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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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Kottner J, Amin R, Tomova‐Simitchieva T, Hillmann K, Blume‐Peytavi U. Effects of a mattress cover with special airflow technology on the structure and function of the sacral and heel skin during loading: A two-arm exploratory crossover trial. Int Wound J 2024; 21:e14957. [PMID: 38994923 PMCID: PMC11240536 DOI: 10.1111/iwj.14957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/14/2024] [Accepted: 06/14/2024] [Indexed: 07/13/2024] Open
Abstract
Prolonged mechanical loading of the skin and underlying soft tissue cause pressure ulceration. The use of special support surfaces are key interventions in pressure ulcer prevention. They modify the degree and duration of soft tissue deformation and have an impact on the skin microclimate. The objective of this randomized cross-over trial was to compare skin responses and comfort after lying for 2.5 h supine on a support surface with and without a coverlet that was intended to assist with heat and moisture removal at the patient/surface interface. In addition, physiological saline solution was administered to simulate an incontinence episode on the mattress next to the participants' skin surface. In total, 12 volunteers (mean age 69 years) with diabetes mellitus participated. After loading, skin surface temperature, stratum corneum hydration and skin surface pH increased, whereas erythema and structural stiffness decreased at the sacral area. At the heel skin area, temperature, erythema, and stratum corneum hydration increased. These results indicate occlusion and soft tissue deformation which was aggravated by the saline solution. The differences in skin response showed only minor differences between the support surface with or without the coverlet.
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Affiliation(s)
- Jan Kottner
- Institute for Clinical Nursing ScienceCharité – Universitätsmedizin BerlinBerlinGermany
| | - Ruhul Amin
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
- BCSIR Laboratories DhakaBangladesh Council of Scientific and Industrial ResearchDhakaBangladesh
| | - Tsenka Tomova‐Simitchieva
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
| | - Kathrin Hillmann
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
| | - Ulrike Blume‐Peytavi
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
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Deprez J, Ohde N, Eilegård Wallin A, Bååth C, Hommel A, Hultin L, Josefson A, Kottner J, Beeckman D. Prognostic factors for the development of incontinence-associated dermatitis (IAD): A systematic review. Int Wound J 2024; 21:e14962. [PMID: 39016196 PMCID: PMC11253026 DOI: 10.1111/iwj.14962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/18/2024] Open
Abstract
Incontinence-associated dermatitis (IAD) is an irritant contact dermatitis from prolonged contact with urine or faeces, which can significantly impact patient comfort and quality of life. The identification of prognostic factors for the development of IAD has the potential to enhance management, support preventive measures and guide future research. The objective of this systematic review was to summarize the empirical evidence of prognostic factors for the development of IAD. This study included prospective and retrospective observational studies or clinical trials that described prognostic factors associated with IAD. There were no restrictions on setting, time, language, participants or geographical regions. Exclusion criteria included reviews, editorials, commentaries, methodological articles, letters to the editor, cross-sectional and case-control studies, and case reports. Searches were conducted from inception to April 2024 on MEDLINE, CINAHL, EMBASE and the Cochrane Library. The studies were assessed by two independent reviewers using the QUIPS and the CHARMS-PF for data extraction. A narrative synthesis approach was employed due to study heterogeneity and using the 'vote counting based on direction' method and the sign test. The overall certainty of evidence was assessed using adapted GRADE criteria. The review included 12 studies and identified 15 potential predictors. Moderate-quality evidence suggests that increased stool frequency, limited mobility and friction/shear problems are risk factors for IAD development. Female sex, older age, vasopressor use and loose/liquid stool are risk factors supported by low-quality evidence. Increased stool frequency, limited mobility and friction/shear problems seem to be risk factors for the development of IAD. There is insufficient evidence to support the predictive validity of female sex, older age, loose/liquid stool and vasopressor use. There is substantial methodological variability across studies, making it challenging to make comparisons. Large-scale cohort studies in different settings that incorporate our review findings should be conducted in the future.
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Affiliation(s)
- Julie Deprez
- Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
| | - Nils Ohde
- Institute of Clinical Nursing ScienceCharité UniversitätsmedizinBerlinGermany
| | - Alexandra Eilegård Wallin
- Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Carina Bååth
- Department of Health SciencesFaculty of Health, Science and Technology, Karlstad UniversityKarlstadSweden
- Faculty of Health, Welfare and OrganisationØstfold University CollegeHaldenNorway
| | - Ami Hommel
- Department of Care ScienceMalmö UniversityMalmöSweden
| | - Lisa Hultin
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
| | - Anna Josefson
- School of Medical Sciences, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
- Department of DermatologyÖrebro University HospitalÖrebroSweden
| | - Jan Kottner
- Institute of Clinical Nursing ScienceCharité UniversitätsmedizinBerlinGermany
| | - Dimitri Beeckman
- Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
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Ramadan F. Managing incontinence-associated dermatitis in the community: an overview. Br J Community Nurs 2024; 29:294-295. [PMID: 38814833 DOI: 10.12968/bjcn.2024.29.6.294] [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: 06/01/2024]
Abstract
Incontinence-associated dermatitis (IAD) is often treated a hygienic challenge, rather than a serious condition with potentially life-threatening consequences. More appropriate education on the management strategies specific to IAD is required, in order for personalised and effective care that reflects the critical nature of this condition to be provided. Francesca Ramadan provides an overview of the key elements of best practice in IAD management and treatment.
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Barakat‐Johnson M, Stephenson J, Lai M, Basjarahil S, Campbell J, Cunich M, Disher G, Geering S, Ko N, Leahy C, Leong T, McClure E, O'Grady M, Walsh J, White K, Coyer F. Impact of an evidence-based bundle on incontinence-associated dermatitis prevalence in hospital patients: A quasi-experimental translational study. Int Wound J 2024; 21:e14936. [PMID: 38899615 PMCID: PMC11187733 DOI: 10.1111/iwj.14936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024] Open
Abstract
The study aimed to evaluate the effect of an intervention on the prevalence and severity of incontinence-associated dermatitis (IAD) in six hospitals in one state in Australia. This quasi-experimental pre-and post-study, conducted in 18 wards, was part of a larger implementation science study on incontinence-associated dermatitis. Skin and incontinence assessments were conducted on patients during February and March 2020 (pre-intervention) and July and August 2021 (post-intervention). The intervention comprised continence assessment and management, an education brochure for patients, family and caregivers on IAD, the Ghent Global IAD Categorisation Tool (GLOBIAD) and a skin care regime with patient skin protection measures (three-in-one barrier cream cloths, minimisation of bed protection layers, use of appropriate continence aid). A total of 1897 patients were assessed (pre-intervention = 964, post-intervention = 933). A total of 343 (35.6%) pre-intervention patients and 351 (37.6%) post-intervention patients had incontinence. The prevalence of hospital-acquired IAD was 6.71% in the pre-intervention group and 4.27% in the post-intervention group; a reduction of 36.3% (p = 0.159) despite higher patient acuity, prevalence of double incontinence and the COVID-19 pandemic in the post-intervention group compared with the pre-intervention group. Our multisite best practice IAD prevention and treatment intervention was able to reduce the prevalence and severity of hospital-acquired IAD, suggesting enduring effectiveness of the intervention.
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Affiliation(s)
- Michelle Barakat‐Johnson
- Executive Nursing and Midwifery ServicesSydney Local Health DistrictSydneyAustralia
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- School of Human and Health SciencesUniversity of HuddersfieldHuddersfieldUK
| | - John Stephenson
- School of Human and Health SciencesUniversity of HuddersfieldHuddersfieldUK
| | - Michelle Lai
- Executive Nursing and Midwifery ServicesSydney Local Health DistrictSydneyAustralia
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Shifa Basjarahil
- The Sutherland Hospital, Nursing and Midwifery ServicesSouth Eastern Sydney Local Health DistrictSydneyAustralia
| | - Jayne Campbell
- Nursing and Midwifery ServicesHunter New England Local Health DistrictNewcastleAustralia
| | - Michelle Cunich
- Charles Perkins Centre, Sydney School of Medicine (Central Clinical School), Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- Sydney Health Economics CollaborativeSydney Local Health DistrictSydneyAustralia
| | - Gary Disher
- Strategic Reform and Planning BranchNew South Wales Ministry of HealthSydneyAustralia
| | - Samara Geering
- Nursing and Midwifery Services Research AllianceSouth Western Sydney Local Health DistrictSydneyAustralia
- Ingham Institute for Applied Medical ResearchSydneyAustralia
| | - Natalie Ko
- Nursing and Midwifery Services, Concord Repatriation General HospitalSydney Local Health DistrictSydneyAustralia
| | - Catherine Leahy
- Quality, Clinical Safety and NursingWestern New South Wales Local Health DistrictOrangeAustralia
| | - Thomas Leong
- Nursing and Midwifery Services, Royal Prince Alfred HospitalSydney Local Health DistrictSydneyAustralia
| | - Eve McClure
- Aged and Chronic Care and Rehabilitation ServicesSydney Local Health DistrictSydneyAustralia
| | - Melissa O'Grady
- Nursing and Midwifery Services, Concord Repatriation General HospitalSydney Local Health DistrictSydneyAustralia
| | - Joan Walsh
- The Sutherland Hospital, Nursing and Midwifery ServicesSouth Eastern Sydney Local Health DistrictSydneyAustralia
| | - Kate White
- Executive Nursing and Midwifery ServicesSydney Local Health DistrictSydneyAustralia
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Fiona Coyer
- School of Nursing, Midwifery and Social WorkThe University of QueenslandBrisbaneAustralia
- Institute of Skin Integrity and Infection PreventionThe University of HuddersfieldHuddersfieldUK
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Owen EJ, Heylen RA, Stewart K, Winyard PG, Jenkins ATA. Detecting and monitoring incontinence associated dermatitis: Does impedance spectroscopy have a part to play? Proc Inst Mech Eng H 2024; 238:655-666. [PMID: 36882988 PMCID: PMC11318234 DOI: 10.1177/09544119231159178] [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: 11/28/2022] [Accepted: 02/06/2023] [Indexed: 03/09/2023]
Abstract
In this review, current understanding of the prevention and treatment of Incontinence Associated Dermatitis (IAD) is discussed. The need for preventative measures which target specific faecal/urinary irritants is highlighted, including the role of urease inhibitors. There is no existing internationally and clinically accepted method to diagnose and categorise the severity of IAD. Diagnosis currently relies on visual inspection; non-invasive techniques to assess skin barrier function could remove subjectiveness, particularly in darker skin tones. Impedance spectroscopy is a non-invasive technique which can be used to monitor skin barrier function, supporting visual assessments. Six studies (2003-2021) which used impedance to assess dermatitis were reviewed; inflamed skin was distinguishable from healthy skin in each case. This suggests that impedance spectroscopy could be useful in diagnosis early-stage IAD, potentially enabling earlier intervention. Finally, the authors present their initial findings on the role of urease in skin breakdown in an in vivo IAD model, using impedance spectroscopy.
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Affiliation(s)
- Emily J Owen
- Department of Chemistry, University of Bath, Bath, UK
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Owen EJ, Heylen RA, Stewart K, Winyard PG, Jenkins ATA. The multi-factorial modes of action of urease in the pathogenesis of incontinence associated dermatitis. SKIN HEALTH AND DISEASE 2024; 4:e349. [PMID: 38846694 PMCID: PMC11150740 DOI: 10.1002/ski2.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/11/2024] [Accepted: 02/05/2024] [Indexed: 06/09/2024]
Abstract
Background Incontinence Associated Dermatitis (IAD) is a type of skin inflammation caused by chronic exposure to urine and/or faeces. Current treatment strategies involve creating a barrier between the skin and urine/faeces rather than targeting specific irritants. Urease expressing pathogens catalyse the conversion of urea, present in urine, into ammonia. The accumulation of ammonia causes an elevation in skin pH which is believed to activate faecal enzymes which damage skin, and opportunistic pathogens, which lead to secondary infections. Objectives To develop a better, multi-factorial model of IAD pathogenesis, including the effect of urease-expressing bacteria on skin, mechanism of damage of urease and urease-triggered activity of faecal enzymes and secondary pathogens. To study the effect of urease inhibition on preventing IAD skin damage. Methods Five separate studies were made using ex vivo porcine skin and in vivo human skin models. Measurements of the change in skin barrier function were made using skin impedance, trans-epidermal water loss (TEWL), stratum corneum moisture and pH. Skin was exposed to artificial urine, inoculated with various microbes, enzymes and chemicals to examine the influence of: 1) urease-positive Proteus mirabilis 2) ammonia, 3) combination of P. mirabilis and a faecal enzyme, trypsin, 4) combination of P. mirabilis and opportunistic pathogens, Candida albicans and Staphylococcus aureus, 5) inhibition of urease using acetohydroxamic acid (AHA) on barrier function. Results The urease-mediated production of ammonia had two principal effects: it elevated skin pH and caused inflammation, leading to significant breakdown in skin (stratum corneum) barrier function. Urease was found to further increase the activity of faecal enzymes and opportunistic pathogens, due to elevated skin pH. The urease inhibitor, AHA, was shown to have significantly reduced damage to skin barrier function, measured as its electrical resistance. Conclusions Targeted therapeutic strategies should be developed to prevent the manifestation of IAD, rather than creating a generic barrier between skin and urine/faeces. Urease has been identified as a crucial component in the manifestation of IAD, due to its role in the production of ammonia. Urease inhibition provides a promising therapeutic target to halt the progression of IAD.
