) and whether there were racial/ethnic disparities in IASD prevention. Predictors of preventing IASD were also examined. Four national data sets provided potential predictors at multiple levels. Disparities were analyzed using the Peters-Belson method; predictors of preventing IASD were assessed using hierarchical logistic regression. Prevention of IASD was received by 0.12 of residents and no racial/ethnic disparities were found. Predictors of preventing IASD were primarily resident-level factors including limitations in activities of daily living, poor nutrition, and more oxygenation problems.
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Affiliation(s)
- Donna Z Bliss
- 1 University of Minnesota School of Nursing, Minneapolis, MN, USA
| | - Olga V Gurvich
- 1 University of Minnesota School of Nursing, Minneapolis, MN, USA
| | | | - Lynn E Eberly
- 2 School of Public Health Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Kay Savik
- 1 University of Minnesota School of Nursing, Minneapolis, MN, USA
| | - Susan Harms
- 1 University of Minnesota School of Nursing, Minneapolis, MN, USA.,3 College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | | | - Jean F Wyman
- 1 University of Minnesota School of Nursing, Minneapolis, MN, USA
| | - Beth Virnig
- 4 School of Public Health Division of Health Services Research and Policy, University of Minnesota, Minneapolis, MN, USA
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Fujimura T, Makino M, Takagi M, Maki K, Murakami E, Tasaka Y, Sato N, Akiba S, Hotta M, Kitahara T, Ando K. The influence of incontinence on the characteristic properties of the skin in bedridden elderly subjects. Int J Dermatol 2015; 55:e234-40. [DOI: 10.1111/ijd.13170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 06/20/2015] [Accepted: 08/03/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Tsutomu Fujimura
- Biological Science Research; Kao Corporation; Haga Tochigi Japan
| | - Mayumi Makino
- Department of Nursing; Medical Corporation; Saijyo Central Hospital; Saijyo Ehime Japan
| | - Miyuki Takagi
- Department of Nursing; Medical Corporation; Saijyo Central Hospital; Saijyo Ehime Japan
| | - Kumiko Maki
- Department of Nursing; Medical Corporation; Saijyo Central Hospital; Saijyo Ehime Japan
| | - Emiko Murakami
- Department of Nursing; Medical Corporation; Saijyo Central Hospital; Saijyo Ehime Japan
| | - Yoshiko Tasaka
- Department of Nursing; Medical Corporation; Saijyo Central Hospital; Saijyo Ehime Japan
| | - Noriko Sato
- Biological Science Research; Kao Corporation; Haga Tochigi Japan
| | - Shunichi Akiba
- Biological Science Research; Kao Corporation; Haga Tochigi Japan
| | - Mitsuyuki Hotta
- Biological Science Research; Kao Corporation; Haga Tochigi Japan
| | - Takashi Kitahara
- Biological Science Research; Kao Corporation; Haga Tochigi Japan
| | - Kikue Ando
- Department of Nursing; Medical Corporation; Saijyo Central Hospital; Saijyo Ehime Japan
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Mugita Y, Minematsu T, Huang L, Nakagami G, Kishi C, Ichikawa Y, Nagase T, Oe M, Noguchi H, Mori T, Abe M, Sugama J, Sanada H. Histopathology of Incontinence-Associated Skin Lesions: Inner Tissue Damage Due to Invasion of Proteolytic Enzymes and Bacteria in Macerated Rat Skin. PLoS One 2015; 10:e0138117. [PMID: 26407180 PMCID: PMC4583398 DOI: 10.1371/journal.pone.0138117] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 08/25/2015] [Indexed: 12/25/2022] Open
Abstract
A common complication in patients with incontinence is perineal skin lesions, which are recognized as a form of dermatitis. In these patients, perineal skin is exposed to digestive enzymes and intestinal bacterial flora, as well as excessive water. The relative contributions of digestive enzymes and intestinal bacterial flora to skin lesion formation have not been fully shown. This study was conducted to reveal the process of histopathological changes caused by proteases and bacterial inoculation in skin maceration. For skin maceration, agarose gel containing proteases was applied to the dorsal skin of male Sprague-Dawley rats for 4 h, followed by Pseudomonas aeruginosa inoculation for 30 min. Macroscopic changes, histological changes, bacterial distribution, inflammatory response, and keratinocyte proliferation and differentiation were examined. Proteases induced digestion in the prickle cell layer of the epidermis, and slight bleeding in the papillary dermis and around hair follicles in the macerated skin without macroscopic evidence of erosion. Bacterial inoculation of the skin macerated by proteolytic solution resulted in the formation of bacteria-rich clusters comprising numerous microorganisms and inflammatory cells within the papillary dermis, with remarkable tissue damage around the clusters. Tissue damage expanded by day 2. On day 3, the proliferative keratinocyte layer was elongated from the bulge region of the hair follicles. Application of proteases and P. aeruginosa induced skin lesion formation internally without macroscopic erosion of the overhydrated area, suggesting that the histopathology might be different from regular dermatitis. The healing process of this lesion is similar to transepidermal elimination.
