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Qi L, Zhao Q, Guo L, Zhao B, Zhang M. Prevention and care for moisture-associated skin damage: A scoping review. J Tissue Viability 2024; 33:362-375. [PMID: 38906753 DOI: 10.1016/j.jtv.2024.06.002] [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: 07/21/2023] [Revised: 03/14/2024] [Accepted: 06/05/2024] [Indexed: 06/23/2024]
Abstract
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.
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Affiliation(s)
- Lin Qi
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China; Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Qingsheng Zhao
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China; Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Lianrong Guo
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China; Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Bingnan Zhao
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China
| | - Min Zhang
- Qilu Hospital of Shandong University, Jinan, Shandong Province, China.
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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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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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Scientific and Clinical Abstracts From WOCNext® 2023: Las Vegas, Nevada ♦ June 4-7, 2023. J Wound Ostomy Continence Nurs 2023; 50:S1-S78. [PMID: 37632270 DOI: 10.1097/won.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Liu H, Du A, Tian Y, Gao M, Ji S, Mi J, Shao X, Huang D, Cao X. The ability of critical care nurses to identify pressure injury and incontinence-associated dermatitis: A multicentre cross-sectional survey. Nurs Open 2022; 10:1556-1564. [PMID: 36266743 PMCID: PMC9912419 DOI: 10.1002/nop2.1406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 04/22/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022] Open
Abstract
AIM To investigate the ability of critical care nurses to identify pressure injury and incontinence-associated dermatitis and analyse the possible influencing factors. DESIGN Cross-sectional survey. METHODS This study was conducted at 24 hospitals across 12 provinces in China. A self-made electronic questionnaire was used. Nurses identified and judged injuries according to the information provided. RESULTS The average identification score for pressure injury and incontinence-associated dermatitis was 9.00 ± 3.51 points, and only 2.16% of nurses scored ≥16 points. The average correct identification rate for pressure injury and incontinence-associated dermatitis was 45%. The correct identification rate for stage 1 pressure injury was the highest, while those for stage 3, stage 4, deep tissue pressure injury and unstageable pressure injury were all lower than 50%; incontinence-associated dermatitis was also easily misjudged. Nurses' educational backgrounds, professional titles, job positions, hospital levels and learning frequency were the factors that affected their ability to identify pressure injury and incontinence-associated dermatitis.
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Affiliation(s)
- Huan Liu
- Department of Critical Care MedicineWest China Hospital of Sichuan UniversityChengduChina
| | - Aiping Du
- Department of Critical Care MedicineWest China Hospital of Sichuan UniversityChengduChina
| | - Yongming Tian
- Department of Critical Care MedicineWest China Hospital of Sichuan UniversityChengduChina
| | - Mingrong Gao
- Department of Critical Care MedicineThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Shuming Ji
- Office of Program Design and StatisticsWest China Hospital of Sichuan UniversityChengduChina
| | - Jie Mi
- Department of Critical Care MedicineThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Xiaoping Shao
- Department of Critical Care MedicineShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Debin Huang
- Department of Critical Care MedicineThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Xiaoyi Cao
- Department of NursingWest China Hospital of Sichuan UniversityChengduChina
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General Skin Issues in the Adult Rehabilitation Population. Phys Med Rehabil Clin N Am 2022; 33:745-758. [DOI: 10.1016/j.pmr.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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O’NeillI DG, Rowe D, Brodbelt DC, Pegram C, Hendricks A. Ironing out the wrinkles and folds in the epidemiology of skin fold dermatitis in dog breeds in the UK. Sci Rep 2022; 12:10553. [PMID: 35794173 PMCID: PMC9259571 DOI: 10.1038/s41598-022-14483-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/07/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractSkin fold dermatitis (intertrigo) is an inflammatory process of closely apposing skin surfaces. Extreme conformations towards folded skin in many dog breeds are linked with higher risk. Using anonymised primary-care veterinary data from the VetCompass Programme, this study aimed to report the frequency, demographic risk factors and clinical management for skin fold dermatitis in the UK. Risk factor analysis used random effects multivariable logistic regression modelling. From a study population of 905,553 dogs, the one-year period prevalence in dogs overall was 0.37% (95% CI 0.35–0.39). Diagnosis was supported by laboratory testing in 4.21% cases. Systemic antibiosis was used in 42.30% cases. Compared with crossbreed dogs, the most highly predisposed breeds were English Bulldog (odds ratio [OR] 49.07, 95% CI 37.79–63.70), French Bulldog (OR 25.92, 95% CI 19.62–34.26,) and Pug (OR 16.27, 95% CI 12.20–21.69). The most protected breeds were Yorkshire Terrier (OR 0.14, 95% CI 0.03–0.56), Border Collie (OR 0.31, 95% CI 0.11–0.84), Jack Russell Terrier (OR 0.53, 95% CI 0.30–0.92) and Labrador Retriever (OR 0.57, 95% CI 0.35–0.93). This study adds further evidence to the welfare concerns around high popularity of dog breeds with extreme conformations. The three breeds with by far the highest odds of skin fold dermatitis represent an extreme brachycephalic conformation.
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Zhang X, Wang X, Zhao X, Zhang Y. A Structured Skin Care Protocol for Preventing and Treating Incontinence-associated Dermatitis in Critically Ill Patients. Adv Skin Wound Care 2022; 35:335-342. [PMID: 35703853 DOI: 10.1097/01.asw.0000828972.70137.8a] [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 examine the effectiveness of a structured skin care protocol for preventing and treating incontinence-associated dermatitis (IAD) in critically ill patients. METHODS Participants were drawn from the ICUs of three teaching hospitals between January 2016 and December 2017. Patients were eligible if they were ≥18 years old, had idiopathic fecal incontinence, had diarrhea but were unable to sense it, and were expected to stay in the ICU for at least 72 hours after developing incontinence. A total of 143 patients were enrolled: 79 in the experimental group and 64 in the control group. In the first phase of the study, routine skin care measures were used; in the second phase, three ICU caregivers were trained to provide a structured skin care protocol. Trained research team members conducted the data collection and analysis. The TREND (Transparent Reporting of Evaluations with Nonrandomized Designs) Statement Checklist was followed in reporting the study results. RESULTS Application of the structured skin care protocol reduced the incidence of IAD from 35.9% in the control phase to 17.7% in the intervention phase (χ2 = 6.117, P < .05) and also decreased the severity of IAD (z = -2.023, P < .05). Further, IAD developed later (z = -2.116, P < .05) in the intervention group than in the control group. In addition, the nursing times to prevent or manage IAD did not differ significantly between the groups (t = -0.258, P > .05; t = -1.190, P > .05). CONCLUSIONS Use of the developed structured skin care protocol for IAD in critically ill patients lowered the incidence and severity of IAD and delayed IAD development.