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Wall B, Kelly AM, White P, McCann M. Incontinence-associated dermatitis in older adults in residential care settings: a point prevalence study. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S16-S28. [PMID: 38722011 DOI: 10.12968/bjon.2024.33.9.s16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Incontinence-associated dermatitis (IAD) is a skin inflammation caused by contact with urine or faeces or both. It has a negative effect on the patient's quality of life and is indicative of the care provided. However, globally there is a lack of empirical data on the prevalence of IAD. AIM To identify, for the first time, the proportion of older adults in extended care settings in Ireland affected by IAD. DESIGN Cross-sectional, multisite, point prevalence survey, across three community extended care settings for older people in Ireland. METHODS Two clinical nurse specialists, using the Scottish Excoriation and Moisture Related Skin Damage Tool, identified the presence of IAD through clinical observation and visual skin inspection. IAD prevalence was calculated for the total population and incontinent population sets using percentages and confidence intervals (CI). RESULTS The prevalence of incontinence was 86.4% (n=165), a significantly higher proportion were female (P=0.003). The point prevalence of IAD across the total population and incontinent population was 11.5% (22/191; 95% CI, 7.4-19.9%) and 13.3% (22/164; 95% CI, 8.5-19.5%), respectively. Being incontinent was associated with being female, more dependent (Barthel), having possible cognitive impairment, poorer mobility (Braden and Waterlow) and a high risk of pressure ulcers (Waterlow). A logistic regression analysis found no predictor variables for IAD among the variables that met the cut-off point for this analysis. CONCLUSIONS The study provides the first point prevalence empirical data on the occurrence of IAD in Ireland. It can inform decision-making on future planning and budgeting of new quality improvement projects and act as a benchmark for ongoing auditing of IAD.
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Affiliation(s)
- Breda Wall
- Clinical Nurse Specialist in Wound Management and Tissue Viability, St Vincent's Hospital, Athy, Ireland
| | - Anne Marie Kelly
- Clinical Nurse Specialist - Continence Promotion and Management of Incontinence, Continence Promotion Service, Meath Campus, Dublin, Ireland
| | - Patricia White
- Project Officer, European Association for Palliative Care, previously Research Fellow at Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Margaret McCann
- Assistant Professor and Postgraduate Specialist Educational Facilitator, School of Nursing and Midwifery, Trinity College Dublin, Ireland
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Xiang SY, He HC, Liu Y, Yu BJ, Mai SY, Li MY, Yan XY, Huang XH. Care Needs of Older Adults With Urinary Incontinence: A Cross-Sectional Study. J Gerontol Nurs 2024; 50:43-49. [PMID: 38691116 DOI: 10.3928/00989134-20240416-07] [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: 05/03/2024]
Abstract
PURPOSE To explore care requirements of older adults with urinary incontinence (UI) and contributing factors. METHOD This cross-sectional study used the Older Adults Urinary Incontinence Care Needs Inventory to survey participants with UI in three large-scale tertiary hospitals located in Guangzhou City, China, from January 2023 to November 2023. Statistical analyses, including analysis of variance, t tests, correlation analyses, and linear regression models, were conducted to assess factors influencing participants' care needs. RESULTS A total of 530 older adults with UI participated in the survey and mean standardized score for overall care needs was 78.65 (SD = 5.01), with mean scores for each dimension ranging from 70.88 (SD = 10.55) for social participation needs to 82.45 (SD = 7.11) for health education needs. Factors that were found to influence incontinence care needs in older adults included age, literacy level, number of leaks, and type of disease (F = 37.07, adjusted R2 = 0.290, p < 0.001). CONCLUSION Comprehensive care for older adults with UI, encompassing physiological, psychological, and social aspects, is crucial. It is essential to tailor care to individual needs and characteristics, taking into account factors, such as age and education, to ensure effective care. [Journal of Gerontological Nursing, 50(5), 43-49.].
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Ximenes RRC, Chaves EMC, Girão ALA, Gonçalves MHRB, Ferreira SL, de Carvalho REFL. Knowledge of nursing staff before and after training on incontinence-associated dermatitis. Rev Esc Enferm USP 2024; 58:e20230272. [PMID: 38558025 PMCID: PMC11021019 DOI: 10.1590/1980-220x-reeusp-2023-0272en] [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: 09/15/2023] [Accepted: 01/31/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE To verify the knowledge of nursing staff before and after training on incontinence-associated dermatitis. METHOD A study before and after an educational intervention carried out with nursing staff from the medical and surgical clinics and intensive care unit of the university hospital in June 2023. The training took place over three meetings. Data was collected using a questionnaire administered immediately before and after the training. McNemar's test for dependent samples was used to compare before and after training. RESULTS 25 nurses and 14 nursing technicians took part. The items that showed statistical significance were related to the identification and correct differentiation of dermatitis associated with incontinence and pressure injury; and the correct way to sanitize the skin. CONCLUSION The training of the nursing team made it possible to assess their knowledge of how to identify, prevent and treat incontinence-associated dermatitis.
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Affiliation(s)
- Raelly Ramos Campos Ximenes
- Universidade Estadual do Ceará, Programa de Pós-Graduação em Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brazil
| | - Edna Maria Camelo Chaves
- Universidade Estadual do Ceará, Programa de Pós-Graduação em Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brazil
| | | | | | - Saionara Leal Ferreira
- Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, CE, Brazil
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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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Heller R, Torri M, Gaab J, Haubruck P, Moghaddam-Alvandi A, Biglari B. Descriptive Analysis of Surgical Outcomes and Stoma Formation for Treating Sacral and Anal Pressure Injuries in Spinal Cord Injury: A Retrospective Study of Selected Cases. SAGE Open Nurs 2024; 10:23779608241229507. [PMID: 38379575 PMCID: PMC10878226 DOI: 10.1177/23779608241229507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 02/22/2024] Open
Abstract
Introduction Pressure injuries (PIs) arise from sustained pressure on tissue, leading to reduced blood flow to the affected area. In patients with spinal cord injuries (SCIs), these PIs can significantly diminish their independence and overall quality of life. This research sought to assess the frequency of surgical complications in treatment regimens for large sacral PIs involving the anus. Specifically, the study focused on the incorporation of stoma formation in patients with SCIs. Methods A retrospective review identified 25 SCI patients who had extensive sacral PIs. These patients underwent intestinal stoma formation as a preparatory step before plastic reconstructive surgery to address the wounds between 2015 and 2020. Results Successful wound closure was achieved in all instances. Notably, each patient had experienced a minimum of three unsuccessful reconstructive surgeries elsewhere before this intervention. The observed rate of surgical complications aligned with findings from previous analogous studies. Conclusion While often viewed as a treatment of last resort, an intestinal stoma might serve as a valuable strategy, particularly for SCI patients with extensive PIs near the anal region, to promote the healing of such injuries. Tailored decision-making is essential to ensure the best possible patient outcomes.
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Affiliation(s)
- Raban Heller
- Department of Traumatology and Orthopaedics Septic and Reconstructive Surgery, Bundeswehr Hospital Berlin, Berlin, Germany
- Institute for Experimental Endocrinology, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marco Torri
- Department of Paraplegiology, BG Trauma Centre Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Jasmin Gaab
- Department of Traumatology and Orthopaedics Septic and Reconstructive Surgery, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Patrick Haubruck
- Raymond Purves Bone and Joint Research Laboratory, Kolling Institute, Institute of Bone and Joint Research, Faculty of Medicine and Health University of Sydney, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | | | - Bahram Biglari
- Department of Paraplegiology, BG Trauma Centre Ludwigshafen, Ludwigshafen am Rhein, Germany
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13
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Qiao G, Banharak S. Incontinence-Associated Dermatitis in Older Intensive Care Patients: A Review and Case Report. J Multidiscip Healthc 2023; 16:3299-3308. [PMID: 37954467 PMCID: PMC10637259 DOI: 10.2147/jmdh.s434275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023] Open
Abstract
Background Incontinence-Associated Dermatitis is a serious skin injury causing suffering, secondary infection, and inducing almost six times more pressure sore than normal skin patients. This moisture and chemical skin irritation is a concern, especially for intensive care unit nurses. This study aimed to review the effective nursing strategy for preventing and caring for incontinence-associated dermatitis in older intensive care unit patients and pilot its feasibility. Methods The five databases, including PubMed, Google Scholar, CINAHL Complete, WanFang, and CNKI, were searched, and articles were screened and extracted. The strategies and details of prevention and care for incontinence-associated dermatitis were reviewed and summarized. Finally, selected strategies were applied to five intensive care unit patients with various health conditions and levels of Incontinence-Associated Dermatitis severity. Results The literature review found that there is a standardized nursing process for incontinence-associated dermatitis. The prevention and care strategies for incontinence-associated dermatitis include assessment, risk factor management, skin cleaning, skin protection, and health education and training. In actual clinical application, personalized nursing measures can positively impact patients. Five case studies from our pilot confirmed this finding. Conclusion Personalized nursing measures can positively impact patients in actual clinical applications. Our five case studies implementing the strategies from the review confirmed this finding. In clinical work, it is recommended to develop personalized nursing programs for specific risk factors of older intensive care unit patients. Protocol Registration TCTR20230808004.
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Affiliation(s)
- Guojin Qiao
- Nursing Department, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China
| | - Samoraphop Banharak
- Department of Gerontological Nursing, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand
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Abiakam NS, Jayabal H, Abbas S, Filingeri D, Bader DL, Worsley PR. The Effects of Incontinence Pad Application on Loaded Skin With Reference to Biophysical and Biochemical Parameters: An Exploratory Cohort Study Using a Repeated-Measures Design. J Wound Ostomy Continence Nurs 2023; 50:512-520. [PMID: 37966081 DOI: 10.1097/won.0000000000001032] [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: 11/16/2023]
Abstract
PURPOSE The purpose of this study was to evaluate temporal changes in skin responses following exposure to moisture alone or moisture in combination with mechanical loading. DESIGN Comparison cohort with a repeated-measures design. SUBJECTS AND SETTINGS The sample comprised 12 healthy volunteers. Participants were purposely sampled from 2 different age groups; half were 32 to 39 years old and half were 50 to 62 years old. Participants identified as White, Black, or mixed; 83% (n = 10) identified as White; 8 (67%) were female. METHODS Four sites at the sacrum were challenged with the application of specimens taken from 2 absorbent products; the pad specimens were applied dry or saturated with synthetic urine (SU; pH = 8); a further site from the sacral skin was also selected and used as a control. Skin assessments were performed at different points in time: (1) 60 minutes after exposure to dry or SU-saturated pad specimens; (2) 60 minutes after exposure to pads and mechanical loading (application of pressure in the form of 45°C high sitting); and (3) 30 minutes after removal of all pads (recovery period). Outcome measures were transepidermal water loss (TEWL), stratum corneum (SC) hydration, erythema, pH, and skin inflammatory biomarkers measured at each of the time points described earlier. RESULTS The control site and those exposed to dry pads showed minimal time-dependent changes irrespective of the parameter investigated. In contrast, significant increases in TEWL (P = .0000007) and SC hydration responses (P = .0000007) were detected at the sites under absorbent pad specimens after saturation with SU (exposure to moisture). In some participants, TEWL and SC hydration parameters were significantly higher during pressure application. Skin pH remained in the mildly acidic range throughout the test session, and no consistent trends were observed with erythema. Skin inflammatory biomarkers also exhibited considerable variability across participants; none changed significantly over time. Significant differences (P = .02) were also detected following the exposure of moisture in combination with pressure. CONCLUSION We evaluated an array of parameters to identify changes following skin exposure to 2 absorbent pads in the presence and absence of SU and mechanical loading. Analysis revealed changes in skin barrier properties in the presence of moisture and/or pressure. This observation suggests a need for frequent pad changing as well as periods of skin off-loading to protect the skin health of individuals with incontinence.
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Affiliation(s)
- Nkemjika S Abiakam
- Nkemjika S. Abiakam, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Hemalatha Jayabal, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Shabira Abbas, PhD, Essity AB, Gothenburg, Sweden
- Davide Filingeri, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Dan L. Bader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Peter R. Worsley, DSc, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Hemalatha Jayabal
- Nkemjika S. Abiakam, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Hemalatha Jayabal, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Shabira Abbas, PhD, Essity AB, Gothenburg, Sweden
- Davide Filingeri, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Dan L. Bader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Peter R. Worsley, DSc, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Shabira Abbas
- Nkemjika S. Abiakam, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Hemalatha Jayabal, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Shabira Abbas, PhD, Essity AB, Gothenburg, Sweden
- Davide Filingeri, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Dan L. Bader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Peter R. Worsley, DSc, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Davide Filingeri
- Nkemjika S. Abiakam, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Hemalatha Jayabal, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Shabira Abbas, PhD, Essity AB, Gothenburg, Sweden
- Davide Filingeri, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Dan L. Bader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Peter R. Worsley, DSc, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Dan L Bader
- Nkemjika S. Abiakam, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Hemalatha Jayabal, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Shabira Abbas, PhD, Essity AB, Gothenburg, Sweden
- Davide Filingeri, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Dan L. Bader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Peter R. Worsley, DSc, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Peter R Worsley
- Nkemjika S. Abiakam, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Hemalatha Jayabal, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Shabira Abbas, PhD, Essity AB, Gothenburg, Sweden
- Davide Filingeri, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Dan L. Bader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Peter R. Worsley, DSc, School of Health Sciences, University of Southampton, Southampton, United Kingdom
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Deprez J, Kottner J, Eilegård Wallin A, Ohde N, Bååth C, Hommel A, Hultin L, Josefson A, Beeckman D. What are the prognostic factors for the development of incontinence-associated dermatitis (IAD): a protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e073115. [PMID: 37429690 DOI: 10.1136/bmjopen-2023-073115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
INTRODUCTION Incontinence-associated dermatitis (IAD) is irritant contact dermatitis and skin damage associated with prolonged skin contact with urine and/or faeces. Identifying prognostic factors for the development of IAD may improve management, facilitate prevention and inform future research. METHODS AND ANALYSIS This protocol follows the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Prospective and retrospective observational studies or clinical trials in which prognostic factors associated with the development of IAD are described are eligible. There are no restrictions on study setting, time, language, participant characteristics or geographical regions. Reviews, editorials, commentaries, methodological articles, letters to the editor, cross-sectional and case-control studies, and case reports are excluded. MEDLINE, CINAHL, EMBASE and The Cochrane Library will be searched from inception until May 2023. Two independent reviewers will independently evaluate studies. The Quality in Prognostic Studies tool will be used to assess the risk of bias, and the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies-Prognostic Factors checklist will be used for data extraction of the included studies. Separate analyses will be conducted for each identified prognostic factor, with adjusted and unadjusted estimated measures analysed separately. Evidence will be summarised with a meta-analysis when possible, and narratively otherwise. The Q and I2 statistics will be calculated in order to quantify heterogeneity. The quality of the evidence obtained will be evaluated according to the Grades of Recommendation Assessment, Development and Evaluation guidance. ETHICS AND DISSEMINATION No ethical approval is needed since all data is already publicly accessible. The results of this work will be published in a peer-reviewed scientific journal.