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Affiliation(s)
- Yuko Mugita
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Research fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Takeo Minematsu
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Lijuan Huang
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Research Institute for Biomedical Sciences, Tokyo University of Science, Chiba, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chihiro Kishi
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Takashi Nagase
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Makoto Oe
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Noguchi
- Department of Life Support Technology (Molten), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taketoshi Mori
- Department of Life Support Technology (Molten), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masatoshi Abe
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Sapporo Skin Clinic, Kojinkai, Sapporo, Hokkaido, Japan
| | - Junko Sugama
- Department of Clinical Nursing, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- * E-mail:
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Park KH, Choi H. Adaptation and Evaluation of the Incontinence Care Protocol. J Korean Acad Nurs 2015; 45:357-66. [DOI: 10.4040/jkan.2015.45.3.357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kyung Hee Park
- Department of Nursing, Samsung Medical Center, Seoul, Korea
| | - Heejung Choi
- Department of Nursing, Konkuk University, Chungju, Korea
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Refinement of an Instrument for Assessing Incontinent-Associated Dermatitis and Its Severity for Use With Darker-Toned Skin. J Wound Ostomy Continence Nurs 2014; 41:365-70. [DOI: 10.1097/won.0000000000000034] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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40
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Campbell JL, Coyer FM, Osborne SR. Incontinence-associated dermatitis: a cross-sectional prevalence study in the Australian acute care hospital setting. Int Wound J 2014; 13:403-11. [PMID: 24974872 DOI: 10.1111/iwj.12322] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 04/11/2014] [Accepted: 05/28/2014] [Indexed: 11/29/2022] Open
Abstract
The purpose of this cross-sectional study was to identify the prevalence of incontinence and incontinence-associated dermatitis (IAD) in Australian acute care patients and to describe the products worn to manage incontinence, and those provided at the bedside for perineal skin care. Data on 376 inpatients were collected over 2 days at a major Australian teaching hospital. The mean age of the sample group was 62 years and 52% of the patients were male. The prevalence rate of incontinence was 24% (91/376). Urinary incontinence was significantly more prevalent in females (10%) than males (6%) (χ(2) = 4·458, df = 1, P = 0·035). IAD occurred in 10% (38/376) of the sample group, with 42% (38/91) of incontinent patients having IAD. Semi-formed and liquid stool were associated with IAD (χ(2) = 5·520, df = 1, P = 0·027). Clinical indication of fungal infection was present in 32% (12/38) of patients with IAD. Absorbent disposable briefs were the most common incontinence aids used (80%, 70/91), with soap/water and disposable washcloths being the clean-up products most commonly available (60%, 55/91) at the bedside. Further data are needed to validate this high prevalence. Studies that address prevention of IAD and the effectiveness of management strategies are also needed.