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Affiliation(s)
- Xiaoxue Zhang
- In the General Surgery Department at Xuanwu Hospital, Capital Medical University, Beijing, China, Xiaoxue Zhang is Nurse; Xinran Wang is Head Nurse and Professor; and Xiaowei Zhao is Head Nurse. Yu Zhang is Nurse, Urinary Surgery Department, Beijing Hospital. Acknowledgments: This work was supported by the Beijing Municipal Administration of Hospitals Incubating Program (grant PX2016037) and the Chinese Nursing Association Project (grant ZHKY201711). The authors gratefully acknowledge the financial support of the Beijing Municipal Administration of Hospitals Incubating Program and Chinese Nursing Association Project. They also thank the nurses in three ICUs for their effort in the protocol implementation. The authors have disclosed no other financial relationships related to this article. Submitted May 6, 2021; accepted in revised form July 23, 2021
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McNichol L, Bliss DZ, Gray M. Moisture-Associated Skin Damage: Expanding Practice Based on the Newest ICD-10-CM Codes for Irritant Contact Dermatitis Associated With Digestive Secretions and Fecal or Urinary Effluent From an Abdominal Stoma or Enterocutaneous Fistula. J Wound Ostomy Continence Nurs 2022; 49:235-239. [PMID: 35523238 PMCID: PMC9093722 DOI: 10.1097/won.0000000000000873] [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: 11/25/2022]
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, characterized by inflammation with or without denudation of affected skin. In 2020, the Wound, Ostomy and Continence Nurses Society commissioned an initiative that led to the addition of multiple International Classification of Diseases, Tenth Revision, Clinical Modification codes (ICD-10-CM) for irritant contact dermatitis caused by various forms of MASD for use in the United States. In a recent 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 for each of these codes. This is the second in a series of 2 follow-up articles providing a more detailed description of the MASD conditions to which the newest irritant contact dermatitis ICD-10-CM codes apply. Specifically, this article reviews the clinical manifestations and assessment, pathophysiology, epidemiology, prevention, and management of irritant contact dermatitis associated with digestive secretions from a stoma or fistula, and fecal or urinary effluent from an abdominal stoma or enterocutaneous fistula.
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Affiliation(s)
- Laurie McNichol
- Correspondence: Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, FAAN, 11 Bluff Ridge Court, Greensboro, NC 27455 ()
| | - Donna Z. Bliss
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, FAAN, WOC Nurse, Cone Health, Greensboro, North Carolina
- Donna Z. Bliss, PhD, RN, FGSA, FAAN, University of Minnesota School of Nursing, Minneapolis
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, Charlottesville
| | - Mikel Gray
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, FAAN, WOC Nurse, Cone Health, Greensboro, North Carolina
- Donna Z. Bliss, PhD, RN, FGSA, FAAN, University of Minnesota School of Nursing, Minneapolis
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, Charlottesville
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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: 1] [Impact Index Per Article: 0.5] [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, 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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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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13
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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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14
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Wang CM, Chien YJ, Huang CY, Su NC, Lin HL, Chen CH, Chen CJ, Hsu H. Management of incontinence-associated dermatitis with topical antibiotics and antifungal medication. J Wound Care 2021; 30:S24-S27. [PMID: 33856927 DOI: 10.12968/jowc.2021.30.sup4.s24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The primary goals of managing incontinence-associated dermatitis (IAD) are to control the incontinence and to stop the progress of dermatitis. This study evaluated the effectiveness of using a combination of topical antibiotic and topical antifungal medication to manage IAD. METHOD Patients with grade 2 IAD treated with a combination of topical antibiotic Biomycin (CBC Biotechnological and Pharmaceutical, Taiwan) and antifungal clotrimazole (Sinphar Group, Taiwan) between January 2017 and January 2019 were included in this retrospective study. Data collected included patients' age, sex, diagnosis, body mass index, comorbidities and surface area involved. Patients were reviewed fortnightly until the wounds had healed, the patient was discharged or had died. RESULTS A total of 76 patients were included. There were 39 men and 37 women with a mean age of 74 years. In 58 (76%) patients, the surface area involved was >50cm2, in 13 (17%) patients the involved area was 20-50cm2 and in five (7%) patients the area involved was <20cm2. The mean number of days treated was 10.3 (range: 1-53). A total of 46 (61%) patients showed total healing of their IAD, 17 (22%) patients showed improvement of >50% of the involved area, seven (9%) patients showed improvement of 0-50%, five (7%) patients showed no improvement and one (1%) patient showed an increase in the area involved. CONCLUSION This combination of treatment was effective in the management of IAD. It was cheap, easy to apply, easy to remove and easily accessible. It could be used efficiently by the hospital staff and the patient's family.
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Affiliation(s)
- Chin-Min Wang
- Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan
| | - Yu-Ju Chien
- Yonghe District Health Center, Department of Health, New Taipei City Government
| | - Chiao-Yi Huang
- Division of Plastic Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan
| | - Na-Chi Su
- Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan
| | - Hsing Long Lin
- Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan
| | - Ching-Hsiang Chen
- Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan
| | - Chia-Jung Chen
- Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan
| | - Honda Hsu
- Division of Plastic Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan.,chool of Medicine, Institute of Medical Sciences, Tzu Chi University, Hualien, 97004, Taiwan
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15
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Pather P, Doubrovsky A, Jack L, Coyer F. Incontinence-associated dermatitis: who is affected? J Wound Care 2021; 30:261-267. [PMID: 33856906 DOI: 10.12968/jowc.2021.30.4.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Intensive care unit (ICU) patients possess multiple risk factors for developing loss of skin integrity, particularly incontinence-associated dermatitis (IAD). IAD is an inflammatory skin condition resulting from repeated and prolonged contact with urine, faeces or both. This study aimed to measure the incidence and clinical characteristics of adult ICU patients with IAD. METHOD This was a prospective observational study conducted over three months in an adult ICU. Included patients were ≥18 years who experienced faecal incontinence during their intensive care admission. Patients were excluded if they had an ileostomy or colostomy, had IAD on admission, or were continent of urine and faeces. Skin inspections were performed every second day on all recruited patients by trained research nurses. Other data were collected from patient medical records. RESULTS A total of 37 patients took part in the study. Incidence of IAD was 35.1%; 13 patients who had incontinence developed IAD. The mean time to onset of IAD was 3.69 days, median 3 days (SD: 1.8, range: 2-8 days). Of the 13 patients who developed IAD, 12 (92.3%) patients were initially assessed as having category 1 IAD and one (7.7%) patient was initially assessed with category 2 IAD. Of the patients with category 1 IAD, one patient (7.7%) progressed to category 2 IAD severity. CONCLUSION A larger sample is recommended to fully explore ICU patient characteristics and IAD development. The incidence of IAD in ICU patients was high at 35%, indicating this condition requires due consideration in ICU patients.