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Affiliation(s)
- Julie Deprez
- Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jan Kottner
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Institute of Clinical Nursing Science, Charité Universitätsmedizin, Berlin, Germany
| | - Alexandra Eilegård Wallin
- Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Nils Ohde
- Institute of Clinical Nursing Science, Charité Universitätsmedizin, Berlin, Germany
| | - Carina Bååth
- Department of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
- Faculty of Health, Welfare and Organisation, Østfold University College - Campus Frederikstad, Fredrikstad, Norway
| | - Ami Hommel
- Department of Care Science, Malmö University, Malmö, Sweden
| | - Lisa Hultin
- Department of Public Health and Caring Sciences, Upsalla University, Upsalla, Sweden
- Upsalla University Hospital, Upsalla, Sweden
| | - Anna Josefson
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Dermatology, Örebro University Hospital, Örebro, Sweden
| | - Dimitri Beeckman
- Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Romanelli M, Voegeli D, Colboc H, Bassetto F, Janowska A, Scarpa C, Meaume S. The diagnosis, management and prevention of intertrigo in adults: a review. J Wound Care 2023; 32:411-420. [PMID: 37405940 DOI: 10.12968/jowc.2023.32.7.411] [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: 07/07/2023]
Abstract
Intertrigo is a common inflammatory skin disorder caused by skin-on-skin friction in skin folds, due to moisture becoming trapped because of poor air circulation. This can occur in any area of the body where two skin surfaces are in close contact with each other. The aim of this scoping review was to systematically map, review and synthesise evidence on intertrigo in adults. We identified a wide range of evidence and performed a narrative integration of this related to the diagnosis, management and prevention of intertrigo. A literature search was conducted within the following databases: Cochrane Library, MEDLINE, CINAHL, PubMed and EMBASE. After reviewing articles for duplicates and relevance, 55 articles were included. The incorporation of intertrigo in the ICD-11 provides a clear definition and should improve the accuracy of estimates. With regards to the diagnosis, prevention and management of intertrigo, the literature demonstrates consensus among health professionals in approach and this forms the basis for the recommendations of this review: identify predisposing factors and educate patient in reducing these; educate patients in skin fold management and adopt structured skin care routine; treat secondary infection with appropriate topical agent; consider using moisture-wicking textiles within skin folds to reduce skin-on-skin friction, wick away moisture and reduce secondary infection. Overall, the quality of evidence on which to determine the strength of any recommendations for practice remains low. There remains the need for well-designed studies to test proposed interventions and build a robust evidence base.
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Affiliation(s)
| | - David Voegeli
- Faculty of Health & Wellbeing, University of Winchester, UK
| | - Hester Colboc
- Department of Geriatrics and Wound Healing, University of Sorbonne, Rothschild Hospital, Paris, France
| | | | | | | | - Sylvie Meaume
- Department of Geriatrics and Wound Healing, University of Sorbonne, Rothschild Hospital, Paris, France
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Salomé GM. A Booklet on the Assessment, Prevention, and Treatment of Incontinence-Associated Dermatitis. Adv Skin Wound Care 2023; 36:355-360. [PMID: 37212588 DOI: 10.1097/01.asw.0000926624.17117.0f] [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: 05/23/2023]
Abstract
OBJECTIVE Printed materials have been used as educational resources to assist healthcare professionals in evidence-based clinical practice by providing guidelines for treatment, prevention, and self-care. The aim of this study was to develop and validate a booklet on the risk assessment, prevention, and treatment of incontinence-associated dermatitis. METHODS This was a descriptive, analytic, and quantitative study. The booklet was developed in six steps: situational diagnosis, development of the research question, integrative review of the literature, synthesis of knowledge, structuring and design, and validation of the content. An expert panel composed of 27 experienced nurses carried out content validation using the Delphi technique. The content validity index (CVI) and Cronbach α coefficient were calculated. RESULTS The mean Cronbach α for the evaluation questionnaire was .91, indicating excellent internal consistency. The evaluators classified the content of the booklet from "inadequate" to "totally adequate" (overall CVI, 0.91) in the first round of consultation and from "adequate" and "totally adequate" (overall CVI, 1.0) in a second round of consultation. The booklet was therefore considered validated. CONCLUSIONS A booklet on risk assessment, prevention, and treatment of incontinence-associated dermatitis was created and validated by an expert panel, obtaining 100% consensus among the evaluators in the second round of consultation.
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Affiliation(s)
- Geraldo Magela Salomé
- Geraldo Magela Salomé, PhD, RN, is Associate Professor, Professional Master's Program in Applied Health Sciences, Universidade do Vale do Sapucai (UNIVAS), Pouso Alegre, Minas Gerais, Brazil
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McDermott P, Smith J, Lorton L. The effectiveness of the Attends Product Selector Tool in continence management in a care home setting. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S13-S17. [PMID: 37173089 DOI: 10.12968/bjon.2023.32.9.s13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Qualified nurses are accountable for selecting a suitable containment product for care home residents, which can be challenging for both the resident and health professional. Absorbent incontinence products are the most commonly used products for containing leakage. The purpose of this observational study was to review and understand how effective the Attends Product Selector Tool is when used to assess a resident for an appropriate disposable incontinence product and the in-use experience of products in relation to containment, product use and effectiveness. The study was undertaken in three care homes, with 92 residents who had an initial assessment undertaken either by an Attends Product Manager or a nurse trained in how to use the tool. A total of 316 products over a 48-hour period were individually assessed by the observer to check the time the pad was changed, the type of pad used, the voided volume in the pad and if the pad had leaked. The results showed that some residents had their products changed inappropriately. Not all residents were using the products that best suited their assessment; this mostly occurred at night. Overall, the tool was effective in enabling staff to select an appropriate style of containment product. However, when it came to selecting the absorbency, the assessor tended to choose a higher absorbency rather than starting at the lower absorbency in the product guide range. The observer found the assessed product was not always used and was sometimes changed inappropriately due to lack of communication and staff turnover.
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Affiliation(s)
- Patricia McDermott
- Consultant Clinical Nurse Specialist - Urology, Adult Community Services, States of Guernsey
| | | | - Lindsay Lorton
- Attends Brand Clinical Business Support Manager, Attends Ltd
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Barch DH, Seibert JH, Kandilov A, Bernacet A, Deutsch A, Wang XJ, Scherer E, McMullen T, Mandl S, Levitt A, Frank J, Stephanopoulos C, Smith LM. Cross-setting Comparison of Risk Factors for Pressure Injuries Acquired in Post-Acute Care. Adv Skin Wound Care 2023; 36:128-136. [PMID: 36812077 DOI: 10.1097/01.asw.0000912008.97430.b4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
GENERAL PURPOSE To provide information on the association between risk factors and the development of new or worsened stage 2 to 4 pressure injuries (PIs) in patients in long-term care hospitals (LTCHs), inpatient rehabilitation facilities (IRFs), and skilled nursing facilities (SNFs). TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Compare the unadjusted PI incidence in SNF, IRF, and LTCH populations.2. Explain the extent to which the clinical risk factors of functional limitation (bed mobility), bowel incontinence, diabetes/peripheral vascular disease/peripheral arterial disease, and low body mass index are associated with new or worsened stage 2 to 4 PIs across the SNF, IRF, and LTCH populations.3. Compare the incidence of new or worsened stage 2 to 4 PI development in SNF, IRF, and LTCH populations associated with high body mass index, urinary incontinence, dual urinary and bowel incontinence, and advanced age.
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Beeson T, Pittman J, Davis CR. Effectiveness of an External Urinary Device for Female Anatomy and Trends in Catheter-Associated Urinary Tract Infections. J Wound Ostomy Continence Nurs 2023; 50:137-141. [PMID: 36867037 PMCID: PMC9990593 DOI: 10.1097/won.0000000000000951] [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: 03/04/2023]
Abstract
PURPOSE The purpose of this study was to examine the effectiveness of an external female urinary management system (external urinary device for female anatomy [EUDFA]) in critically ill women unable to self-toilet and to identify rates of indwelling catheter use, catheter-associated urinary tract infections (CAUTIs), urinary incontinence (UI), and incontinence-associated dermatitis (IAD) before and after the introduction of the EUDFA. DESIGN Prospective, observational, and quasi-experimental design. SUBJECTS AND SETTING The sample comprised 50 adult female patients in 4 critical/progressive care units using an EUDFA at a large academic hospital in the Midwestern United States. All adult patients in these units were included in the aggregate data. METHODS Prospective data collected from the adult female patients over 7 days included urine diverted from the device to a canister and total leakage. Aggregate unit rates of indwelling catheter use, CAUTIs, UI, and IAD were retrospectively examined during 2016, 2018, and 2019. Means and percentages were compared using t tests or chi-square tests. RESULTS The EUDFA successfully diverted 85.5% of patients' urine. Indwelling urinary catheter use was significantly lower in 2018 (40.6%) and 2019 (36.6%) compared with 2016 (43.9%) (P < .01). The rate of CAUTIs was lower in 2019 than in 2016, but not significantly (1.34 per 1000 catheter-days vs 0.50, P = .08). The percentage of incontinent patients with IAD was 69.2% in 2016 and 39.5% in 2018-2019 (P = .06). CONCLUSIONS The EUDFA was effective in diverting urine from critically ill female incontinent patients and indwelling catheter utilization.
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Affiliation(s)
- Terrie Beeson
- Correspondence: Terrie Beeson, MSN, RN, CCRN, ACNS-BC, Indiana University Health Academic Health Center, 1030 West Michigan St, Indianapolis, IN, 46202 ()
| | - Joyce Pittman
- Terrie Beeson, MSN, RN, CCRN, ACNS-BC, Indiana University Health Academic Health Center, Indianapolis
- Joyce Pittman, PhD, RN, ANP-BC, FNP-BC, CWOCN, FAAN, College of Nursing, University of South Alabama, Mobile
- Carmen R. Davis, MSN, RN, CCRN, CNS-BC, Indiana University Health Academic Health Center, Indianapolis
| | - Carmen R. Davis
- Terrie Beeson, MSN, RN, CCRN, ACNS-BC, Indiana University Health Academic Health Center, Indianapolis
- Joyce Pittman, PhD, RN, ANP-BC, FNP-BC, CWOCN, FAAN, College of Nursing, University of South Alabama, Mobile
- Carmen R. Davis, MSN, RN, CCRN, CNS-BC, Indiana University Health Academic Health Center, Indianapolis
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Lindsay C, Wolfe L, Ductan C, LeBlanc K. The Influence of Absorbent Products on Skin Integrity: A Scoping Review. J Wound Ostomy Continence Nurs 2023; 50:151-160. [PMID: 36867039 DOI: 10.1097/won.0000000000000957] [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: 03/04/2023]
Abstract
PURPOSE Absorbent products are commonly used to absorb urine and fecal matter and to mitigate potential skin complications such as incontinence-associated dermatitis (IAD). Evidence concerning the effect these products have on skin integrity is limited. This scoping review aimed to explore the evidence/literature on the effect of absorbent containment products on skin integrity. METHOD A scoping literature review. SEARCH STRATEGY The electronic databases CINAHL, Embase, MEDLINE, and Scopus were searched for published articles between 2014 and 2019. Inclusion criteria were studies that focused on urinary and/or fecal incontinence, use of incontinent absorbent containment products, impact on skin integrity, and published in English. The search identified a total of 441 articles that were identified for the title and abstract review. FINDINGS Twelve studies met inclusion criteria and were included in the review. Variability in the study designs did not allow firm conclusions regarding which absorbent products contributed to or prevented IAD. Specifically, we found variations in assessment of IAD, study settings, and types of products used. IMPLICATIONS There is insufficient evidence to support the effectiveness of one product category over another for maintaining skin integrity in persons with urinary or fecal incontinence. This paucity of evidence illustrates the need for standardized terminology, a widely used instrument for assessment of IAD, and identification of a standard absorbent product. Additional research using both in vitro and in vivo models, along with real-world clinical studies, is needed to enhance current knowledge and evidence of the impact of absorbent products on skin integrity.
