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

In-home use study evaluating user satisfaction with newly developed MoliCare Premium Pants

BACKGROUND

High-quality absorbent products with effective performance characteristics help maintain user dignity and normalise incontinence.

AIM

The study evaluated the most important performance characteristics of newly developed MoliCare Premium Pants.

METHODS

Fifty-two adults with incontinence in Germany were surveyed for their views and levels of satisfaction with various performance features of the tested absorbent incontinence product via a computer-assisted personal interview.

FINDINGS

All features of the product received positive feedback from all respondents. More than 94% of participants 'agreed' that the new design performed very well on each characteristic; 98% of users were 'highly satisfied' and 'satisfied' with the MoliCare product.

CONCLUSIONS

The new design performed particularly well with regard to different performance aspects. The redesigned MoliCare Premium Pants with innovative features is suitable specifically for individuals with incontinence and can help them continue a normal lifestyle independently without feeling embarrassed due to their continence problem.

Prevention and care for moisture-associated skin damage: A scoping review

OBJECTIVE

Moisture-associated skin damage (MASD) is an inflammatory skin condition caused by long-term exposure to a moist environment, which can compromise the integrity of the barrier and increase pain. This scoping review aimed to systematically analyze the research status of prevention and care for MASD.

METHODS

We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. PubMed, MEDLINE, Scopus, Web of Science, CINAHL, and the Cochrane Database of Systematic Reviews were searched for relevant articles until March 2023.

RESULTS

Based on eligibility criteria, 34 research studies and review articles were included. The prevalence of MASD varies greatly in different medical environments and patient groups. The high-risk factors included prolonged exposure to excessive water, chemical irritation such as urine or feces, mechanical factors such as friction or improper removal of medical adhesives and local bacterial colonization. Prevention measures mainly include avoiding skin exposure to moisture, skin cleansing, moisturizing and the treatment of secondary bacterial infection.

CONCLUSION

A variety of factors have an impact on MASD. Nurses should select suitable tools to screen high-risk patients and take targeted preventive measures according to the related types of skin injury to reduce the incidence of MASD.

Risk Factors for Incontinence-Associated Dermatitis in Critically Ill Patients with Incontinence: A Systematic Review and Meta-analysis

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.

Managing incontinence-associated dermatitis in the community: an overview

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.

Knowledge of nursing staff before and after training on incontinence-associated dermatitis

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.

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

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.

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

BACKGROUND

Incontinence-associated dermatitis (IAD) is a major concern among hospitals, especially in intensive care units (ICUs).

PURPOSE

To describe ICU nurses' knowledge, attitudes, and practices of IAD and to examine the relationships with IAD prevalence in the ICU setting.

METHODS

A descriptive correlational design was used including the Knowledge, Attitudes and Practices of Incontinence-Associated Dermatitis Questionnaire and 1-month IAD prevalence data.

RESULTS

The prevalence of IAD in ICUs was 6.89%. A positive correlation was found between IAD prevalence and nurses' IAD knowledge and attitudes. Nurses working in the ICU for more than 7 years, caring for patients at high risk for or having IAD, and thinking IAD-related nursing practices were sufficient had significantly higher IAD knowledge, attitudes, and practices.

CONCLUSIONS

Findings indicate that ICU nurses learned about IAD through clinical experience and have inadequate training on IAD. A standardized evidence-based care protocol for IAD should be developed.

Incontinence during and following hospitalisation: a prospective study of prevalence, incidence and association with clinical outcomes

BACKGROUND

Incontinence is common in hospitalised older adults but few studies report new incidence during or following hospitalisation.

OBJECTIVE

To describe prevalence and incidence of incontinence in older inpatients and associations with clinical outcomes.

DESIGN

Secondary analysis of prospectively collected data from consecutive consenting inpatients age 65 years and older on medical and surgical wards in four Australian public hospitals.

METHODS

Participants self-reported urinary and faecal incontinence 2 weeks prior to admission, at hospital discharge and 30 days after discharge as part of comprehensive assessment by a trained research assistant. Outcomes were length of stay, facility discharge, 30-day readmission and 6-month mortality.