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Affiliation(s)
- Jill L Campbell
- Skin Integrity Service, Royal Brisbane and Women's Hospital, Brisbane, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Fiona M Coyer
- Skin Integrity Service, Royal Brisbane and Women's Hospital, Brisbane, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Sonya R Osborne
- Skin Integrity Service, Royal Brisbane and Women's Hospital, Brisbane, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Australia
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Incontinence-associated dermatitis in community-dwelling individuals with fecal incontinence. J Wound Ostomy Continence Nurs 2014; 40:181-4. [PMID: 23442827 DOI: 10.1097/won.0b013e31827e8b3d] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the occurrence and severity of incontinence-associated dermatitis among community-dwelling individuals with fecal incontinence. DESIGN Descriptive and comparative secondary data analysis. SUBJECTS AND SETTING One hundred eighty-nine community-dwelling individuals with fecal incontinence who participated in a study comparing the effects of dietary fiber on fecal incontinence. METHODS A survey on the use of absorbent products that contained questions about subjects' history of skin damage was administered at the start of the study. RESULTS Incontinence-associated dermatitis occurred in 52.5% of the community-living individuals with fecal incontinence. The severity of incontinence-associated dermatitis was mostly mild to moderate and occurred periodically. Redness without broken skin was the most common manifestation (68%). Most individuals (95%) reported the location of skin damage to be the anal/rectal area. Those with double incontinence also reported dermatitis around the vagina or penis. Individuals with a greater severity of fecal incontinence had a greater severity of incontinence-associated dermatitis (r = 0.27, P = .000). Both the frequency of incontinence (r = 0.23, P < .002) and the amount of feces leaked (r = 0.23, P < .002) had a significant correlation with incontinence-associated dermatitis severity. There were no significant differences in the occurrence or severity of incontinence-associated dermatitis by sex, age, or presence of double incontinence. CONCLUSION A high percentage of individuals in the community with fecal incontinence suffer from incontinence-associated dermatitis at times. This population may benefit from consultation with a WOC nurse about prevention and management of incontinence-associated dermatitis.
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Ichikawa-Shigeta Y, Sugama J, Sanada H, Nakatani T, Konya C, Nakagami G, Minematsu T, Yusuf S, Supriadi, Mugita Y. Physiological and appearance characteristics of skin maceration in elderly women with incontinence. J Wound Care 2014; 23:18-9, 22-23, 26 passim. [DOI: 10.12968/jowc.2014.23.1.18] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Y. Ichikawa-Shigeta
- Department of Clinical nursing, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa university, Ishikawa, japan
| | - J. Sugama
- Department of Clinical nursing, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa university, Ishikawa, japan
| | - H. Sanada
- Department of Gerontological nursing/Wound Care Management, Graduate School of Medicine, The university of Tokyo, Tokyo, japan
| | - T. Nakatani
- Department of Clinical nursing, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa university, Ishikawa, japan
| | - C. Konya
- Department of adult nursing, Kanazawa Medical university, Ishikawa, japan
| | - G. Nakagami
- Department of Gerontological nursing/Wound Care Management, Graduate School of Medicine, The university of Tokyo, Tokyo, japan
| | - T. Minematsu
- Department of Gerontological nursing/Wound Care Management, Graduate School of Medicine, The university of Tokyo, Tokyo, japan
| | - S. Yusuf
- Department of Clinical nursing, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa university, Ishikawa, japan
| | - Supriadi
- Department of Clinical nursing, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa university, Ishikawa, japan
| | - Y. Mugita
- Department of Gerontological nursing/Wound Care Management, Graduate School of Medicine, The university of Tokyo, Tokyo, japan