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Affiliation(s)
- Carly Lindsay
- Carly Lindsay, RN, BNSc, MClSc-WH, NSWOC, WOCC(C), Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
- Lauren Wolfe, RN, BSN, MClSc-WH, NSWOC, CWOCN, Vancouver Coastal Health, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Charline Ductan, RN, BScN, MClSc-WH, CGN(C), Sunnybrook St. Michael's Hospital - Unity Health, Toronto, Ontario, Canada
- Kimberly LeBlanc, PhD, RN, NSWOC, WOCC (C), FCAN, Academic Chair, Wound, Ostomy and Continence Institute; Association of Nurses Specialized in Wound, Ostomy and Continence Canada; Advanced Practice Nurse, KDS Professional Consulting; Adjunct Professor, Faculty of Health Sciences, Western University; Affiliate Faculty, Ingram School of Nursing; Faculty of Medicine, McGill University, Orléans, Ontario, Canada and Honorary Senior Lecturer, School of Medicine, Cardiff University, Wales, United Kingdom
| | - Lauren Wolfe
- Carly Lindsay, RN, BNSc, MClSc-WH, NSWOC, WOCC(C), Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
- Lauren Wolfe, RN, BSN, MClSc-WH, NSWOC, CWOCN, Vancouver Coastal Health, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Charline Ductan, RN, BScN, MClSc-WH, CGN(C), Sunnybrook St. Michael's Hospital - Unity Health, Toronto, Ontario, Canada
- Kimberly LeBlanc, PhD, RN, NSWOC, WOCC (C), FCAN, Academic Chair, Wound, Ostomy and Continence Institute; Association of Nurses Specialized in Wound, Ostomy and Continence Canada; Advanced Practice Nurse, KDS Professional Consulting; Adjunct Professor, Faculty of Health Sciences, Western University; Affiliate Faculty, Ingram School of Nursing; Faculty of Medicine, McGill University, Orléans, Ontario, Canada and Honorary Senior Lecturer, School of Medicine, Cardiff University, Wales, United Kingdom
| | - Charline Ductan
- Carly Lindsay, RN, BNSc, MClSc-WH, NSWOC, WOCC(C), Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
- Lauren Wolfe, RN, BSN, MClSc-WH, NSWOC, CWOCN, Vancouver Coastal Health, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Charline Ductan, RN, BScN, MClSc-WH, CGN(C), Sunnybrook St. Michael's Hospital - Unity Health, Toronto, Ontario, Canada
- Kimberly LeBlanc, PhD, RN, NSWOC, WOCC (C), FCAN, Academic Chair, Wound, Ostomy and Continence Institute; Association of Nurses Specialized in Wound, Ostomy and Continence Canada; Advanced Practice Nurse, KDS Professional Consulting; Adjunct Professor, Faculty of Health Sciences, Western University; Affiliate Faculty, Ingram School of Nursing; Faculty of Medicine, McGill University, Orléans, Ontario, Canada and Honorary Senior Lecturer, School of Medicine, Cardiff University, Wales, United Kingdom
| | - Kimberly LeBlanc
- Carly Lindsay, RN, BNSc, MClSc-WH, NSWOC, WOCC(C), Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
- Lauren Wolfe, RN, BSN, MClSc-WH, NSWOC, CWOCN, Vancouver Coastal Health, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Charline Ductan, RN, BScN, MClSc-WH, CGN(C), Sunnybrook St. Michael's Hospital - Unity Health, Toronto, Ontario, Canada
- Kimberly LeBlanc, PhD, RN, NSWOC, WOCC (C), FCAN, Academic Chair, Wound, Ostomy and Continence Institute; Association of Nurses Specialized in Wound, Ostomy and Continence Canada; Advanced Practice Nurse, KDS Professional Consulting; Adjunct Professor, Faculty of Health Sciences, Western University; Affiliate Faculty, Ingram School of Nursing; Faculty of Medicine, McGill University, Orléans, Ontario, Canada and Honorary Senior Lecturer, School of Medicine, Cardiff University, Wales, United Kingdom
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22
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Gunasegaran N, Ang SY, Ng YZ, Lee NES, Agus N, Lee CW, Ong CE, Mostafa SS, Aloweni F. The effectiveness of a hydrocolloid crusting method versus standard care in the treatment of incontinence-associated dermatitis among adult patients in an acute care setting: A randomised controlled trial. J Tissue Viability 2023; 32:171-178. [PMID: 36717288 DOI: 10.1016/j.jtv.2023.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/26/2022] [Accepted: 01/20/2023] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Incontinence-associated dermatitis (IAD) is a type of irritant contact dermatitis due to prolonged exposure of the skin to moisture induced by urine or/and faeces. The main principles when treating IAD involves protecting the skin from further exposure to irritants, establishing a healing environment, and eradicating skin infections. This study aimed to evaluate the effectiveness of the hydrocolloid crusting method (HCM) versus the standard care method (SCM) in treating IAD. METHOD A randomised controlled trial was conducted in an acute tertiary hospital in Singapore between August 2019 to September 2021. Using computer-generated numbers, patients were randomised into either HCM or SCM treatment groups. HCM treatment involved cleansing the affected area with a pH-neutral non-rinse moisturising cleanser, and the application of alternate layers of hydrocolloid powder, and non-sting film barrier spray (repeated three times during each use). Patients in the SCM treatment group received the same cleanser followed by a 30% zinc oxide barrier cream. IAD was assessed daily for up to seven days by the wound care nurses using the IAD severity tool. The primary outcome of the study was the mean difference in IAD score per day between both methods. RESULTS Forty-four patients were eligible and recruited (22 in HCM; 22 in SCM). Patients in both groups were comparable in age and gender. IAD Category 2 was more predominant in both methods. The most common location of IAD was at the perianal skin and diarrhea related to gastroenteritis was the most prevalent cause of IAD. More patients in the SCM group (n = 12; 54.5%) had their IAD healed within seven days compared to HCM, (n = 7; 31.8%) group. However, the average decrease in IAD scores per day for both methods were found to be similar. CONCLUSION HCM can be considered as a treatment of IAD along with the use of SCM. A skin care regimen should include effective cleansing, skin protection, and moisturization in IAD management.
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Affiliation(s)
| | - Shin Yuh Ang
- Nursing Division, Singapore General Hospital, Singapore.
| | - Yi Zhen Ng
- Skin Research Institute of Singapore, Singapore.
| | | | - Nurliyana Agus
- Nursing Division, Singapore General Hospital, Singapore.
| | - Chee Woei Lee
- Nursing Division, Singapore General Hospital, Singapore.
| | - Choo Eng Ong
- Nursing Division, Singapore General Hospital, Singapore.
| | | | - Fazila Aloweni
- Nursing Division, Singapore General Hospital, Singapore.
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Risk factors for nursing home admission among older adults: Analysis of basic movements and activities of daily living. PLoS One 2023; 18:e0279312. [PMID: 36706104 PMCID: PMC9882900 DOI: 10.1371/journal.pone.0279312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 12/05/2022] [Indexed: 01/28/2023] Open
Abstract
This retrospective study aimed to clarify the risk of older adults' nursing home placement in terms of basic movements and activities of daily living (ADLs) by analyzing data from a long-term care insurance certification survey in 2016‒2018 in City A. Of the 21,520 people certified as needing care, 16,865 could be followed up until 2018. Data on sex, age, household structure, and level of care required were obtained. Those who lived at home and at nursing homes were categorized as the "Unchanged group" and the "Changed group," respectively. Multivariate binomial logistic regression analysis was performed, with group type as the dependent variable and basic movement and ADL scores as the independent variables. For factor analysis according to care level, participants were classified into support need levels 1 and 2, care need levels 1 and 2, and care need levels 3, 4, and 5. For those categorized into support need levels 1 and 2, standing on one leg and transferring (basic movements) and urination and face cleaning (ADLs) were associated with nursing home placement. For those in care need levels 1 and 2, getting up and transferring (basic movements) and bathing, urination, face cleaning, and hair styling (ADL) were significantly associated with nursing home placement. For those in care need levels 3, 4, and 5, sitting and transferring (basic movements) and self-feeding and defecation (ADL) were significant. Occupational therapists must focus on older adults' declining ADLs and basic movements and relay the necessary information to patients, families, and other healthcare professionals to ensure appropriate and prompt care delivery.
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24
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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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25
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Li Q, Zhu D, Liu Y, Qin L, Long X, Yu X. Efficacy of modified isolation in incontinence associated dermatitis. Am J Transl Res 2023; 15:1326-1333. [PMID: 36915781 PMCID: PMC10006786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/06/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE To analyze the value of modified isolation in preventing the occurrence of incontinence associated dermatitis (IAD) in patients with incontinence, and to provide high value skin care intervention for the patients. METHODS Clinical data of 204 patients were collected for retrospective analysis. The patients were divided into a conventional group (conventional skin care protocol, n=102) and a modified group (modified isolation care protocol, n=102) according to the different treatment regimens. The differences in the incidence of IAD, time to IAD, required weekly care, cost of nursing supplies, perineal skin status and nursing satisfaction were compared between the two groups. RESULTS Compared with the conventional group, the modified group had a greatly lower incidence of IAD (42.16% vs. 2.94%), longer time to IAD occurrence (5.75±1.25 vs. 12.50±1.50), less required weekly care (43.05±8.41 vs. 13.54±2.57), lower cost of nursing supplies (330.16±98.44 vs. 115.53±32.58), and a better correlation between perineal skin status and nursing satisfaction (all P<0.05). CONCLUSION Modified isolation can greatly reduce the incidence of IAD in incontinent patients, improve their status of the perineal skin, increase patient satisfaction with care, and reduce the cost of required nursing supplies. So, modified isolation may serve as the preferred care protocol for incontinent patients.
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Affiliation(s)
- Qingcui Li
- Department of Gastrointestinal Surgery, Fengdu People's Hospital Chongqing 408200, China
| | - Dejuan Zhu
- Department of Stomatology, Fengdu People's Hospital Chongqing 408200, China
| | - Yong Liu
- Department of Rehabilitation, Fengdu People's Hospital Chongqing 408200, China
| | - Lianying Qin
- Quality Management Office, Fengdu People's Hospital Chongqing 408200, China
| | - Xue Long
- Department of Neurosurgery, Fengdu People's Hospital Chongqing 408200, China
| | - Xuan Yu
- Department of Hepatobiliary Surgery, Fengdu People's Hospital Chongqing 408200, China
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26
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Domingues BW, Souza TMPD, Wojastyk LDMC, Santos VLCDG, Nogueira PC. DERMATITE ASSOCIADA À INCONTINÊNCIA: PREVALÊNCIA E FATORES ASSOCIADOS EM UNIDADE DE TERAPIA INTENSIVA. ESTIMA 2022. [DOI: 10.30886/estima.v20.1281_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objetivo:Analisar a prevalência pontual de dermatite associada à incontinência (DAI) e os fatores associados em pacientes adultos internados em unidades de terapia intensiva (UTIs). Método: Estudo transversal, observacional, retrospectivo, realizado com 105 pacientes em UTI de três hospitais universitários localizados no estado de São Paulo. As variáveis demográficas, clínicas e de DAI foram coletadas do banco de dados do projeto de pesquisa “Prevalência de lesão por pressão em Unidade de Terapia Intensiva”, composto por informações extraídas dos prontuários e de exames físicos. Os dados foram analisados por meio de estatística descritiva e inferencial. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Instituição proponente. Resultados: Dos 105 pacientes, 58 (55,2%) eram do sexo masculino, com média de idade de 55,76 anos (desvio padrão = 16,4), 105 (91,3%) estavam com cateter urinário e 89,4% usavam fraldas. Dez pacientes apresentaram DAI, com prevalência pontual de 9,5%. O fator associado à DAI foi a admissão por trauma (p = 0,02). Conclusão: Estudos sobre DAI são fundamentais para uma assistência de enfermagem de qualidade, bem estruturada e fundamentada, sobretudo no cuidado aos pacientes críticos.
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Domingues BW, Souza TMPD, Wojastyk LDMC, Santos VLCDG, Nogueira PC. INCONTINENCE-ASSOCIATED DERMATITIS: PREVALENCE AND ASSOCIATED FACTORS IN INTENSIVE CARE UNIT. ESTIMA 2022. [DOI: 10.30886/estima.v20.1281_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To analyze the point prevalence of incontinence-associated dermatitis (IAD) and associated factors in adult patients admitted to Intensive Care Units (ICUs). Method: A cross-sectional, observational, retrospective study carried out with 105 patients in the ICU of three university hospitals located in the state of São Paulo. The demographic and clinical variables and IAD come from the database of the research project “Prevalence of pressure injuries in the Intensive Care Unit,” composed of information from medical records and physical examination. Data were analyzed using descriptive and inferential statistics. The study was approved by the Research Ethics Committee of the proposing institution. Results: Of the 105 patients, 58 (55.24%) were male, with a mean age of 55.76 years (SD = 16.39), 105 (91.3%) had a urinary catheter and 89.4% wore diapers. Ten patients had IAD, with a point prevalence of 9.52%. The factor associated with IAD was admission due to trauma (p = 0.02). Conclusion: Studies on IAD are essential for quality, well-structured and grounded nursing care, especially in the care of critically ill patients.
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28
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Prevalence of Friction Skin Injury on the Buttocks and/or Posterior Thighs in an Acute Care Setting: A Quality Improvement Project. J Wound Ostomy Continence Nurs 2022; 49:518-521. [PMID: 36417373 DOI: 10.1097/won.0000000000000923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE The prevalence of friction skin injury (FcI) in an acute care hospital was evaluated as part of a quality improvement initiative. PARTICIPANTS/SETTING The setting for this quality improvement project was an academic medical center with 728 licensed beds in the central plains of the United States. Data were collected by 33 clinicians: 28 were RN staff members and 5 were patient care technicians. Six of the 28 nurses (21%) were board-certified wound nurses and 2 (7%) were in training but not yet certified. Prevalence data were collected on 354 hospitalized patients. APPROACH Friction skin injuries were measured in conjunction with the institution's quarterly skin survey for the NDNQI PUPS (National Database of Nursing Quality Indicators Pressure Ulcer Prevalence Survey) in August 2019. The prevalence of FcI was calculated using the number of patients with FcI divided by the total number of patients surveyed. OUTCOMES Three hundred fifty-four patients completed the survey in this PUPS; FcI was diagnosed in 8 patients, yielding a prevalence rate of 2.3%. Clinical manifestations of FcI such as lichenification, skin/soft tissue discoloration, skin/soft tissue deformation and/or callus formation, and skin ulceration were also documented. In addition, a majority of patients with FcI were found to have fecal or urinary incontinence (n = 5/8, 63%; 2 had both fecal and urinary incontinence, 25%). Braden Scale for Pressure Sore Risk subscales scores were analyzed; the mean subscale score for moisture was 3.4; the mean subscale score for friction/shear was 1.4; the mean subscale score for activity was 2.6; and the mean subscale score for mobility was 2.9. IMPLICATIONS FOR PRACTICE To the best of my knowledge, this is the first published article documenting FcI prevalence in any care setting. Additional prevalence studies are needed to establish the epidemiology of FcI across care settings and in the community.