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Affiliation(s)
- Priscilla Pather
- Queen Elizabeth ll Jubilee Hospital, Mater Health Services, Intensive Care, Australia
| | - Anna Doubrovsky
- School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Leanne Jack
- Post Graduate Study Area Coordinator Intensive Care Nursing and Emergency Nursing, School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Fiona Coyer
- Joint Appointment Royal Brisbane and Women's Hospital and School of Nursing, Queensland University of Technology Nursing, Brisbane, Australia.,Visiting Professor, Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
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16
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Koudounas S, Mugita Y, Minematsu T, Nakagami G, Weller C, Sanada H. Does the presence of bacterial urinary infection contribute to the development of incontinence-associated dermatitis? A scoping review. J Tissue Viability 2021; 30:256-261. [PMID: 33579585 DOI: 10.1016/j.jtv.2021.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Incontinence-associated dermatitis (IAD) is an inflammatory skin condition caused by the repeated exposure to urine and faeces. It is not common for urinary incontinence only to cause IAD, however patients with urinary tract infections (UTIs) are also at increased risk for IAD. This scoping review aimed to provide a summary of the relationship between bacterial urinary infections and IAD. METHODS We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. PubMed, CINAHL, Medline, and Web of Science were searched for relevant articles from January 2007 through February 2020. RESULTS Based on eligibility criteria, 13 research studies and review articles were included. Despite the acknowledged role of bacterial infections can play in IAD and the importance of eradicating infections for the prevention of skin breakdown, there have been limited studies that have investigated how uropathogenic bacteria, in combination with urine, lead to skin damage and IAD. The use of urinary catheters also predisposes to UTIs; however, prevalence/incidence rates of IAD in these patients are not clear, as they were considered as continent of urine in the included studies. CONCLUSION Further research is needed to elucidate the mechanisms of how bacteria, in combination with urine, lead to IAD.
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Affiliation(s)
- Sofoklis Koudounas
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 113-0033, Tokyo, Japan.
| | - Yuko Mugita
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, 113-0033, Tokyo, Japan.
| | - Takeo Minematsu
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 113-0033, Tokyo, Japan; Department of Skincare Science, Graduate School of Medicine, The University of Tokyo, 113-0033, Tokyo, Japan.
| | - Gojiro Nakagami
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 113-0033, Tokyo, Japan; Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, 113-0033, Tokyo, Japan.
| | - Carolina Weller
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Hiromi Sanada
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 113-0033, Tokyo, Japan; Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, 113-0033, Tokyo, Japan.
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17
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Everink IHJ, Kottner J, van Haastregt JCM, Halfens R, Schols JMGA. Skin areas, clinical severity, duration and risk factors of intertrigo: A secondary data analysis. J Tissue Viability 2020; 30:102-107. [PMID: 33431261 DOI: 10.1016/j.jtv.2020.12.005] [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: 06/02/2020] [Revised: 11/20/2020] [Accepted: 12/22/2020] [Indexed: 11/28/2022]
Abstract
AIM To describe the skin areas most often affected by intertrigo, the clinical severity and duration of intertrigo and possible risk factors. MATERIALS AND METHODS Secondary analysis of data from 2013 to 2016 collected by the International Prevalence Measurement of Care Quality in Dutch hospitals, care homes and community care. RESULTS In total, n = 7865 (mean age 80.1 years) subjects were included in this analysis. The inguinal, breast and gluteal cleft skin areas were most often affected by intertrigo. The skin was often inflamed but not eroded. Strongest associations between intertrigo at inguinal skin and diabetes mellitus (OR 1.8; 95% CI 1.1-3.1), intertrigo at sub mammary folds and urinary incontinence (OR 1.6; 95% CI 0.9-2.9) and between intertrigo at gluteal cleft and urinary incontinence (OR 2.9; 95% CI 1.4-5.2) were observed. CONCLUSION The inguinal region, sub mammary folds and gluteal clefts are most often affected by intertrigo. Female sex, urinary incontinence and high BMI seem to enhance intertrigo risk at all of these skin areas.
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Affiliation(s)
- Irma H J Everink
- Maastricht University, Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), P.O. Box 616, 6200, Maastricht, the Netherlands.
| | - Jan Kottner
- Charité-Universitätsmedizin Berlin, Charité Center for Health and Human Sciences Germany, Chariteplatz 1, 10117, Berlin, Germany; Ghent University, Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Faculty of Medicine and Health Sciences, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Jolanda C M van Haastregt
- Maastricht University, Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), P.O. Box 616, 6200, Maastricht, the Netherlands.
| | - Ruud Halfens
- Maastricht University, Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), P.O. Box 616, 6200, Maastricht, the Netherlands.
| | - Jos M G A Schols
- Maastricht University, Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), P.O. Box 616, 6200, Maastricht, the Netherlands; Maastricht University, Department of Family Medicine and Care and Public Health Research Institute (CAPHRI), P.O. Box 616, 6200, Maastricht, the Netherlands.