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Stephen-Haynes J, Stephens C. Evaluation of clinical and financial outcomes of a new no-sting barrier film and barrier cream in a large UK primary care organisation. Int Wound J 2013; 10:689-96. [PMID: 22835134 PMCID: PMC7950945 DOI: 10.1111/j.1742-481x.2012.01045.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The study involves 95 subjects within a UK Primary Care Organisation and was undertaken in two arms. The objective was to determine the clinical outcomes and clinical acceptability of a newly available range of no-sting barrier film and no-sting barrier cream products offering significant financial benefits. The importance of undertaking this study is underpinned by evidence in the literature relating to the use of no-sting barrier preparations within clinical practice. The first part of the study (arm 1) involved extensive evaluation of either the film or cream barrier in 36 patients and was compared to existing standardised barrier protection care within the organisation. The results indicated that the new product range met all the criteria for formulary inclusion and following this the barrier range was further evaluated in arm 2, 33 patients with barrier cream and 26 patients with barrier film. The entire study was conducted over a 3-month period with patient treatment lasting a minimum of 2 days to a maximum 4-week period adhering to the agreed evaluation protocol as approved by clinical governance. In arm 1 (n = 36), the clinical expectation of the product was met in 32 cases relating to ease of use, conformability, no-sting, quick drying, ease of absorption, compatibility with devices, frequency of application, prevention and management including visual skin improvement resulting in a recommendation for formulary listing in 31 of 36 cases. In arm 2 (n = 59), barrier film and barrier cream performance was consistently rated same as, better than or much better than the existing barrier used. A formulary listing recommendation was made in 51 of 59 cases.
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Affiliation(s)
- Jackie Stephen-Haynes
- Practice Development Unit, Birmingham City University and Worcestershire Health & Care Trust, Worcestershire, UK
| | - Claire Stephens
- Practice Development Unit, Birmingham City University and Worcestershire Health & Care Trust, Worcestershire, UKBirmingham City University and Worcestershire Health & Care Trust, Worcestershire, UK
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Bliss D, Rolnick C, Jackson J, Arntson C, Mullins J, Hepburn K. Health literacy needs related to incontinence and skin damage among family and friend caregivers of individuals with dementia. J Wound Ostomy Continence Nurs 2013; 40:515-23. [PMID: 24448620 PMCID: PMC3900878 DOI: 10.1097/won.0b013e3182a3ff24] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to describe health literacy needs related to incontinence and skin care among family or friend caregivers of individuals with Alzheimer disease (AD) and develop supportive and educational materials that address these needs. DESIGN Descriptive. SUBJECTS AND SETTINGS The sample included 48 family/friend adult caregivers of individuals who had advanced dementia. Caregivers were spouses (44%), daughters (31%), or extended family members/friends (25%) recruited from community-based agencies, with a mean age of 64 ± 14 years (mean ± SD), and 75% were female. Nearly half (48%) had a racially or ethnically diverse background. METHODS Focus groups, interviews, and written surveys were conducted to assess health literacy needs of AD caregivers related to incontinence and skin care; verbal responses were audiotaped, transcribed, and summarized. To address these needs, a set of educational and supportive materials was developed, whose content was directed by caregiver responses and supported by a literature review of current evidence and consultation with clinical and research experts. Study procedures were guided by an advisory committee of AD caregivers. RESULTS Caregivers had numerous health literacy needs related to incontinence and skin care; areas of need were categorized into knowledge, skills, and attitudes. Caregivers expressed a need to validate the health literacy they possessed. Fourteen educational and supportive documents were developed to address these needs. CONCLUSION Materials developed in this study are suitable to incorporate into interventions that support caregivers of persons with AD. They offer the potential to raise health literacy and care capacity of caregivers, increase communication with health care providers, and improve health outcomes of care recipients.