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Hoedl M, Bauer S, Eglseer D, Everink I, Gordon AL, Lohrmann C, Saka B, Schols JMGA, Osmancevic S. Urinary incontinence prevalence and management in nursing homes in Austria, the Netherlands, Turkey and the United Kingdom: A multi-site, cross-sectional study. Arch Gerontol Geriatr 2022; 103:104779. [PMID: 35853273 DOI: 10.1016/j.archger.2022.104779] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim of this study is to describe and compare the prevalence rates of urinary incontinence as well as the management of urinary incontinence in the nursing home setting in Austria, the Netherlands, Turkey and the UK. METHODS This study is a secondary analysis of the 2017 and 2018 data from a multi-site, cross-sectional study which is performed annually in the nursing home setting in Austria, the Netherlands, Turkey and the UK. RESULTS A total of 23,334 nursing home residents was included in this study, most of whom were female. The urinary incontinence prevalence rates ranged from 13.8% in Turkey to 35.1% in Austria. In all countries, the most frequently used intervention for urinary incontinence management was the use of absorbent products and/or catheters (ranging from 81% in Turkey to 94.5% in Austria). The countries differed with regard to the methods used to assess the type of urinary incontinence, scheduled individual bathroom visits and medication evaluation. In the UK (77.1%), scheduled individual bathroom visits were a more frequent measure than in Austria (51.3%), the Netherlands (24.4%) and Turkey (10.2%). CONCLUSION The most frequently used nursing intervention in all countries was the use of absorbent products and/or catheters. Future studies on the over- or misuse of these products are warranted. In order to avoid the over- or misuse of these products in the nursing home setting, the use of the evidence- and consensus-based algorithm provided by the Wound, Ostomy and Continence Nurses Society™ is recommended.
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Affiliation(s)
- Manuela Hoedl
- Institute of Nursing Science, Medical University of Graz, Universitätsplatz 4, Graz 8010, Austria
| | - Silvia Bauer
- Institute of Nursing Science, Medical University of Graz, Universitätsplatz 4, Graz 8010, Austria
| | - Doris Eglseer
- Institute of Nursing Science, Medical University of Graz, Universitätsplatz 4, Graz 8010, Austria
| | - Irma Everink
- Care and Public Health Research Institute, Department Health Services Research, Maastricht University, Minderbroedersberg 4-6, LK Maastricht 6211, the Netherlands
| | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Uttoxeter Road, Derby DE22 3DT, UK; East Midlands Academic Health Sciences Network Patient Safety Collaborative, Triumph Road, Nottingham NG7 2TU, UK; NIHR Applied Research Collaboration - East Midlands (ARC-EM), Triumph Road, Nottingham NG7 2TU, UK
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University of Graz, Universitätsplatz 4, Graz 8010, Austria
| | - Bülent Saka
- Istanbul Faculty of Medicine, Department Internal Medicine, Istanbul University, İstanbul Tıp Fakültesi Çapa - Fatih, LIstanbul, Turkey
| | - Jos M G A Schols
- Care and Public Health Research Institute, Department Health Services Research, Maastricht University, Minderbroedersberg 4-6, LK Maastricht 6211, the Netherlands
| | - Selvedina Osmancevic
- Institute of Nursing Science, Medical University of Graz, Universitätsplatz 4, Graz 8010, Austria.
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30
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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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Sokem JADS, Ferreira AM, Bergamaschi FPR, Coelho MDMF, Sarat CNF, Ribeiro EBR, Souto CC, Carneiro LM, Rigotti MA. INTERVENÇÃO EDUCATIVA SOBRE DERMATITE ASSOCIADA À INCONTINÊNCIA: ESTRATÉGIA DE ENSINO NO INSTAGRAM. ESTIMA 2022. [DOI: 10.30886/estima.v20.1244_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivos:Descrever e avaliar intervenção educativa realizada por meio de mídia social sobre dermatite associada à incontinência (DAI) com profissionais de enfermagem. Métodos:Estudo de intervenção educativa com abordagem qualitativa pela mídia social Instagram para veiculação dos conteúdos do curso sobre a DAI. A coleta de dados foi realizada com 30 profissionais de enfermagem da clínica médica e unidade de terapia intensiva adulta de hospital de ensino público de Mato Grosso do Sul, de fevereiro a março de 2022. Os dados foram coletados durante o curso e apreciados pela análise de conteúdo de Bardin e à luz do referencial teórico da aprendizagem significativa de Ausubel. Resultados: Da análise dos comentários dos cursistas, emergiram quatro categorias temáticas: ancoragem, que retrata o saber prévio; aprendizagem significativa subordinada, a qual apresenta a construção de conhecimento ancorada no saber prévio; aprendizagem por descoberta, evidenciando a autonomia do participante no aprendizado; e avaliação do processo de ensino-aprendizagem, que revela a avaliação do processo educativo. Conclusão: Os resultados mostraram que a intervenção educativa obteve êxito no que tange ao compartilhamento de evidências sobre DAI aos participantes e que a ferramenta Instagram pode ser adotada para ações educativas mesmo em ambiente hospitalar.
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Sokem JADS, Ferreira AM, Bergamaschi FPR, Coelho MDMF, Sarat CNF, Ribeiro EBR, Souto CC, Carneiro LM, Rigotti MA. EDUCATIONAL INTERVENTION ON INCONTINENCE-ASSOCIATED DERMATITIS: TEACHING STRATEGY ON INSTAGRAM. ESTIMA 2022. [DOI: 10.30886/estima.v20.1244_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives: To describe and evaluate, in a formative way, an educational intervention carried out through social media on incontinence-associated dermatitis with nursing professionals from a public hospital. Method: Educational intervention study with a qualitative approach conducted in a virtual way through the social media Instagram as a platform for the dissemination of course content on the subject. Data collection was carried out with 30 nursing professionals from the medical clinic and adult intensive care unit of a public teaching hospital in the state of Mato Grosso do Sul, Brazil, between February and March 2022. Data were collected during the course and analysed through content analysis and according to Ausubel’s meaningful learning theoretical framework perspective. Results: From the analysis of the participants’ comments, four thematic categories emerged: anchoring; subordinated meaningful learning; discovery learning; and evaluation of the teaching- learning process. Conclusion: Through the results found, it was identified that the educational intervention conducted was successful in terms of sharing evidence on the subject to the participants. It was found that the Instagram can be adopted as a tool to carry out educational actions, including in a hospital environment.
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Koloms K, Cox J, VanGilder CA, Edsberg LE. Incontinence Management and Pressure Injury Rates in US Acute Care Hospitals: Analysis of Data From the 2018-2019 International Pressure Injury Prevalence™ (IPUP) Survey. J Wound Ostomy Continence Nurs 2022; 49:405-415. [PMID: 36108224 PMCID: PMC9592164 DOI: 10.1097/won.0000000000000905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to identify and describe the prevalence of incontinence (urinary and/or fecal) and incontinence management practices among patients in US adult acute care settings, with and without hospital-acquired pressure injuries (HAPIs), using the data from the 2018/2019 International Pressure Ulcer Prevalence™ (IPUP) survey. DESIGN Observational, cohort study with cross-sectional data collection and retrospective data analysis. SUBJECTS AND SETTING The sample comprised 296,014 patients hospitalized in 1801 acute care facilities in the United States that participated in 2018 and/or 2019 IPUP survey. Of these, 192,852 (65%) patients had information recorded in the survey on incontinence status and were included in the analytical sample. METHODS Data from the 2018/2019 IPUP database were analyzed to evaluate the prevalence of incontinence (urinary [UI], fecal [FI], and dual [DI]), and the use of incontinence and moisture management strategies. Incontinence prevalence was analyzed between 3 groups of patients: (1) those without pressure injuries; (2) patients with stage 1 and 2 HAPIs; and (3) those with severe HAPIs (stage 3, 4, unstageable, deep tissue pressure injury). Analysis of the subgroups within acute care was also undertaken and included medical-surgical, critical care, and step-down units. RESULTS Incontinent patients were older (mean age 69-74 years depending on type of incontinence as compared to 62 years for continent patients) and had lower Braden Scale scores (range, 14.7-16.7, compared to 19.4 for continent patients). Half of the patients were female, 49.6% male, and 0.4% were unknown. Incontinence was identified in 32% of patients. Among patients with incontinence, 33% had UI, 12% had FI, and 55% had DI. Hospital-acquired pressure injuries were present in 27.4% of continent patients and 72.6% of incontinent patients, with DI having the highest rate of HAPIs. Analysis revealed a higher proportion of incontinent patients with unstageable HAPIs than continent patients (14.9% vs 9.6%, P = .00), as well as a higher proportion of incontinent patients with deep tissue HAPIs as compared to continent patients (27.0% vs 22.1%, P = .00). Significantly more incontinent patients regardless of HAPI status were using a bowel or bladder management system (P = .00). CONCLUSION Results of this study support the importance of incontinence as a risk factor in HAPI development. The prevalence of all types of incontinence was 31.7% for the entire sample. Almost three-fourths (72.6%) of patients with HAPI had UF, FI, or DI. A standardized definition of both UI and FI is needed, given that over 70% of all critical care unit patients with a urinary catheter for incontinence management were still classified as urinary incontinent.
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Affiliation(s)
- Kimberly Koloms
- Correspondence: Kimberly Koloms, MS, Hillrom Inc, now a Baxter company, Deerfield, IL 60015 ()
| | - Jill Cox
- Kimberly Koloms, MS, Hillrom Inc, now a Baxter company, Deerfield, Illinois
- Jill Cox PhD, RN, APN-c, CWOCN, FAAN, Clinical Professor, Rutgers University School of Nursing, Newark, New Jersey/WOC Advanced Practice Nurse Englewood Health, Englewood, New Jersey
- Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee
- Laura E Edsberg, PhD, Professor Natural Sciences, Center for Wound Healing Research, Natural & Health Sciences Research Center, Daemen University, Amherst, New York
| | - Catherine A. VanGilder
- Kimberly Koloms, MS, Hillrom Inc, now a Baxter company, Deerfield, Illinois
- Jill Cox PhD, RN, APN-c, CWOCN, FAAN, Clinical Professor, Rutgers University School of Nursing, Newark, New Jersey/WOC Advanced Practice Nurse Englewood Health, Englewood, New Jersey
- Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee
- Laura E Edsberg, PhD, Professor Natural Sciences, Center for Wound Healing Research, Natural & Health Sciences Research Center, Daemen University, Amherst, New York
| | - Laura E. Edsberg
- Kimberly Koloms, MS, Hillrom Inc, now a Baxter company, Deerfield, Illinois
- Jill Cox PhD, RN, APN-c, CWOCN, FAAN, Clinical Professor, Rutgers University School of Nursing, Newark, New Jersey/WOC Advanced Practice Nurse Englewood Health, Englewood, New Jersey
- Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee
- Laura E Edsberg, PhD, Professor Natural Sciences, Center for Wound Healing Research, Natural & Health Sciences Research Center, Daemen University, Amherst, New York
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Koudounas S, Minematsu T, Mugita Y, Nakai A, Tobe H, Takizawa C, Kunimitsu M, Nakagami G, Sanada H. Bacterial invasion into the epidermis of rats with sodium lauryl sulphate-irritated skin increases damage and induces incontinence-associated dermatitis. Int Wound J 2022; 20:191-200. [PMID: 35916389 PMCID: PMC9797936 DOI: 10.1111/iwj.13864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 01/07/2023] Open
Abstract
Incontinence-associated dermatitis (IAD) is caused by prolonged exposure to urine/liquid stool. It is a common and often painful skin condition in older incontinent adults because of poor prevention. Patients with urinary infections are at risk of developing IAD, and to guide the development of novel prevention strategies, we aimed to develop an animal model of IAD by urine and bacteria. First, contralateral sites on the dorsal skin of Sprague-Dawley rats were compromised by sodium lauryl sulphate (SLS), simulating frequent cleansing with soap/water. Filter discs were then placed inside ring-shaped chambers on foam dressings, inoculated with or without Pseudomonas aeruginosa, covered with agarose gels immersed in cultured filtrated urine, and secured in place with an occlusive dressing for 3 days. Untreated and SLS-compromised sites served as controls. The IAD was developed at bacteria-inoculated sites, characterised by severe IAD-like redness that persisted for up to 3 days post-exposure and higher disruption of the skin barrier function compared with non-inoculated sites. Pathological changes included epidermal thickening, partial skin loss, inflammatory cell infiltration, accumulation of red blood cells, and invasion of bacteria into the epidermis. This novel, clinically relevant IAD rat model can serve for future prevention developments.