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18
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Del Cotillo-Fuente M, Valls-Matarín J, Sandalinas-Mulero I. Efficacy of a comprehensive strategy to reduce moisture-associated skin damage in an intensive care unit: A quasi-experimental study. Intensive Crit Care Nurs 2020; 63:102964. [PMID: 33308944 DOI: 10.1016/j.iccn.2020.102964] [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: 04/17/2020] [Revised: 09/16/2020] [Accepted: 10/13/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Assess the impact of a bundle of interventions to reduce the incidence of moisture-associated skin damage in an intensive care unit. METHODS Quasi-experimental study with pre-post comparison carried out in a general intensive care unit. The intervention consisted of an online training on skin lesions and implementation of a skin care program. In the pre-post intervention period, the skin of the pelvic area was assessed daily until the appearance of a moisture-related lesion or intensive care unit discharge. Demographic and clinical variables, type of moisture lesion and severity were collected. To assess the impact of the intervention the odds ratio (OR) adjusted for the confounding variables was used. RESULTS Trained nurses accounted for 87.7%. In each phase 145 patients were studied. The incidence of moisture-associated skin damage in the pre-phase was of 29% and 14.5% in the post phase. The OR adjusted for the confounding variables (ICU length of stay, obesity, faecal incontinence and non-communicative patients) was 0.44 (95%CI:0.23-0.82). The reduction of incontinence-associated dermatitis presented an OR of 0.81 (95%CI:0.30-2.16) and intertriginous dermatitis of 0.39 (95%CI:0.17-0.85). CONCLUSIONS Online training for nurses and the introduction of structured skin care reduced by half the moisture-associated skin damage, especially intertriginous dermatitis.
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Affiliation(s)
- Mercedes Del Cotillo-Fuente
- Intensive Care Unit, Hospital Universitari Mútua Terrassa, Plaça Dr Robert 5, 08221 Terrassa (Barcelona), Spain.
| | - Josefa Valls-Matarín
- Intensive Care Unit, Hospital Universitari Mútua Terrassa, Plaça Dr Robert 5, 08221 Terrassa (Barcelona), Spain
| | - Inma Sandalinas-Mulero
- Critical Care Area, Hospital Universitari Mútua Terrassa, Plaça Dr Robert 5, 08221 Terrassa (Barcelona), Spain
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19
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Elevated Skin pH Is Associated With an Increased Permeability to Synthetic Urine. J Wound Ostomy Continence Nurs 2020; 48:61-67. [DOI: 10.1097/won.0000000000000716] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Knowledge Gaps in the Etiology and Pathophysiology of Incontinence-Associated Dermatitis. J Wound Ostomy Continence Nurs 2020; 47:388-395. [DOI: 10.1097/won.0000000000000656] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Abstract
Intertrigo, also known as intertriginous dermatitis, is one of the four separate conditions that fall under the umbrella term of moisture-associated skin damage (MASD). It can affect individuals of all ages. Intertrigo is a common inflammatory skin disorder caused by skin-on-skin friction within skin folds, as a result of moisture becoming trapped because of poor air circulation. It can occur in any area of the body where two skin surfaces are in close contact with each other, such as the axillary, inframammary, umbilical and inguinal areas, and is strongly associated with obesity. Consensus clinical expert opinion suggests that investment in the development and adoption of clear skin care and skin fold management protocols can lead to improvements in the patient experience and better clinical outcomes.
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Affiliation(s)
- David Voegeli
- Visiting Professor of Nursing, Department of Health and Care Professions, Faculty of Health & Wellbeing, University of Winchester
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22
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Weyandt G, Breitkopf C, Werner RN, Zidane M, Furtwängler A, Jongen J, Rothhaar A, Schaefer D, Lenhard B. S1‐Leitlinie Diagnostik und Therapie des Analekzems. J Dtsch Dermatol Ges 2020; 18:648-657. [PMID: 32519493 DOI: 10.1111/ddg.14125_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/14/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Gerhard Weyandt
- Klinik für Dermatologie und Allergologie, Klinikum Bayreuth, Bayreuth
| | | | - Ricardo Niklas Werner
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
| | - Miriam Zidane
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
| | - Alex Furtwängler
- Praxisklinik 2000, Proktologische Praxis Freiburg, Freiburg im Breisgau
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Weyandt G, Breitkopf C, Werner RN, Zidane M, Furtwängler A, Jongen J, Rothhaar A, Schaefer D, Lenhard B. German S1 guidelines for the diagnosis and treatment of perianal dermatitis (anal eczema). J Dtsch Dermatol Ges 2020; 18:648-657. [PMID: 32469472 DOI: 10.1111/ddg.14125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/14/2019] [Indexed: 11/30/2022]
Abstract
Perianal dermatitis (anal eczema, perianal eczema) is one of the most common proctological conditions. It may occur as a sequela or a presenting symptom of various proctological, dermatological, allergic or pathogen-induced disorders. The three main types of anal eczema are irritant-toxic, atopic and allergic contact dermatitis. Adequate and successful treatment requires a comprehensive diagnostic workup to determine disease etiology and includes treatment/elimination of causative factors as well as nonpharmacological interventions (avoidance of aggravating factors). In addition, adjuvant topical anti-inflammatory and/or specific symptomatic treatment may be required. The present guidelines contain recommendations for the diagnostic and therapeutic management of perianal dermatitis. Target users of these guidelines are clinicians in the fields of dermatology and proctology, as well as all other specialties involved in the management of patients with perianal dermatitis, both in hospital and office-based settings.
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Affiliation(s)
- Gerhard Weyandt
- Department of Dermatology and Allergology, Klinikum Bayreuth, Bayreuth, Germany
| | | | - Ricardo Niklas Werner
- Department of Dermatology, Venereology und Allergology, Division of Evidence-based Medicine (dEBM), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Miriam Zidane
- Department of Dermatology, Venereology und Allergology, Division of Evidence-based Medicine (dEBM), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alex Furtwängler
- Praxisklinik 2000, Proktologische Praxis Freiburg, Freiburg im Breisgau, Germany
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Scientific and Clinical Abstracts From WOCNext 2020 Reimagined. J Wound Ostomy Continence Nurs 2020. [DOI: 10.1097/won.0000000000000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Takahashi H, Oyama N, Amamoto M, Torii T, Matsuo T, Hasegawa M. Prospective trial for the clinical efficacy of anogenital skin care with miconazole nitrate-containing soap for diaper candidiasis. J Dermatol 2020; 47:385-389. [PMID: 32030818 DOI: 10.1111/1346-8138.15257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 01/09/2020] [Indexed: 12/28/2022]
Abstract
Anogenital skin care for the elderly remains an umbrella term concerning protective and non-interventional regimens, particularly for ordinary diaper users. Our recent investigation has demonstrated the preventive effect of daily anogenital washing with miconazole nitrate-containing soap to the development of diaper candidiasis. We extended this work to cover our hypothesis as to whether the miconazole soap has a therapeutic benefit in genital candidiasis. The study outline includes: (i) the enrollment of 21 bedridden inpatients (84 ± 9 years; eight men and 13 women) who were diagnosed clinically and mycologically with genital candidiasis, and who had never received topical and/or systemic antifungal agents; (ii) administration of anogenital washing with 0.75% miconazole-containing soap once daily for 4 weeks; and (iii) assessment of clinical symptoms and detection of Candida materials by culture and microscopic examination. As assessed by clinical symptom scoring for incontinence-associated dermatitis (IAD), the ratio of patients with severe to moderate symptoms dramatically decreased by 2 weeks and 10 of 21 patients became symptom-free at 4 weeks. The IAD clinical severity score was significantly decreased at 4 weeks. Compared with the baseline positivity, both microscopic and cultured Candida-positive rates were significantly decreased at 4 weeks after washing. All culture-detected fungi were Candida albicans. Severe adverse events did not occur in all participants. Individual medical and risk factors had no significant correlation with clinical severity and duration of candidiasis on variance analysis. In conclusion, topical washing with miconazole soap is a safe and reliable non-medical approach for soothing diaper-associated genital candidiasis in bedridden inpatients in whom it is difficult to perform prompt medical examination.
