Damage control: Differentiating incontinence-associated dermatitis from pressure injury

Detecting Early-Stage Pressure Injury in Patients With Dark Skin Tones Using an Enhanced Physical Assessment Technique and Halogen Lighting

PURPOSE

The purpose of this quality improvement project was to identify stage 1 pressure injuries (PIs) in patients with darker skin tones using an enhanced skin assessment (Skin Assessment for Dark Skin, SADS) and halogen lighting.

PARTICIPANTS AND SETTING

This quality improvement project was conducted on 3 units at a large university teaching hospital in Southeast Michigan. The project was originally designed so that participating patients were identified by bedside nurses as having sufficient melanin to obscure blanching on the hand/forearm using regular lighting, but this goal was not met. Data analysis is based on patients who self-identified as African American or Black, Native Hawaiian or Pacific Islander, Asian, American Indian, and Native Alaskan. Bedside nurses participating in this project were also asked to complete a questionnaire describing their knowledge and experiences with this project and assessment of early-stage PI in patients with darker skin tones.

APPROACH

The Iowa Model of Evidence-Based Practice was used to guide this quality improvement initiative. Following a trigger event, we reviewed pertinent literature and developed an enhanced technique for assessing patients with darker skin tones that involved use of halogen lighting (SADS) and documentation of findings. We selected units from our facility and taught nurses to apply the SADS approach. Data from the electronic medical record and a survey of participating nurses were used to compare findings before and after project implementation. Comparisons were based on descriptive data analysis.

OUTCOMES

Following implementation of the enhanced physical assessment, the participating units experienced a 6% decrease in the total number of facility-acquired PIs during the implementation period.

IMPLICATIONS FOR PRACTICE

The enhanced physical assessment, when paired with halogen lighting, enhanced identification of stage 1 PI in persons with dark skin. The assessment method was easy to teach, learn, and can be performed at the bedside as part of a shift assessment which routinely includes inspection of skin.

Assessment and Identification of Skin Disorders in Skin of Color: An Integrative Review

Skin assessment in patients with dark skin tones (DST) continues to be a challenge for many healthcare providers (HCP) because the visual cues are not always readily identified. For example, identification of early signs of pressure injury when subtle skin color changes are missed has the potential to cause harm and contribute to healthcare disparities. Appropriate wound management can begin only when the wound is correctly identified. For HCPs to identify early signs of skin conditions in DST patients, they must be provided education and effective tools enabling them to identify clinically relevant signs of skin damage in all patients. This article reviews basic anatomy of the skin; it focuses on differences seen in DST and reviews assessment strategies to assist the HCP to identify skin changes and conditions.

Evaluating the Scales Used To Diagnose Incontinence-Associated Dermatitis: A Systematic Review

OBJECTIVE

To investigate the scales used in the diagnosis of incontinence-associated dermatitis (IAD), including the risk factors included in the scales, their reliability and validity, and in which patient groups the scales have been applied.

DATA SOURCES

The relevant studies were screened retrospectively using five MeSH (Medical Subject Headings) keywords in various combinations. Seven international databases were screened between March and July 2019. In total, 2,908 studies published between 2009 and 2019 were evaluated.

STUDY SELECTION

Inclusion criteria for studies were as follows: written in English, published between 2009 and 2019, and investigated a scale developed to diagnose IAD (quantitative studies, randomized controlled studies, or meta-analyses). Studies were excluded if they did not examine scales for diagnosing IAD or were not in English. Nine studies were included in this review: five studies on scale development, one scale revision, one scale reliability study, and two Turkish validity and reliability studies.

DATA EXTRACTION

The study methods, sample characteristics, interventions, validity and reliability analyses, risk factors in the scales, and subdimensions of the scales were examined for each of the nine included studies.

DATA SYNTHESIS

Study samples were composed of nurses, healthcare professionals, patients, or individuals living in a nursing home and ranged in size from 9 to 823 participants. Most data were collected from hospital-wide clinics. The scales used investigated redness, rash, skin loss, incontinence type, infection symptoms, skin color, edema, patient experience, pain, and perineal care habits. Both validity and reliability of the scales were examined in eight of the studies; in one study, only reliability was examined because the scale validity was shown in previous research. Moreover, sensitivity and specificity were indicated in one study.

CONCLUSIONS

There are several competent scales in the literature with proven validity and reliability that can be used to diagnose IAD.

A Qualitative Study on the Experience and Training Needs of ICU Nurses for Incontinence-Associated Dermatitis

OBJECTIVE

To explore the experience of incontinence-associated dermatitis (IAD) as perceived by nurses, obstacles in the nursing process, and need for IAD training and management.

METHODS

This single-setting descriptive qualitative study was conducted from June 5, 2018, to June 22, 2018. Ten nurses working in the respiratory ICU of a local hospital participated in semistructured interviews. The content analysis method was used to analyze, summarize, and refine the interview data.

RESULTS

The experience of ICU nurses with IAD can be divided into four types: nursing based on experiential knowledge, seeking self-improvement, disunity of cleaning methods and wiping skills, and postponement of nursing care because of priority allocation. Obstacles in the nursing process include a lack of relevant nursing knowledge and awareness, as well as the medical supplies needed. The goals of training and management include establishing IAD preventive nursing procedures, providing IAD care products, enhancing the practicality of training content and diversifying training methods, and establishing an information system to assist nurses caring for patients with IAD.

CONCLUSIONS

The knowledge and behavior of ICU nurses regarding IAD need to be improved. Training and management are imperative. Facilities and nurse managers should actively seek solutions to stated obstacles, formulate training methods suitable for clinical needs, and promote the standardization of nursing for IAD.

Pressure ulcer Cat. II-IV incidence on the CuroCell S.A.M. PRO powered reactive air support surface in a high-risk population: A multicentre cohort study in 12 Belgian nursing homes

The primary objective was to study pressure ulcer (PU) category II-IV (including suspected deep tissue injury and unstageable PUs) cumulative incidence and PU incidence density, in a 30day observation period, associated with the use of the CuroCell S.A.M. PRO powered reactive air support surface in nursing home residents at risk for PU development. Secondary objectives were to study (a) PU category I cumulative incidence and PU incidence density and (b) user (caregivers and residents) experiences and perceptions of comfort associated with the use of the support surface under study. A multicentre cohort study was set up in 37 care units of 12 Belgian nursing homes. The sample consisted of 191 residents at risk of PU development (Braden score ≤ 17). The cumulative PU incidence was 4.7% (n = 9). The PU incidence density was 1.7/1000 observation days (9 PU/5370 days). The experience and perceptions of comfort analysis revealed that the CuroCell S.A.M. PRO powered reactive air support surface was comfortable for daily use. The mode of action and the quietness of the pump function had a positive impact on sleep quality. Patient comfort and sleep quality are essential criteria in the selection of a support surface.