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Affiliation(s)
- Sofoklis Koudounas
- Department of Skincare Science, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Takeo Minematsu
- Department of Skincare Science, Graduate School of MedicineThe University of TokyoTokyoJapan,Global Nursing Research Center, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Yuko Mugita
- Department of Gerontological Nursing, Wound Care Management, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Ayano Nakai
- Global Nursing Research Center, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Hiromi Tobe
- Global Nursing Research Center, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Chihiro Takizawa
- Department of Gerontological Nursing, Wound Care Management, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Mao Kunimitsu
- Department of Gerontological Nursing, Wound Care Management, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Gojiro Nakagami
- Global Nursing Research Center, Graduate School of MedicineThe University of TokyoTokyoJapan,Department of Gerontological Nursing, Wound Care Management, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Hiromi Sanada
- Global Nursing Research Center, Graduate School of MedicineThe University of TokyoTokyoJapan,Department of Gerontological Nursing, Wound Care Management, Graduate School of MedicineThe University of TokyoTokyoJapan
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Cunich M, Barakat-Johnson M, Lai M, Arora S, Church J, Basjarahil S, Campbell JL, Disher G, Geering S, Ko N, Leahy C, Leong T, McClure E, O'Grady M, Walsh J, White K, Coyer F. The costs, health outcomes and cost-effectiveness of interventions for the prevention and treatment of incontinence-associated dermatitis: A systematic review. Int J Nurs Stud 2022; 129:104216. [PMID: 35364428 DOI: 10.1016/j.ijnurstu.2022.104216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Incontinence-associated dermatitis is a common, under-recognized painful skin condition associated with poorer quality of life, increased nurse workloads, and costs. OBJECTIVE To systematically review economic evidence for the prevention and treatment of incontinence-associated dermatitis. DESIGN Systematic review of quantitative research. DATA SOURCES PubMed, MEDLINE, EMBASE, Cochrane Library, York Centre for Reviews and Dissemination database, Econlit, Tufts' Cost-Effectiveness Analysis Registry, and Web of Science. REVIEW METHODS A comprehensive search for studies on resource use (costs), health outcomes, and cost-effectiveness of interventions for incontinence-associated dermatitis was conducted. Screening, data extraction, and initial quality assessment were conducted independently by two reviewers, with disagreements/queries regarding quality settled through consensus with the larger team. Quality evaluated using the Consolidated Health Economic Evaluation Reporting Standards checklist and results narratively arranged. FINDINGS Seventeen studies (10 for prevention, one for treatment and six for both prevention and treatment) included. All studies measured resource use from a healthcare provider perspective; 14 quantified resources in monetary terms. Considerable variation existed in the resource use data primarily due to differences in the type of resources counted, selected time horizons, valuation methods, and reporting approaches. Ten studies provided evidence of their intervention to be cost saving (or at least cost avoiding). Five studies on barrier products provided evidence to be cost saving: three for prevention, one for treatment, and one for both prevention and treatment. Two studies of cleanser and barrier products provided evidence to be cost saving for the prevention and treatment of incontinence-associated dermatitis. One study found a cleanser to be a cost saving preventative intervention. One bowel management system was found to be cost saving over time only, and one nurse education intervention was found to be cost saving for preventing and treating incontinence-associated dermatitis. One barrier product was found to be cost-effective for preventing and treating the condition. Finally, one study found a cleanser and barrier product was time saving for prevention. None of the studies incorporated a multi-attribute quality of life measure; however, two studies included person-reported outcome measures for pain. A narrow range of resources (mainly products) were considered, and there was limited information on how they were counted and valued. Analyses relating to heterogeneity among patients/hospital wards or health facilities and uncertainty were lacking. CONCLUSIONS Barrier products are possibly a more cost-effective treatment than others; however, this evidence lacks certainty. Structured health economic evaluations are required for a reliable evidence-base on the interventions for incontinence-associated dermatitis. TWEETABLE ABSTRACT Most incontinence-associated dermatitis studies lack person-reported outcomes, costs beyond product/staff time, and economic evaluation.
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Affiliation(s)
- Michelle Cunich
- Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney, Sydney, New South Wales, Australia; Sydney Institute for Women, Children and their Families, Sydney Local Health District (SLHD), Sydney, New South Wales, Australia; The ANZAC Research Institute, Concord Repatriation General Hospital, Concord, New South Wales, Australia; Sydney Health Economics Collaborative, Sydney Local Health District (SLHD), Sydney, New South Wales, Australia.
| | - Michelle Barakat-Johnson
- Nursing and Midwifery Executive Services, Sydney Local Health District (SLHD), Sydney, New South Wales, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Healthcare Transformation, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.
| | - Michelle Lai
- Nursing and Midwifery Executive Services, Sydney Local Health District (SLHD), Sydney, New South Wales, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Sheena Arora
- Centre for Health Economics Research and Evaluation (CHERE), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
| | - Jody Church
- Centre for Health Economics Research and Evaluation (CHERE), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
| | - Shifa Basjarahil
- Nursing and Midwifery Services, The Sutherland Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.
| | - Jayne L Campbell
- Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia.
| | - Gary Disher
- Strategic Reform and Planning Branch, New South Wales Ministry of Health, Sydney, New South Wales, Australia.
| | - Samara Geering
- Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia.
| | - Natalie Ko
- Nursing and Midwifery Services, Concord Repatriation General Hospital, Sydney Local Health District, Sydney, New South Wales, Australia.
| | - Catherine Leahy
- Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia.
| | - Thomas Leong
- Nursing and Midwifery Services, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia.
| | - Eve McClure
- Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, Sydney, New South Wales, Australia.
| | - Melissa O'Grady
- Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, Sydney, New South Wales, Australia.
| | - Joan Walsh
- Nursing and Midwifery Services, The Sutherland Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.
| | - Kate White
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Cancer Care Research Unit, Sydney Local Health District, Sydney, New South Wales, Australia; The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, New South Wales, Australia.
| | - Fiona Coyer
- Centre for Healthcare Transformation, Queensland University of Technology (QUT), Brisbane, Queensland, Australia; Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.
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Tezcan B, Eraydın C, Karabacak BG. Evaluating the Scales Used To Diagnose Incontinence-Associated Dermatitis: A Systematic Review. Adv Skin Wound Care 2022; 35:1-9. [PMID: 35442923 DOI: 10.1097/01.asw.0000823988.56640.72] [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: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Bilge Tezcan
- Bilge Tezcan, MSc, RN, is PhD Student, Murat State Hospital, Edirne, Turkey; Canan Eraydın, MSc, RN, is PhD Student, Zonguldak Bulent Ecevit University Faculty of Health Sciences, Department of Nursing Fundamentals, Zonguldak, Turkey; and Bilgi Gülseven Karabacak, PhD, is Assistant Professor, Marmara University Faculty of Health Sciences, Department of Nursing Fundamentals, Istanbul, Turkey. The authors have disclosed no financial relationships related to this article. Submitted April 30, 2021; accepted in revised form July 6, 2021
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Edsberg LE, Cox J, Koloms K, VanGilder-Freese CA. Implementation of Pressure Injury Prevention Strategies in Acute Care: Results From the 2018-2019 International Pressure Injury Prevalence Survey. J Wound Ostomy Continence Nurs 2022; 49:211-219. [PMID: 35523235 PMCID: PMC9093720 DOI: 10.1097/won.0000000000000878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the implementation of pressure injury (PI) prevention strategies in adult acute care settings in the United States using the data from the 2018/2019 International Pressure Ulcer Prevalence (IPUP) Survey. DESIGN Observational, cohort study with cross-sectional data collection and retrospective data analysis. SUBJECTS AND SETTING The sample comprised 296,014 patients hospitalized in 1801 acute care facilities in the United States that participated in the 2018 and/or 2019 IPUP Survey. Slightly less than half (49.4%, n = 146,231) were male, 50% (n = 148,997) were female, 0.6% (n = 17,760) were unknown. Their mean age was 64.29 (SD 17.2) years. METHODS Data from the 2018/2019 IPUP database were analyzed to evaluate the implementation of prevention strategies including repositioning, support surface use, head-of-bed (HOB) elevation, heel elevation, moisture management, minimizing linen layers, and nutritional support. Practices were analyzed for differences between patients without pressure injuries, and patients with Stage 1 and 2 hospital-acquired pressure injury (HAPI), and those with severe HAPIs (Stage 3, Stage 4, unstageable, and deep tissue pressure injury). Acute care unit types included critical or intensive care units, medical-surgical inpatient care units, and step-down units. RESULTS Compliance rates to PI prevention strategies varied among patients at risk for HAPIs (Braden Scale for Pressure Sore Risk score ≤18). Daily skin assessment was performed for 86% of patients with no HAPIs and 96.8% of patients with severe HAPIs. Pressure redistribution was used in 74.6% of all patients and in over 90% of patients with severe HAPIs; however, compliance to routine repositioning was reported at lower levels between 67% and 84%, respectively. Heel elevation was reported for over 60% of the patients with severe HAPIs while 31.9% did not receive heel elevation, though only 6% were reported as not needing elevation. The majority of patients had HOB greater than the 30° at the time of the data collection; compliance with minimizing linen layers (≤3) was reported in 76% or more. Moisture management strategies were reportedly used in more than 71% of all patients and 89% for patients with severe HAPIs. Nutrition support was used for 55% to 82% of the patients and only documented as contraindicated in fewer than 2% of all groups. CONCLUSION Study findings revealed substantial compliance rates to PI prevention strategies. Nevertheless, there is potential for improvement in the implementation of some of the most basic prevention strategies including repositioning, heel elevation, nutritional support, and moisture management.
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Affiliation(s)
- Laura E. Edsberg
- Correspondence: Laura E. Edsberg, PhD, Center for Wound Healing Research, Daemen University, 4380 Main St, Amherst, NY 14226 ()
| | - Jill Cox
- Laura E. Edsberg, PhD, Center for Wound Healing Research and Natural & Health Sciences Research Center, Daemen University, Amherst, New York
- Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, and Englewood Health, Englewood, New Jersey
- Kimberly Koloms, MS, Hillrom, Inc., now a Baxter company Batesville, Indiana
- Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee
| | - Kimberly Koloms
- Laura E. Edsberg, PhD, Center for Wound Healing Research and Natural & Health Sciences Research Center, Daemen University, Amherst, New York
- Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, and Englewood Health, Englewood, New Jersey
- Kimberly Koloms, MS, Hillrom, Inc., now a Baxter company Batesville, Indiana
- Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee
| | - Catherine A. VanGilder-Freese
- Laura E. Edsberg, PhD, Center for Wound Healing Research and Natural & Health Sciences Research Center, Daemen University, Amherst, New York
- Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, and Englewood Health, Englewood, New Jersey
- Kimberly Koloms, MS, Hillrom, Inc., now a Baxter company Batesville, Indiana
- Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee
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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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Barakat-Johnson M, Stephenson J, Basjarahil S, Campbell J, Cunich M, Disher G, Geering S, Ko N, Lai M, Leahy C, Leong T, McClure E, O'Grady M, Walsh J, White K, Coyer F. Clinician Knowledge of Incontinence-Associated Dermatitis: A Multisite Survey of Healthcare Professionals in Acute and Subacute Settings. J Wound Ostomy Continence Nurs 2022; 49:159-167. [PMID: 35255068 DOI: 10.1097/won.0000000000000846] [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: 11/25/2022]
Abstract
PURPOSE This study examined clinicians' knowledge of incontinence-associated dermatitis (IAD) using the Barakat-Johnson Incontinence-Associated Dermatitis Knowledge Tool (Know-IAD). DESIGN A cross-sectional multicenter survey. SUBJECTS AND SETTING The setting was 6 hospitals across 5 health districts in New South Wales, Australia. The participants were nurses (registered nurses and enrolled nurses), physicians, allied health (occupational therapists, dietitians, and physiotherapists), and students (nursing and allied health). METHODS Data about IAD knowledge were collected from November 2019 to January 2020. The Know-IAD, an 18-item validated instrument that measures knowledge of IAD in 3 domains (etiology and risk, classification and diagnosis, and prevention and management), was administered to a cross section of eligible clinicians. The participants anonymously completed hard copy surveys. Descriptive and exploratory analyses were conducted to quantify clinicians' knowledge about the etiology and risk, classification and diagnosis, and prevention and management of IAD. A mean knowledge score of 70% was considered to be satisfactory. RESULTS Four hundred twelve respondents completed the survey. One hundred twenty nine respondents (31.3%) achieved 70% correct responses and greater for the entire set of items. For the etiology and risk domain, 348 respondents (84.5%) obtained a score of 70% correct responses and greater, 67 respondents (16.3%) achieved 70% correct responses and greater for the classification and diagnosis domain, and 84 respondents (20.4%) achieved 70% correct responses and greater for the prevention and management domain. CONCLUSION Clinicians tend to have low knowledge and recognition of IAD, particularly in the areas of classification and diagnosis along with prevention and management. They tend to have higher knowledge of how IAD is caused and the risk factors. This study has identified knowledge gaps for further education that can improve assessment, prevention, and management of IAD.
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Affiliation(s)
- Michelle Barakat-Johnson
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - John Stephenson
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Shifa Basjarahil
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jayne Campbell
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Michelle Cunich
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Gary Disher
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Samara Geering
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Natalie Ko
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Michelle Lai
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Catherine Leahy
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Thomas Leong
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Eve McClure
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Melissa O'Grady
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Joan Walsh
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Kate White
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Fiona Coyer
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Zhang H, Ma Y, Wang Q, Zhang X, Han L. Incidence and prevalence of pressure injuries in children patients: A systematic review and meta-analysis. J Tissue Viability 2022; 31:142-151. [PMID: 34312030 DOI: 10.1016/j.jtv.2021.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/02/2021] [Accepted: 07/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pressure injuries presently has been a serious healthcare problem all over the world. Children were recognized as the high-risk population of pressure injuries in the latest prevention and treatment of pressure injuries clinical practice guideline. However, the estimates of incidence, and prevalence of pressure injuries in hospitalized children patients vary considerable in relevant published studies. OBJECTIVE To systematically quantify the incidence and prevalence of pressure injuries (PIs) in hospitalized children and the most affected PIs sites. METHODS A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Electronic databases searches of the Cochrane Library, Pubmed, Web of Science, Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, China Knowledge Resource Integrated Database (CNKI), Wanfang Database, Chinese Biomedical Database (CBM), and Weipu Database (VIP), and hand-search through references were conducted to find relevant articles. Studies were evaluated independently by two researchers and audited by a third researcher. The data were extracted and presented in tables. The risk of bias was assessed using Hoy's tool. The I2 statistic and random-effects model were used to assess the heterogeneity. Meta-regression analysis and subgroup analysis were conducted to examine between-study heterogeneity. RESULTS A total of 6, 672 articles were screened, and 30 studies with 251, 501 participants were ultimately included in this review. The pooled incidence of PIs for 3, 205 children was 13.5% (95% CI: 10.5-16.5); and the pooled prevalence of PIs for 4, 639 children was 12.2% (95% CI: 8.0-16.3). The most affected body sites were occiput, ears, and nose. Meta-regression and subgroup analysis showed that the inpatient ward, and region were the sources of heterogeneity. CONCLUSIONS The incidence and prevalence of PIs was significantly higher than the adults. Our discoveries recommended that healthcare givers ought to pay more consideration to diminish the happens of PIs. Additionally, more research may be needed to improve our understanding of the characteristics of PIs among children and to identify PIs risk factors to prevent and treat it in children effectively.