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Affiliation(s)
- Hidenori Takahashi
- Department of Dermatology, Division of Medicine, Faculty of Medical Sciences, University of Fukui Hospital, Fukui, Japan.,Department of Dermatology, JCHO Fukui Katsuyama General Hospital, Fukui, Japan
| | - Noritaka Oyama
- Department of Dermatology, Division of Medicine, Faculty of Medical Sciences, University of Fukui Hospital, Fukui, Japan
| | - Masaya Amamoto
- Dermatology Clinical Examination, JCHO Fukui Katsuyama General Hospital, Fukui, Japan
| | - Tomoko Torii
- Dermatology Clinical Examination, JCHO Fukui Katsuyama General Hospital, Fukui, Japan
| | - Tomoko Matsuo
- Dermatology Clinical Examination, JCHO Fukui Katsuyama General Hospital, Fukui, Japan
| | - Minoru Hasegawa
- Department of Dermatology, Division of Medicine, Faculty of Medical Sciences, University of Fukui Hospital, Fukui, Japan
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Kottner J, Everink I, van Haastregt J, Blume-Peytavi U, Schols J. Prevalence of intertrigo and associated factors: A secondary data analysis of four annual multicentre prevalence studies in the Netherlands. Int J Nurs Stud 2020; 104:103437. [DOI: 10.1016/j.ijnurstu.2019.103437] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 08/12/2019] [Accepted: 09/21/2019] [Indexed: 01/25/2023]
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A Survey of Turkish Nurses' Knowledge of Incontinence-Associated Dermatitis. J Wound Ostomy Continence Nurs 2020; 46:434-440. [PMID: 31513132 DOI: 10.1097/won.0000000000000567] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to determine the knowledge of incontinence-associated dermatitis (IAD) among nurses working in intensive care units. DESIGN Descriptive study. SUBJECTS AND SETTING The study was conducted in 6 intensive care units of a 550-bed academic research hospital in Turkey. Licensed practical and registered nurses with a minimum of a Bachelor of Science in Nursing degree employed full-time on these units were invited to participate. METHODS The survey consisted of statements that examined the demographic characteristics (14 questions) and knowledge levels (59 statements) of the nurses. For each statement, nurses were required to mark only one of the following options: "correct," "incorrect," or "no knowledge." Data were collected from July to September 2016. The Shapiro-Wilk test, Mann-Whitney U test, Kruskal-Wallis H test, post hoc multiple comparison test, and Spearman's correlation coefficient were used to analyze the data. RESULTS Of the 126 RNs who participated in the study, 46.83% (n = 59) had an undergraduate degree in nursing. The majority (29.37%) practiced in gastroenterology surgery and urology intensive care units. The mean knowledge score was 33.05 ± 10.16 (min = 0, max = 59). The most correctly answered statement (94.44%; n = 119) was "The pH of the skin plays a role in skin barrier function." The statement with the most incorrect or "no knowledge" answers (96.03%; n = 120) was "The natural moisturizing factor found in the structure of corneocytes helps the skin to maintain its oil levels." Based on correctly answered statements, we found knowledge levels of the prevention and treatment of IAD were higher among nurses with a master of science degree in nursing (40.67 ± 4.32) and lower among licensed practical nursing (29.12 ± 10.08) (P < .05). CONCLUSION In this study, knowledge of the nurses on identification, prevention, and treatment of IAD was low. Comprehensive basic nursing education and in-service training programs on IAD are recommended.
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Emilia NL, Yusuf S, Astrada A. The prevalence of pressure injury in patients with incontinence: Literature review. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2019.07.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Affiliation(s)
- Kathleen Francis
- Kathleen Francis is NP coordinator of the Wound Ostomy Continence Specialist team at Maimonides Medical Center in Brooklyn, N.Y
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Kottner J, Kolbig N, Bültemann A, Dissemond J. Inkontinenzassoziierte Dermatitis: ein Positionspapier. Hautarzt 2019; 71:46-52. [DOI: 10.1007/s00105-019-04480-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Role of the Wound, Ostomy and Continence Nurse in Continence Care: 2018 Update. J Wound Ostomy Continence Nurs 2019; 46:221-225. [PMID: 31083065 DOI: 10.1097/won.0000000000000529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The Wound, Ostomy and Continence Nurses Society believes the tri-specialty certified nurse (Certified Wound Ostomy Continence Nurse [CWOCN]) or advanced practice tri-specialty certified nurse (Certified Wound Ostomy Continence Nurse-Advanced Practice [CWOCN-AP]) possesses unique knowledge, expertise for assessment, and first-line management of incontinence as well as for prevention of incontinence. The CWOCN or CWOCN-AP provides care and consultation in the treatment of potential and actual skin complications through absorption, and containment, in persons with urinary, fecal, or dual incontinence. This executive summary describes the role of the CWOCN or CWOCN-AP in the delivery of continence care across care settings. The original statement is available at https://cdn.ymaws.com/www.wocn.org/resource/collection/6D79B935-1AA0-4791-886F-E361D29F152D/Role_of_Continence_Nurse__2018_.pdf.