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Affiliation(s)
| | | | - Jody Jackson
- HealthPartners Research Foundation, Bloomington, MN
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Braunschmidt B, Müller G, Jukic-Puntigam M, Steininger A. The Inter-Rater Reliability of the Incontinence-Associated Dermatitis Intervention Tool-D (IADIT-D) Between Two Independent Registered Nurses of Nursing Home Residents in Long-Term Care Facilities. J Nurs Meas 2013; 21:284-95. [DOI: 10.1891/1061-3749.21.2.284] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose: Incontinence-associated dermatitis (IAD) is the clinical manifestation of moisture related skin damage (Beeckman, Woodward, & Gray, 2011). Valid assessment instruments are needed for risk assessment and classification of IAD. Aim of the quantitative-descriptive cross-sectional study was to determine the inter-rater reliability of the item scores of the German Incontinence Associated Dermatitis Intervention Tool (IADIT-D) between two independent assessors of nursing home residents (n = 381) in long-term care facilities. The 19 pairs of assessors consisted of registered nurses. Methods: The data analysis was computed first with the calculation of the total percentage of agreement. Because this value is not randomly adjusted, the calculation of the Kappa-coefficients and AC1-Statistic was done as well. Results: The total percentage of the inter-rater agreement was 84% (n = 319). In a second step of analysis, the calculation of all items determined high (κ = .70) and very high agreement (AC1 = .83) levels, respectively. For the risk assessment (κ = .82; AC1 = .94), the values amounted to very high agreement levels and for the classification (κw = .70; AC1 = .76) to high agreement levels. Conclusions: The high to very high agreement values of IADIT-D demonstrate that the items can be regarded as stable in regards to the inter-rater reliability for the use in long-term care facilities. In addition, further validation studies are needed.
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Abstract
BACKGROUND As the population ages, an increasing number of elderly persons will undergo surgery for rectal cancer. The use of sphincter-sparing surgery in frail older adults is controversial. OBJECTIVE The aim of this study was to examine mortality and bowel function after proctectomy in nursing home residents. DESIGN This is a retrospective cohort study. SETTING This investigation was conducted in nursing homes in the United States contracted with the Center for Medicare and Medicaid Services. PATIENTS Nursing home residents age 65 and older undergoing proctectomy for rectal cancer (2000-2005) were included. MAIN OUTCOME MEASURES The primary outcomes measured were fecal incontinence and the 1-year mortality rate. RESULTS Operative mortality was 18% after proctectomy with permanent colostomy and 13% after sphincter-sparing proctectomy (adjusted relative risk, 1.25 (95% CI 0.90-1.73), p = 0.188). One-year mortality was high: 40% after sphincter-sparing proctectomy and 51% after proctectomy with permanent colostomy (adjusted hazard ratio 1.32 (95% CI 1.09-1.60), p = 0.004). After sphincter-sparing proctectomy, 37% of residents were incontinent of feces. Residents with the poorest functional status (Minimum Data Set-Activities of Daily Living quartile 4) were significantly more likely to be incontinent of feces than residents with the best functional status (Minimum Data Set-Activities of Daily Living quartile 1) (76% vs 13%, adjusted relative risk 3.28 (95% CI 1.74- 6.18), p= 0.0002). Fecal incontinence was also associated with dementia (adjusted relative risk 1.55 (95% CI 1.15-2.09), p = 0.004) and renal failure (adjusted relative risk 1.93 (95% CI 1.10-3.38), p = 0.022). LIMITATIONS Measures of fecal incontinence in nursing home registries are not as well studied as those commonly used in clinical practice. CONCLUSIONS Sphincter-sparing proctectomy in nursing home residents is frequently associated with postoperative fecal incontinence and should be considered only for continent patients with good functional status.