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Affiliation(s)
- Hongyan Zhang
- Department of Nursing, Gansu Provincial Hospital, Lanzhou City, Gansu Province, China.
| | - Yuxia Ma
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China.
| | - Qing Wang
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China.
| | - Xiujuan Zhang
- Department of Respiratory, Gansu Provincial Hospital, Lanzhou City, Gansu Province, China.
| | - Lin Han
- Department of Nursing, Gansu Provincial Hospital, Lanzhou City, Gansu Province, China.
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Koudounas S, Bader DL, Voegeli D. An exploratory study of the effects of the pH of synthetic urine on skin integrity in healthy participants. Skin Pharmacol Physiol 2022; 35:166-173. [DOI: 10.1159/000522289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/26/2022] [Indexed: 11/19/2022]
Abstract
Background: Incontinence-associated dermatitis (IAD) develops from prolonged exposure of skin to urine and/or stool and represents a common complication in older adults, reducing the quality of life. Increased pH is an important etiologic factor of IAD, however, the relationship between urinary pH and skin barrier disruption remains unclear.
Objective: To examine the effects of synthetic urine (s-urine) at various pH on transepidermal water loss (TEWL), stratum corneum hydration (SCH) and skin surface pH.
Methods: S-urine solutions (pH 5.0-9.0) were applied to the volar forearms of 15 healthy participants for 2 hrs, with another site serving as the untreated control. Measurements of TEWL, SCH and skin surface pH were obtained at baseline and after each challenge. Skin buffering capacity was also examined in 5 volunteers by recording skin pH at baseline, after 2 hrs exposure and every 5 mins for 40 mins.
Results: TEWL and SCH were increased following exposure to s-urine compared to baseline values. Although there was tendency for pH to an increase after exposure, further investigation showed that changes are only temporal as pH value is restored to baseline within 5 mins. There were no significant differences between solutions.
Conclusions: This study revealed that urine disrupts healthy skin integrity; however, its effects are not pH dependent. Transient changes were observed on the acid mantle of the skin due to its innate buffering capacity. Future studies need to examine the effects of urine combined with bacteria responsible for pH elevation in patients with urinary incontinence.
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Fecal diversion does not support healing of anus-near pressure ulcers in patients with spinal cord injury-results of a retrospective cohort study. Spinal Cord 2022; 60:477-483. [PMID: 34621008 PMCID: PMC9209324 DOI: 10.1038/s41393-021-00717-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 11/28/2022]
Abstract
STUDY DESIGN Retrospective cohort study including spinal cord injured patients with anus-near pressure ulcers. OBJECTIVE The primary objective was to evaluate the impact of stool diversion via stoma on the decubital wound healing. Secondary objectives included the risk of complications and ulcer recurrence. Associations between the wound healing and potentially interfering parameters were determined. SETTING University hospital with a spinal cord injury unit. METHODS A total of 463 consecutive patients who presented with a decubitus were retrospectively included. Patients with and without a stoma were compared using descriptive and explorative statistics including multiple regression analysis. RESULTS The severity of the pressure ulcers was determined as stage 3 in two-thirds and stage 4 in one-third of all cases. The wound healing lasted longer in the 71 stoma-presenting patients than in the 392 patients with undeviated defecation (77 vs. 59 days, p = 0.02). The age (regression coefficient b = 0.41, p = 0.02), the ASA classification (b = 16.04, p = 0.001) and the stage of the ulcers (b = 19.65, p = 0.001) were associated with prolonged ulcer treatment in the univariate analysis. The multiple regression analysis revealed that the fecal diversion (b = -18.19, p = 0.03) and the stage of the ulcers (b = 21.62, p = 0.001) were the only predictors of delayed wound healing. CONCLUSION The presence of a stoma is not related to improved wound healing of ulcers near the anus. On the contrary, stoma patients needed more time until complete wound healing, conceivably related to selection bias. Nonetheless, we currently do not recommend fecal diversion to be the standard concept for decubitus treatment.
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Duarte GM, Medeiros AMDB, Vasconcelos CDA, Silva GRFD, Andrade EMLR. Conhecimento de enfermeiros sobre dermatite associada à incontinência em um hospital de ensino. Rev Gaucha Enferm 2022. [DOI: 10.1590/1983-1447.2022.20210326.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO Objetivo: Verificar o conhecimento de enfermeiros acerca da dermatite associada à incontinência em um hospital de ensino. Método: Pesquisa descritiva, transversal e com análise quantitativa, realizado com 90 enfermeiros de um hospital universitário do nordeste do País entre janeiro e fevereiro de 2021. Os dados foram coletados através de um questionário online auto aplicado. Os dados foram analisados através do teste Exato de Fisher. Resultados: 75,6% dos participantes apresentaram conhecimento sobre a definição de dermatite associada à incontinência, contudo a maioria dos participantes errou sobre diversos fatores, tais como: identificação da imagem (58,9%), avaliação (66,7%), prevenção e tratamento (58,9%), método de avaliação de risco (62,2%). Conclusão: Os participantes apresentam fragilidades no conhecimento de dermatite associada à incontinência. Recomenda-se a reprodução deste estudo em outros cenários, a fim de contribuir com a produção de protocolos que otimizem o manejo.
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Barakat-Johnson M, Beeckman D, Campbell J, Dunk AM, Lai M, Stephenson J, Coyer F. Development and Psychometric Testing of a Knowledge Instrument on Incontinence-Associated Dermatitis for Clinicians: The Know-IAD. J Wound Ostomy Continence Nurs 2022; 49:70-77. [PMID: 35040816 DOI: 10.1097/won.0000000000000837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to describe the development and evaluation of the psychometric properties of an instrument used to assess clinician knowledge of Incontinence-associated dermatitis (IAD). DESIGN The instrument was developed in three phases: Phase 1 involved item development; Phase 2 evaluated content validity of the instrument by surveying clinicians and stakeholders within a single state of Australia and, Phase 3 used a pilot multisite cross-sectional survey design to determine composite reliability and evaluate scores of the knowledge tool. SUBJECTS AND SETTINGS In Phase 1, the instrument was developed by five persons with clinical and research subject expertise in the area of IAD. In Phase 2, content validity was evaluated by a group of 13 clinicians (nurses, physicians, occupational therapists, dietitians, and physiotherapists) working in acute care across one Australian state, New South Wales, along with two consumer representatives. In Phase 3, clinicians, working across six hospitals in New South Wales and on wards with patients diagnosed with incontinence-associated dermatitis, participated in pilot-testing the instrument. METHODS During Phase 1, a group of local and international experts developed items for a draft tool based on an international consensus document, our prior research evaluating incontinence-associated dermatitis knowledge, and agreement among an expert panel of clinicians and researchers. Phase 2 used a survey design to determine content validity of the knowledge tool. Specifically, we calculated item- and scale-level content validity ratios and content validity indices for all questions within the draft instrument. Phase 3 comprised pilot-testing of the knowledge tool using a cross-sectional survey. Analysis involved confirmatory factor analysis to confirm the hypothesized model structure of the knowledge tool, as measured by model goodness-of-fit. Composite reliability testing was undertaken to determine the extent of internal consistency between constituent items of each construct. RESULTS During Phase 1, a draft version of the Barakat-Johnson Incontinence-Associated Dermatitis Knowledge tool (Know-IAD), comprising 19 items and divided into three domains of IAD-related knowledge: 1) Etiology and Risk, 2) Classification and Diagnosis, and 3) Prevention and Management was developed. In Phase 2, 18 of the 19 items demonstrated high scale content validity ratios scores on relevance (0.75) and clarity (0.82); and high scale-content validity indices scores on relevance (0.87) and clarity (0.91). In Phase 3, the final 18-item Know-IAD tool demonstrated construct validity by a model goodness-of-fit. Construct validity was excellent for the Etiology and Risk domain (root mean squared error=0.02) and Prevention and Management domain (root mean squared error=0.02); it was good for the Classification and Diagnosis domain (root mean squared error=0.04). Composite reliability (CR) was good in the Etiology and Risk domain (CR=0.76), Prevention and Management domains (CR=0.75), and adequate in the Classification and Diagnosis domain (CR=0.64). Respondents had good understanding of etiology and risk (72.6% correct responses); fairly good understanding of prevention and management of IAD (64.0% correct responses) and moderate understanding of classification and diagnosis (40.2% correct responses). CONCLUSIONS The Know-IAD demonstrated good psychometric properties and provides preliminary evidence that it can be applied to evaluate clinician knowledge on IAD.
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Affiliation(s)
- Michelle Barakat-Johnson
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology
- Dimitri Beeckman, PhD, MSc, BSc , Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Belgium; Swedish Centre for Skin and Wound Research (SCENTR), Nursing Science Unit, School of Health Sciences, Örebro University, Sweden
- Jill Campbell, PhD, Grad Dip (Wound Care), BHlthSc (Nursing), RN , National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast, Australia; Royal Brisbane and Women's Hospital
- Ann-Marie Dunk, MN (Research), BHlthSc (Nursing), RN , Tissue Viability Canberra Hospital, Canberra, Australia
- Michelle Lai, MRes (Philosophy), BA-Psychology , Faculty of Medicine and Health University of Sydney, Sydney, Sydney Local Health District Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Fiona Coyer, PhD, MSc (Nursing), RN , School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology and Intensive Care Services, Royal Brisbane and Women's Hospital, Queensland Australia; Institute for Skin Integrity and Infection Prevention, University of Huddersfield, United Kingdom
| | - Dimitri Beeckman
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology
- Dimitri Beeckman, PhD, MSc, BSc , Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Belgium; Swedish Centre for Skin and Wound Research (SCENTR), Nursing Science Unit, School of Health Sciences, Örebro University, Sweden
- Jill Campbell, PhD, Grad Dip (Wound Care), BHlthSc (Nursing), RN , National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast, Australia; Royal Brisbane and Women's Hospital
- Ann-Marie Dunk, MN (Research), BHlthSc (Nursing), RN , Tissue Viability Canberra Hospital, Canberra, Australia
- Michelle Lai, MRes (Philosophy), BA-Psychology , Faculty of Medicine and Health University of Sydney, Sydney, Sydney Local Health District Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Fiona Coyer, PhD, MSc (Nursing), RN , School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology and Intensive Care Services, Royal Brisbane and Women's Hospital, Queensland Australia; Institute for Skin Integrity and Infection Prevention, University of Huddersfield, United Kingdom
| | - Jill Campbell
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology
- Dimitri Beeckman, PhD, MSc, BSc , Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Belgium; Swedish Centre for Skin and Wound Research (SCENTR), Nursing Science Unit, School of Health Sciences, Örebro University, Sweden
- Jill Campbell, PhD, Grad Dip (Wound Care), BHlthSc (Nursing), RN , National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast, Australia; Royal Brisbane and Women's Hospital
- Ann-Marie Dunk, MN (Research), BHlthSc (Nursing), RN , Tissue Viability Canberra Hospital, Canberra, Australia
- Michelle Lai, MRes (Philosophy), BA-Psychology , Faculty of Medicine and Health University of Sydney, Sydney, Sydney Local Health District Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Fiona Coyer, PhD, MSc (Nursing), RN , School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology and Intensive Care Services, Royal Brisbane and Women's Hospital, Queensland Australia; Institute for Skin Integrity and Infection Prevention, University of Huddersfield, United Kingdom
| | - Ann-Marie Dunk
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology
- Dimitri Beeckman, PhD, MSc, BSc , Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Belgium; Swedish Centre for Skin and Wound Research (SCENTR), Nursing Science Unit, School of Health Sciences, Örebro University, Sweden
- Jill Campbell, PhD, Grad Dip (Wound Care), BHlthSc (Nursing), RN , National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast, Australia; Royal Brisbane and Women's Hospital
- Ann-Marie Dunk, MN (Research), BHlthSc (Nursing), RN , Tissue Viability Canberra Hospital, Canberra, Australia
- Michelle Lai, MRes (Philosophy), BA-Psychology , Faculty of Medicine and Health University of Sydney, Sydney, Sydney Local Health District Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Fiona Coyer, PhD, MSc (Nursing), RN , School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology and Intensive Care Services, Royal Brisbane and Women's Hospital, Queensland Australia; Institute for Skin Integrity and Infection Prevention, University of Huddersfield, United Kingdom
| | - Michelle Lai
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology
- Dimitri Beeckman, PhD, MSc, BSc , Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Belgium; Swedish Centre for Skin and Wound Research (SCENTR), Nursing Science Unit, School of Health Sciences, Örebro University, Sweden
- Jill Campbell, PhD, Grad Dip (Wound Care), BHlthSc (Nursing), RN , National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast, Australia; Royal Brisbane and Women's Hospital
- Ann-Marie Dunk, MN (Research), BHlthSc (Nursing), RN , Tissue Viability Canberra Hospital, Canberra, Australia
- Michelle Lai, MRes (Philosophy), BA-Psychology , Faculty of Medicine and Health University of Sydney, Sydney, Sydney Local Health District Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Fiona Coyer, PhD, MSc (Nursing), RN , School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology and Intensive Care Services, Royal Brisbane and Women's Hospital, Queensland Australia; Institute for Skin Integrity and Infection Prevention, University of Huddersfield, United Kingdom