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Gabriel S, Hahnel E, Blume-Peytavi U, Kottner J. Prevalence and associated factors of intertrigo in aged nursing home residents: a multi-center cross-sectional prevalence study. BMC Geriatr 2019; 19:105. [PMID: 30987588 PMCID: PMC6466768 DOI: 10.1186/s12877-019-1100-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/06/2019] [Indexed: 11/26/2022] Open
Abstract
Background In geriatric and long-term care settings, intertrigo seems to be common, but generalizable epidemiological estimates are lacking. Aim of this study was to measure the prevalence of intertrigo in aged nursing home residents and to identify possible relationships with demographic and health characteristics. Methods A cross-sectional prevalence study was conducted between September 2014 and May 2015 in a random sample of ten institutional long-term care facilities in Berlin, Germany. In total 223, aged long-term care residents were included. Mean age was 83.6 (SD 8.0) years and mean Barthel score was 45.1 (SD 23.8). Board certified dermatologists and study assistants performed skin assessments and measurements according to standard operating procedures. Mean differences and odds ratios between residents with and without intertrigo were calculated. Results The prevalence of intertrigo was 16.1% (95% CI 11.6 to 21.2%). The submammary fold was most often affected (9.9%), followed by the inguinal region (9.4%), axilla (0.5%) and abdominal region (0.5%). Increased age was statistically significantly associated with the presence of intertrigo (OR 1.05; 95% CI 1.00 to 1.10). Care dependency in bathing activities was associated with intertrigo. Obesity, sex and skin functional parameters were not associated with intertrigo. Conclusions Every sixth nursing home resident was affected by intertrigo indicating the high load of this skin condition in this population. Older age seems to be associated with intertrigo. Care dependency in bathing activities was likely to be associated with intertrigo. Structured skin care regimens are needed to prevent and treat intertrigo in this population. Trial registration This study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526. Registration date: 8th November 2014.
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Affiliation(s)
- Sabrina Gabriel
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Elisabeth Hahnel
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Blume-Peytavi
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Kottner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
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Prevention and Management of Incontinence-Associated Dermatitis in the Pediatric Population: An Integrative Review. J Wound Ostomy Continence Nurs 2019; 46:30-37. [PMID: 30608338 DOI: 10.1097/won.0000000000000490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An integrative review was conducted to synthesize evidence on prevention and management of incontinence-associated dermatitis (IAD) in the pediatric population. A 5-step integrative process was used to guide the review. Articles published from January 2000 to April 6, 2017, were identified and retrieved from CINAHL, PubMed, ProQuest (MEDLINE), and Scopus; key terms were associated with IAD, pediatric, prevention, and management. Supplemental and manual searches were carried out to identify other relevant studies. The studies' findings were extracted and summarized in a table of evidence, with their quality evaluated using the Joanna Briggs Institute's Critical Appraisal Checklist. Sixteen articles were included in the review. Articles explored prevention and management strategies including skin cleansing technique, diaper selection, and the application of topical skin care products. Inconsistent and limited evidence was found regarding the benefits of using disposable wipes in preference to water-moistened washcloths in the cleansing process and on the use of superabsorbent polymer diapers with breathable outer lining in IAD prevention. Findings were inconclusive with regard to the best topical skin care product for IAD care. However, the application of skin protectants was encouraged by the authors, as well as promoted in various clinical guidelines. The development of a structured skin care regimen supplemented by a comprehensive patient education program was advised to enhance the prevention and management of IAD.
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Meehan AJ, Maher AB, Brent L, Copanitsanou P, Cross J, Kimber C, MacDonald V, Marques A, Peng L, Queirós C, Roigk P, Sheehan KJ, Skúladóttir SS, Hommel A. The International Collaboration of Orthopaedic Nursing (ICON): Best practice nursing care standards for older adults with fragility hip fracture. Int J Orthop Trauma Nurs 2019; 32:3-26. [DOI: 10.1016/j.ijotn.2018.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Writers AM. Follow gentle cleansing practices to minimize the development of incontinence-associated dermatitis in the elderly. DRUGS & THERAPY PERSPECTIVES 2018. [DOI: 10.1007/s40267-018-0553-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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McNichol LL, Ayello EA, Phearman LA, Pezzella PA, Culver EA. Incontinence-Associated Dermatitis: State of the Science and Knowledge Translation. Adv Skin Wound Care 2018; 31:502-513. [DOI: 10.1097/01.asw.0000546234.12260.61] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
BACKGROUND: Protecting the skin against moisture-associated damage is an important component of comprehensive skin and wound care. Based on a review of literature, the authors propose key interventions to protect and prevent damage in the skin folds, perineum, and areas surrounding a wound or stoma. OBJECTIVE: The aim of this scoping review is to identify and provide a narrative integration of the existing evidence related to the management and prevention of moisture-associated skin damage (MASD). METHODS: Study authors searched several databases for a broad spectrum of published and unpublished studies in English, published between 2000 and July 2015. Selected study information was collated in several different formats; ultimately, key findings were aggregated into a thematic description of the evidence to help generate a set of summative statements or recommendations. RESULTS: Based on inclusion criteria, 37 articles were considered appropriate for this review. Findings included functional definitions and prevalence rates of the 4 types of MASD, assessment scales for each, and 7 evidence-based strategies for the management of MASD. CONCLUSIONS: Based on this scoping review of literature, the authors propose key interventions to protect and prevent MASD including the use of barrier ointments, liquid polymers, and cyanoacrylates to create a protective layer that simultaneously maintains hydration levels while blocking external moisture and irritants.