RESULTS

Analysis included 970 participants (mean age 76.7 years, 48.9% female). Urinary and/or faecal incontinence was self-reported in 310/970 (32.0%, [95% confidence interval (CI) 29.0-35.0]) participants 2 weeks before admission, 201/834 (24.1% [95% CI 21.2-27.2]) at discharge and 193/776 (24.9% [95% CI 21.9-28.1]) 30 days after discharge. Continence patterns were dynamic within the peri-hospital period. Of participants without pre-hospital incontinence, 74/567 (13.1% [95% CI 10.4-16.1) reported incontinence at discharge and 85/537 (15.8% [95% CI 12.8-19.2]) reported incontinence at 30 days follow-up. Median hospital stay was longer in participants with pre-hospital incontinence (7 vs. 6 days, P = 0.02) even in adjusted analyses and pre-hospital incontinence was significantly associated with mortality in unadjusted but not adjusted analyses.

CONCLUSION

Pre-hospital, hospital-acquired and new post-hospital incontinence are common in older inpatients. Better understanding of incontinence patterns may help target interventions to reduce this complication.

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

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

Effectiveness of an External Urinary Device for Female Anatomy and Trends in Catheter-Associated Urinary Tract Infections

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.

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

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.

Prevalence of Friction Skin Injury on the Buttocks and/or Posterior Thighs in an Acute Care Setting: A Quality Improvement Project

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.

INTERVENÇÃO EDUCATIVA SOBRE DERMATITE ASSOCIADA À INCONTINÊNCIA: ESTRATÉGIA DE ENSINO NO INSTAGRAM

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.

EDUCATIONAL INTERVENTION ON INCONTINENCE-ASSOCIATED DERMATITIS: TEACHING STRATEGY ON INSTAGRAM

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.

Incontinence Management and Pressure Injury Rates in US Acute Care Hospitals: Analysis of Data From the 2018-2019 International Pressure Injury Prevalence™ (IPUP) Survey

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.

Bacterial invasion into the epidermis of rats with sodium lauryl sulphate-irritated skin increases damage and induces incontinence-associated dermatitis

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.

Factors Influencing Nursing Students' Knowledge of and Attitudes Toward Urinary Incontinence

PURPOSE

This study aimed to determine nursing students' knowledge about and attitudes toward patients with urinary incontinence.

SUBJECTS AND SETTING

The sample comprised 392 nursing students from 5 educational institutions in Hong Kong; all participants were enrolled in year 4 or 5 of their undergraduate nursing program, and all had completed formal education on urinary incontinence and clinical experience caring for patients with urinary incontinence.

METHODS

A cross-sectional survey was conducted in February 2017. Participants completed a 55-item questionnaire that included items querying demographic and pertinent professional background information, along with 2 validated instruments: the Urinary Incontinence Knowledge Scale (UIKS) and the Urinary Incontinence Attitude Scale (UIAS). Analysis of variance was performed to compare the differences in scores among nursing students based on demographic or educational background. Pearson's correlation coefficient or χ2 was used to examine the relationships between variables and multivariate regression analyses were performed to identify the predictors of attitude toward urinary incontinence.

RESULTS

Urinary incontinence knowledge was moderate (mean 22.0/30, SD 4.4) and attitudes about urinary incontinence were positive (mean 41.6/60, SD 4.5). There was a significant correlation between attitudes and knowledge (r = 0.175, P = .001), institution at which the students received training (χ2 = 161.790, P = .000), and the experience of having taken a course that included instruction about urinary incontinence (χ2 = 37.707, P = .014). Regression analysis revealed that knowledge and institution were predictors of attitudes. Participants reported high level of interest in learning more about urinary incontinence (71.2%).

CONCLUSIONS

Nursing students residing in Hong Kong have a moderate level of knowledge and positive attitude toward urinary incontinence. This study suggests that educational institution and specific instruction about urinary incontinence play key roles in developing positive attitudes toward caring for patients with urinary incontinence.

Moisture-Associated Skin Damage: Expanding and Updating Practice Based on the Newest ICD-10-CM Codes

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.

Clinician Knowledge of Incontinence-Associated Dermatitis: A Multisite Survey of Healthcare Professionals in Acute and Subacute Settings

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.