| | - John Stephenson
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology
- Dimitri Beeckman, PhD, MSc, BSc , Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Belgium; Swedish Centre for Skin and Wound Research (SCENTR), Nursing Science Unit, School of Health Sciences, Örebro University, Sweden
- Jill Campbell, PhD, Grad Dip (Wound Care), BHlthSc (Nursing), RN , National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast, Australia; Royal Brisbane and Women's Hospital
- Ann-Marie Dunk, MN (Research), BHlthSc (Nursing), RN , Tissue Viability Canberra Hospital, Canberra, Australia
- Michelle Lai, MRes (Philosophy), BA-Psychology , Faculty of Medicine and Health University of Sydney, Sydney, Sydney Local Health District Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Fiona Coyer, PhD, MSc (Nursing), RN , School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology and Intensive Care Services, Royal Brisbane and Women's Hospital, Queensland Australia; Institute for Skin Integrity and Infection Prevention, University of Huddersfield, United Kingdom
| | - Fiona Coyer
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology
- Dimitri Beeckman, PhD, MSc, BSc , Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Belgium; Swedish Centre for Skin and Wound Research (SCENTR), Nursing Science Unit, School of Health Sciences, Örebro University, Sweden
- Jill Campbell, PhD, Grad Dip (Wound Care), BHlthSc (Nursing), RN , National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Gold Coast, Australia; Royal Brisbane and Women's Hospital
- Ann-Marie Dunk, MN (Research), BHlthSc (Nursing), RN , Tissue Viability Canberra Hospital, Canberra, Australia
- Michelle Lai, MRes (Philosophy), BA-Psychology , Faculty of Medicine and Health University of Sydney, Sydney, Sydney Local Health District Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Fiona Coyer, PhD, MSc (Nursing), RN , School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology and Intensive Care Services, Royal Brisbane and Women's Hospital, Queensland Australia; Institute for Skin Integrity and Infection Prevention, University of Huddersfield, United Kingdom
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Banharak S, Panpanit L, Subindee S, Narongsanoi P, Sanun-Aur P, Kulwong W, Songtin P, Khemphimai W. Prevention and Care for Incontinence-Associated Dermatitis Among Older Adults: A Systematic Review. J Multidiscip Healthc 2021; 14:2983-3004. [PMID: 34729012 PMCID: PMC8556723 DOI: 10.2147/jmdh.s329672] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/28/2021] [Indexed: 12/25/2022] Open
Abstract
Background The prevalent rate of incontinence-associated dermatitis (IAD) trends upward in older populations. Skin breakdown from IAD impacts the quality of life of older adults and reflects the quality of care in hospitals and long-term care facilities. Specific and appropriate interventions for prevention and care are needed. This systematic review aims to review optimal strategies for prevention and care for older adults with IAD. Methods PubMed, CINAHL, SCOPUS, Medline, ProQuest, ThaiLIS, ThaiJo, and E-Thesis were searched for articles published between January 2010 and December 2020. Only articles focusing on older adults were included for the review. Results Eleven articles met the inclusion/exclusion criteria. Interventions for the prevention and care of IAD among older adults were categorized as assessment, incontinence management/causative factors management, cleansing, application of medical products for both skin moisturizing and skin barrier, body positioning, nutrition promotion, health education and training, and outcome evaluation. Specific prevention and care strategies for older adults with IAD included using specific assessment tools, applying skin cleansing pH from 4.0 to 6.8, body positioning, and promoting food with high protein. Other strategies were similar to those reported for adult patients. Conclusion The systematic review extracted current and specific prevention and care strategies for IAD in older adults. The prevention and care strategies from this systematic review should be applied in clinical practice. However, more rigorous research methodology is recommended in future studies, especially in examining intervention outcomes. Nurses and other health professionals should be educated and trained to understand the causes of IAD in older adults and the specific prevention and care strategies for this population. Because older adults are prone to skin damage, and this type of skin breakdown differs from pressure ulcers, the tools for assessment and evaluation, and the strategies for prevention and care require special attention. Prospero Registration Number CRD42021251711. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/nGSwevz-SIQ
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Affiliation(s)
- Samoraphop Banharak
- Department of Gerontological Nursing, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand
| | - Ladawan Panpanit
- Department of Gerontological Nursing, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand
| | - Suttinan Subindee
- Department of Gerontological Nursing, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand
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Kayser SA, Koloms K, Murray A, Khawar W, Gray M. Incontinence and Incontinence-Associated Dermatitis in Acute Care: A Retrospective Analysis of Total Cost of Care and Patient Outcomes From the Premier Healthcare Database. J Wound Ostomy Continence Nurs 2021; 48:545-552. [PMID: 34781311 PMCID: PMC8601665 DOI: 10.1097/won.0000000000000818] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the prevalence of incontinence and treatment of incontinence-associated dermatitis (IAD) and associations with outcomes including total cost of care, length of stay (LOS), 30-day readmission, sacral area pressure injuries present on admission and hospital acquired pressure injuries, and progression of all sacral area pressure injuries to a higher stage. DESIGN Retrospective analysis. SUBJECTS AND SETTINGS Data were retrieved from the Premier Healthcare Database and comprised more than 15 million unique adult patient admissions from 937 hospitals. Patients were 18 years or older and admitted to a participating hospital between January 1, 2016, and December 31, 2019. METHODS Given the absence of an IAD International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code, we categorized patients treated for IAD by selecting patients with a documented incontinence ICD-10-CM code and a documented charge for dermatology products used to treat IAD. The t test and χ2 tests determined whether incontinence and treatment for IAD were associated with outcomes. RESULTS Incontinence prevalence was 1.5% for the entire sample; prevalence rate for IAD among incontinent patients was 0.7%. As compared to continent patients, incontinent patients had longer LOS (6.4 days versus 4.4 days), were 1.4 times more likely to be readmitted, 4.7 times more likely to have a sacral pressure injury upon admission pressure injury, 5.1 times more likely to have a sacral hospital-acquired pressure injury, and 5.8 times more likely to have a sacral pressure injury progress to a severe stage. As compared to incontinent patients without IAD treatment, those with IAD treatment had longer LOS (9.7 days versus 6.4 days), were 1.3 times more likely to be readmitted, and were 2.0 times more likely to have a sacral hospital-acquired pressure injury. Total index hospital costs were 1.2 times higher for incontinent patients and 1.3 times higher for patients with IAD treatment. CONCLUSIONS Incontinence and IAD prevalence are substantially lower than past research due to underreporting of incontinence. The lack of an ICD-10-CM code for IAD further exacerbates the underreporting of IAD. Despite low prevalence numbers, our results show higher health care costs and worse outcomes for incontinent patients and patients with IAD treatment.
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Affiliation(s)
- Susan A. Kayser
- Susan A. Kayser, PhD, Hillrom Holdings, Inc, Batesville, Indiana
- Kimberly Koloms, MS, Hillrom Holdings, Inc, Chicago, Illinois
- Angela Murray, MN, RN, Hillrom Holdings, Inc, Chicago, Illinois
- Waqaar Khawar, MD, Hillrom Holdings, Inc, Chicago, Illinois
- Mikel Gray, PhD, Department of Urology, University of Virginia Charlottesville
| | - Kimberly Koloms
- Susan A. Kayser, PhD, Hillrom Holdings, Inc, Batesville, Indiana
- Kimberly Koloms, MS, Hillrom Holdings, Inc, Chicago, Illinois
- Angela Murray, MN, RN, Hillrom Holdings, Inc, Chicago, Illinois
- Waqaar Khawar, MD, Hillrom Holdings, Inc, Chicago, Illinois
- Mikel Gray, PhD, Department of Urology, University of Virginia Charlottesville
| | - Angela Murray
- Susan A. Kayser, PhD, Hillrom Holdings, Inc, Batesville, Indiana
- Kimberly Koloms, MS, Hillrom Holdings, Inc, Chicago, Illinois
- Angela Murray, MN, RN, Hillrom Holdings, Inc, Chicago, Illinois
- Waqaar Khawar, MD, Hillrom Holdings, Inc, Chicago, Illinois
- Mikel Gray, PhD, Department of Urology, University of Virginia Charlottesville
| | - Waqaar Khawar
- Susan A. Kayser, PhD, Hillrom Holdings, Inc, Batesville, Indiana
- Kimberly Koloms, MS, Hillrom Holdings, Inc, Chicago, Illinois
- Angela Murray, MN, RN, Hillrom Holdings, Inc, Chicago, Illinois
- Waqaar Khawar, MD, Hillrom Holdings, Inc, Chicago, Illinois
- Mikel Gray, PhD, Department of Urology, University of Virginia Charlottesville
| | - Mikel Gray
- Susan A. Kayser, PhD, Hillrom Holdings, Inc, Batesville, Indiana
- Kimberly Koloms, MS, Hillrom Holdings, Inc, Chicago, Illinois
- Angela Murray, MN, RN, Hillrom Holdings, Inc, Chicago, Illinois
- Waqaar Khawar, MD, Hillrom Holdings, Inc, Chicago, Illinois
- Mikel Gray, PhD, Department of Urology, University of Virginia Charlottesville
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Zhang Y, Zhang P, Liu JE, Gao F. A Qualitative Study on the Experience and Training Needs of ICU Nurses for Incontinence-Associated Dermatitis. Adv Skin Wound Care 2021; 34:532-537. [PMID: 34546204 DOI: 10.1097/01.asw.0000790484.36520.9a] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Yu Zhang
- At the Capital Medical University in Beijing, China, Yu Zhang, MSN, RN, is Nurse, Department of Respiratory and Critical Care Medicine; Peng Zhang, MSc, is Attending Doctor, Department of Urology, Beijing Chao-Yang Hospital; Jun-E Liu, MD, is Professor, School of Nursing; and Fengli Gao, MD, is Director, Nursing Department, Beijing Chao-Yang Hospital. Acknowledgment: The authors thank the Nursing Department of Beijing Chao-Yang Hospital for supporting this study, including the ICU nurses who agreed to share their experience and devote time and effort to this project. The authors have disclosed no financial relationships related to this article. Submitted September 24, 2020; accepted in revised form December 10, 2020
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48
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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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Dissemond J, Assenheimer B, Gerber V, Hintner M, Puntigam MJ, Kolbig N, Koller S, Kurz P, Läuchli S, Probst S, Protz K, Steiniger A, Strohal R, Traber J, Kottner J. Flüssigkeits‐assoziierte Hautschäden (FAH): Eine
Best Practice
Empfehlung von Wund‐D.A.CH. J Dtsch Dermatol Ges 2021; 19:815-827. [PMID: 34139095 DOI: 10.1111/ddg.14388_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/01/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Joachim Dissemond
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum, Essen, Deutschland
| | - Bernd Assenheimer
- Schule für Pflegeberufe, Universitätsklinikum, Tübingen, Deutschland
| | - Veronika Gerber
- Schulung und Beratung im Wundmanagement, Spelle, Deutschland
| | | | | | - Norbert Kolbig
- Stabstelle Wundmanagement, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | | | - Peter Kurz
- WPM Wund Pflege Management, Bad Pirawarth, Österreich
| | | | | | - Kerstin Protz
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, CWC - Comprehensive Wound Center, Universitätsklinikum Hamburg, Hamburg, Deutschland
| | | | - Robert Strohal
- Abteilung für Dermatologie und Venerologie, Landeskrankenhaus Feldkirch, Feldkirch, Österreich
| | - Jürg Traber
- Chirurgie/Gefässchirurgie FEBVS, Phlebologie SGP, Venenklinik Bellevue, Kreuzlingen, Schweiz
| | - Jan Kottner
- CharitéCentrum 1 für Human- und Gesundheitswissenschaften, Charité -Universitätsmedizin Berlin, Berlin, Deutschland
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Koudounas S, Bader DL, Voegeli D. Investigating the release of inflammatory cytokines in a human model of incontinence-associated dermatitis. J Tissue Viability 2021; 30:427-433. [PMID: 34144890 DOI: 10.1016/j.jtv.2021.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/25/2021] [Accepted: 06/07/2021] [Indexed: 11/26/2022]
Abstract
Incontinence-associated dermatitis (IAD) is a painful complication in elderly patients, leading to reduced quality of life. Despite recent attention, its underlying inflammatory mechanisms remain poorly understood. This study was designed to quantify the release of inflammatory cytokines in a human model of IAD. The left volar forearm of ten healthy volunteers was exposed to synthetic urine and synthetic faeces for 2 h, simulating the effects of urinary and faecal incontinence, respectively, and the subsequent cytokine response compared to that of an untreated control site. Inflammatory cytokines were collected using both the Sebutape® absorption method and dermal microdialysis and quantified using immunoassays. Results from the former demonstrated an upregulation in IL-1α, IL-1RA and TNF-α. Synthetic urine caused a higher median increase in IL-1α from baseline compared to synthetic faeces, whereas synthetic faeces were associated with significantly higher median TNF-α levels compared to synthetic urine (p = 0.01). An increase in IL-1α/IL-1RA ratio was also observed with significant differences evident following exposure to synthetic urine (p = 0.047). Additionally, microdialysis revealed a time-dependent increase in IL-1β and IL-8 following exposure of up to 120 min to synthetic urine and synthetic faeces, respectively. This study demonstrated the suitability of both sampling approaches to recover quantifiable cytokine levels in biofluids for the assessment of skin status following exposure to synthetic fluids associated with incontinence. Findings suggest some differences in the inflammatory mechanisms of IAD, depending on moisture source, and the potential of the cytokines, IL-1α and TNF-α, as responsive markers of early skin damage caused by incontinence.
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Affiliation(s)
- Sofoklis Koudounas
- Skin Health Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, SO16 6YD, UK.
| | - Dan L Bader
- Skin Health Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, SO16 6YD, UK.
| | - David Voegeli
- Faculty Health & Wellbeing, University of Winchester, Winchester, SO22 4NR, UK.
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