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Evaluation of Validity and Reliability of a Revised Incontinence-Associated Skin Damage Severity Instrument (IASD.D.2) by 3 Groups of Nursing Staff. J Wound Ostomy Continence Nurs 2018; 45:449-455. [DOI: 10.1097/won.0000000000000466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Incontinence, Incontinence-Associated Dermatitis, and Pressure Injuries in a Health District in Australia. J Wound Ostomy Continence Nurs 2018; 45:349-355. [DOI: 10.1097/won.0000000000000446] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- Melaine Lumbers
- Freelance Tissue Viability Nurse and Health Visitor, Bedford
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41
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Affiliation(s)
- Kathleen Francis
- Kathleen Francis is NP coordinator of the Wound Ostomy Continence Specialist team at Maimonides Medical Center in Brooklyn, N.Y
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42
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Wilson M. Incontinence-associated dermatitis from a urinary incontinence perspective. ACTA ACUST UNITED AC 2018; 27:S4-S17. [DOI: 10.12968/bjon.2018.27.9.s4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Mary Wilson
- Retired Nurse Practitioner for Bladder and Bowel Health, Humber NHS Foundation Trust
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Beeckman D, Van den Bussche K, Alves P, Arnold Long MC, Beele H, Ciprandi G, Coyer F, de Groot T, De Meyer D, Deschepper E, Dunk AM, Fourie A, García-Molina P, Gray M, Iblasi A, Jelnes R, Johansen E, Karadağ A, Leblanc K, Kis Dadara Z, Meaume S, Pokorna A, Romanelli M, Ruppert S, Schoonhoven L, Smet S, Smith C, Steininger A, Stockmayr M, Van Damme N, Voegeli D, Van Hecke A, Verhaeghe S, Woo K, Kottner J. Towards an international language for incontinence-associated dermatitis (IAD): design and evaluation of psychometric properties of the Ghent Global IAD Categorization Tool (GLOBIAD) in 30 countries. Br J Dermatol 2018; 178:1331-1340. [PMID: 29315488 DOI: 10.1111/bjd.16327] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Incontinence-associated dermatitis (IAD) is a specific type of irritant contact dermatitis with different severity levels. An internationally accepted instrument to assess the severity of IAD in adults, with established diagnostic accuracy, agreement and reliability, is needed to support clinical practice and research. OBJECTIVES To design the Ghent Global IAD Categorization Tool (GLOBIAD) and evaluate its psychometric properties. METHODS The design was based on expert consultation using a three-round Delphi procedure with 34 experts from 13 countries. The instrument was tested using IAD photographs, which reflected different severity levels, in a sample of 823 healthcare professionals from 30 countries. Measures for diagnostic accuracy (sensitivity and specificity), agreement, interrater reliability (multirater Fleiss kappa) and intrarater reliability (Cohen's kappa) were assessed. RESULTS The GLOBIAD consists of two categories based on the presence of persistent redness (category 1) and skin loss (category 2), both of which are subdivided based on the presence of clinical signs of infection. The agreement for differentiating between category 1 and category 2 was 0·86 [95% confidence interval (CI) 0·86-0·87], with a sensitivity of 90% and a specificity of 84%. The overall agreement was 0·55 (95% CI 0·55-0·56). The Fleiss kappa for differentiating between category 1 and category 2 was 0·65 (95% CI 0·65-0·65). The overall Fleiss kappa was 0·41 (95% CI 0·41-0·41). The Cohen's kappa for differentiating between category 1 and category 2 was 0·76 (95% CI 0·75-0·77). The overall Cohen's kappa was 0·61 (95% CI 0·59-0·62). CONCLUSIONS The development of the GLOBIAD is a major step towards a better systematic assessment of IAD in clinical practice and research worldwide. However, further validation is needed.
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Affiliation(s)
- D Beeckman
- University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, Ghent, Belgium.,School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - K Van den Bussche
- University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, Ghent, Belgium
| | - P Alves
- Centre for Interdisciplinary Research in Health, Institute of Health Sciences, Catholic University of Portugal, Oporto, Portugal
| | - M C Arnold Long
- Department of Nursing, Roper Hospital, Charleston, SC, U.S.A
| | - H Beele
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - G Ciprandi
- Department of Pediatric Surgery, Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - F Coyer
- Intensive Care Services, Royal Brisbane and Women's Hospital and School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - T de Groot
- Wond Expertise Centrum, Lange Land Ziekenhuis, Zoetermeer, the Netherlands
| | - D De Meyer
- University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, Ghent, Belgium
| | - E Deschepper
- University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, Ghent, Belgium
| | - A M Dunk
- Tissue Viability Unit, Canberra Hospital, ACT Health, Canberra, Australia
| | - A Fourie
- Scientific Affairs & Education Manager, 3M (Critical and Chronic Care Solutions), Johannesburg, South Africa
| | - P García-Molina
- Department of Nursing, University of Valencia, Valencia, Spain
| | - M Gray
- Department of Urology, University of Virginia, Charlottesville, VA, U.S.A
| | - A Iblasi
- Wound Care, King Saud Medical City (KSMC), Riyadh, Saudi Arabia
| | - R Jelnes
- Wound Clinic, Sygehus Sonderjylland, Sonderborg, Denmark
| | - E Johansen
- University College of Southeast Norway, Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, Drammen, Norway
| | - A Karadağ
- School of Nursing, Koc University, Istanbul, Turkey
| | - K Leblanc
- School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Z Kis Dadara
- Development of Care, Barmherzige Brüder Austria, Vienna, Austria
| | - S Meaume
- Geriatric and Wound Healing Department, APHP, Hôpital Rothschild, Paris, France
| | - A Pokorna
- Department of Nursing, Masaryk University, Faculty of Medicine, Brno, Czech Republic
| | - M Romanelli
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - S Ruppert
- Department of Medicine II, Vienna General Hospital, Vienna, Austria
| | - L Schoonhoven
- Faculty of Health Sciences, University of Southampton, Southampton, U.K.,National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC Wessex), University of Southampton, Southampton, U.K.,Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, the Netherlands
| | - S Smet
- Wound Care Center, Ghent University Hospital, Ghent, Belgium
| | - C Smith
- Wound Ostomy Clinic, Marion General Hospital, Marion, IN, U.S.A
| | - A Steininger
- Private Universität für Medizinische Informatik und Technik (UMIT) und Pflegeakademie der Barmherzigen Brüder Wien Pflegewissenschaft und Gerontologie, Vienna, Austria
| | - M Stockmayr
- Department of Surgery, Vienna General Hospital, Vienna, Austria
| | - N Van Damme
- University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, Ghent, Belgium
| | - D Voegeli
- Faculty of Health Sciences, University of Southampton, Southampton, U.K
| | - A Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, Ghent, Belgium
| | - S Verhaeghe
- University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, Ghent, Belgium
| | - K Woo
- Department of Nursing, Queen's University, Kingston, Canada
| | - J Kottner
- University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, Ghent, Belgium.,Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité-Universtitätsmedizin Berlin, Berlin, Germany
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Bitencourt GR, Alves LDAF, Santana RF. Practice of use of diapers in hospitalized adults and elderly: cross-sectional study. Rev Bras Enferm 2018; 71:343-349. [DOI: 10.1590/0034-7167-2016-0341] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 02/05/2017] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: analyze the practice of use of diapers in adults and elderly in hospital. Method: observational cross-sectional study, with a sample of 105 participants assigned according to the data collection period, from September 2013 to January 2014, in the surgical clinic wards in a University Hospital. Results: it was observed that 38% of the 105 participants of the study did not need the use of diapers. 18% used it because they were disabled and 16% had their cognitive system damaged. As they were hospitalized, it was identified that 51.4% of patients were there ranging from 02 to 10 days, and 60% used diapers for the same period. It is also identified that long term urinary catheter (24.8%), as technology associated to diapers in the urinary control and to pressure ulcers (12.4%), being the main complication. Conclusion: the use of diapers did not have specific criteria to be selected. For this, it was proposed an "Evaluation Scale of Diapers Use in Adults", as for indication as for its monitoring to help the study transposal for the nursing practice.