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A 3-in-1 perineal care washcloth impregnated with dimethicone 3% versus water and pH neutral soap to prevent and treat incontinence-associated dermatitis: a randomized, controlled clinical trial. J Wound Ostomy Continence Nurs 2012; 38:627-34. [PMID: 21952346 DOI: 10.1097/won.0b013e31822efe52] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE We compared the effectiveness of a 3-in-1 perineal care washcloth versus standard of care (water and pH neutral soap) to prevent and treat incontinence-associated dermatitis (IAD). The product under study was a soft, premoistened washcloth, including a 3% dimethicone formula, with cleansing, moisturizing, and barrier protection properties. DESIGN Randomized, controlled clinical trial. SUBJECTS AND SETTING The study sample comprised a random sample of 11 nursing home wards (6 experimental and 5 control) in a convenience sample of 4 nursing homes in Belgium. The sample included nursing home residents at risk for and/or affected by IAD defined as incontinent of urine, feces, urine/feces, and/or having erythema of the perineal skin (not caused by pressure/shear), and/or having an edematous skin in the genital area. METHODS Participants in the experimental group were treated according to a standardized protocol, including the use of a 3-in-1 perineal care washcloth impregnated with a 3% dimethicone skin protectant. Participants in the control group received perineal skin care with water and pH neutral soap, the standard of care in Belgian nursing homes. The study period was 120 days. Data were collected between February and May 2010. Incontinence-associated dermatitis prevalence and severity were assessed using the IAD Skin Condition Assessment Tool. The surface (cm), redness, and depth of the perineal lesion were assessed daily by the nurses. This tool generates a cumulative severity score (maximum score = 10) based on area of skin affected, degree of redness, and depth of erosion. RESULTS Four hundred sixty-four nursing home residents were assessed and 32.9% (n = 141) met the criteria for inclusion, including 73 subjects in the experimental group and 68 in the control group. Baseline IAD prevalence was comparable in both groups (experimental: 22.3% vs control: 22.8%, P = .76). Baseline IAD severity was 6.9/10 in the experimental group and 7.3/10 in the control group. A significant intervention effect on IAD prevalence was found (experimental: 8.1% vs control: 27.1%, F = 3.1, P = .003). A nonsignificant effect on IAD severity could be determined (experimental: 3.8/10 vs control: 6.9/10, F = 0.8, P = .06). CONCLUSION The use of a 3-in-1 washcloth, impregnated with a 3% dimethicone formula, resulted in a significantly reduced prevalence of IAD and a trend toward less severe lesions. These findings provide indicative evidence for the use of 3-in-1 perineal care washcloth as an effective intervention against the use of water and a pH neutral soap to prevent and/or treat IAD.
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Incontinence-associated dermatitis in critically ill adults: time to development, severity, and risk factors. J Wound Ostomy Continence Nurs 2011; 38:433-45. [PMID: 21747261 DOI: 10.1097/won.0b013e318220b703] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to determine the time to development, severity, and risk factors of incontinence-associated dermatitis (IAD) among critically ill patients with fecal incontinence. SUBJECTS AND SETTING Forty-five patients with a mean age of 49.4 ± 18.5 years (mean ± SD) in the surgical/trauma critical care unit (ICU) of 1 of 3 urban hospitals who were free of any perineal skin damage at study start participated in the study. The majority (76%) were male. METHODS Surveillance of skin for IAD and chart review of data initially and daily. RESULTS Incontinence-associated dermatitis developed in 36% of patients. The median time to onset of IAD was 4 days (range, 1-6). Eighty-one percent of patients still had IAD at discharge from the ICU and at the end of their surveillance (median time = 7 days, range, 1-19 days). The severity of erythema associated with IAD was mild, moderate, or severe for 13%, 11%, or 4% (means) of the time patients were observed. Denudement occurred 9% of the observed time. Frequent incontinence of loose or liquid stools and diminished cognitive awareness were significant independent risk factors for development of IAD sooner. CONCLUSION Incontinence-associated dermatitis develops in critically ill patients with fecal incontinence relatively quickly and does not resolve in most before their discharge from the ICU. Early monitoring and prevention of IAD, especially in patients with diminished cognition or with frequent leakage of loose or liquid feces, are recommended to promote skin health.
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Marchetti F, Corallo JP, Ritter J, Sands LR. Retention Cuff Pressure Study of 3 Indwelling Stool Management Systems. J Wound Ostomy Continence Nurs 2011; 38:569-73. [DOI: 10.1097/won.0b013e31822ad43c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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