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Abstract
PURPOSE To provide information from a literature review about the prevention, recognition, and treatment for contact dermatitis. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES After participating in this educational activity, the participant should be better able to:1. Identify signs and symptoms of and diagnostic measures for contact dermatitis.2. Identify causes and risks for contact dermatitis.3. Select appropriate treatment for contact dermatitis and its prevention. ABSTRACT Contact dermatitis to wound care products is a common, often neglected problem. A review was conducted to identify articles relevant to contact dermatitis.A PubMed English-language literature review was conducted for appropriate articles published between January 2000 and December 2015.Contact dermatitis is both irritant (80% of cases) or allergic (20% of cases). Frequent use of potential contact allergens and impaired barrier function of the skin can lead to rising sensitization in patients with chronic wounds. Common known allergens to avoid in wound care patients include fragrances, colophony, lanolin, and topical antibiotics.Clinicians should be cognizant of the allergens in wound care products and the potential for sensitization. All medical devices, including wound dressings, adhesives, and bandages, should be labeled with their complete ingredients, and manufacturers should be encouraged to remove common allergens from wound care products, including topical creams, ointments, and dressings.
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Coyer F, Campbell J. Incontinence-associated dermatitis in the critically ill patient: an intensive care perspective. Nurs Crit Care 2017; 23:198-206. [PMID: 29266568 DOI: 10.1111/nicc.12331] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/29/2017] [Accepted: 11/14/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Incontinence-associated dermatitis is a skin disorder evident as a complication of incontinence. It is characterized by perineal, buttock and groin erythema and skin breakdown. Incontinence-associated dermatitis is a ubiquitous, nosocomial condition commonly present in critically ill patients in the intensive care unit. Critically ill patients, by the nature of their critical illness and therapies used to treat their presenting condition, are commonly predisposed to faecal incontinence and are consequently at high risk of developing incontinence-associated dermatitis. However, this condition is under-explored and under-reported in the intensive care literature. OBJECTIVE The aim of this paper is to provide a review of the literature relating to incontinence-associated dermatitis from the critically ill patients in the intensive care setting. DISCUSSION There is a paucity of literature addressing this condition in the intensive care context, with only 11 studies identified. This paper will provide an overview of the definitions, prevalence and incidence of incontinence-associated dermatitis. Furthermore, an exposition of incontinence-associated dermatitis from the critically ill patient and intensive care nursing perspectives will be presented through a review of the skin barrier function, clinical presentation, risk factors, clinical assessment and severity categorization, prevention and management of incontinence-associated dermatitis. CONCLUSION It is imperative that critical care nurses have an appreciation of incontinence-associated dermatitis as a common, yet preventable condition, and are equipped with knowledge to appropriately prevent and manage this common complication.
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Affiliation(s)
- Fiona Coyer
- School of Nursing, Queensland University of Technology and Intensive Care Services, Royal Brisbane and Women's Hospital, Metro North Hospital Health Service, Herston, Queensland 4006, Australia.,Visiting Professor, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
| | - Jill Campbell
- Skin Integrity Services, Royal Brisbane and Women's Hospital, Metro North Hospital Health Service, Herston, Queensland 4006, Australia
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Beele H, Smet S, Van Damme N, Beeckman D. Incontinence-Associated Dermatitis: Pathogenesis, Contributing Factors, Prevention and Management Options. Drugs Aging 2017; 35:1-10. [DOI: 10.1007/s40266-017-0507-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Voegeli D. Prevention and management of incontinence-associated dermatitis. ACTA ACUST UNITED AC 2017; 26:1128-1132. [DOI: 10.12968/bjon.2017.26.20.1128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David Voegeli
- Associate Professor of Nursing, Skin Health Research Group, Faculty of Health Sciences, University of Southampton
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Clinical Evaluation of a Skin Protectant for the Management of Incontinence-Associated Dermatitis: An Open-Label, Nonrandomized, Prospective Study. J Wound Ostomy Continence Nurs 2017; 44:172-180. [PMID: 28267125 PMCID: PMC5344181 DOI: 10.1097/won.0000000000000307] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE: The purpose of this study was to evaluate the efficacy of an investigational skin protectant product at managing severe skin breakdown associated with incontinence. DESIGN: Open-label, nonrandomized, prospective study. SUBJECTS AND SETTING: The sample comprised 16 patients; inclusion criteria were: patients older than 18 years, cared for in the intensive care unit of a level I trauma center hospital or in long-term care facilities in the northeast region of the United States, and had incontinence-associated dermatitis (IAD). Twelve of the patients had epidermal skin loss and 4 had severe redness. METHODS: The investigational product is a formulation based on acrylate chemistry. The skin protectant application schedule was twice weekly for up to 3 weeks for a maximum of 6 applications during the study period. The skin was evaluated via a skin assessment instrument specifically designed for use in this study; this instrument has not undergone validation studies. The main outcome measure was changes in the instrument score over time. In addition, complete reepithelialization was recorded when observed, and pain scores (associated with IAD) were noted in participants who were able to report pain. RESULTS: The IAD score improved in 13 of 16 patients, remained unchanged in 1 patient, and deteriorated in 2 patients. The median percent improvement in the skin assessment instrument was 96% (P = .013). Four of the patients with epidermal skin loss had complete reepithelialization of the skin surface with 4 to 6 applications of the skin protectant, and 5 had substantial improvement. The 4 patients with severe red skin returned to healthy normal skin with 2 to 4 skin protectant applications. Substantial pain reduction was reported by all 9 patients who reported pain at enrollment. No adverse events associated with the skin protectant application were reported during data collection. CONCLUSION: Results of this study suggest that an acrylate-based product, evaluated here for the first time in patients, may be effective as a protective barrier in the presence of continued incontinence. Additional research is needed to confirm these findings.
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Bliss DZ, Mathiason MA, Gurvich O, Savik K, Eberly LE, Fisher J, Wiltzen KR, Akermark H, Hildebrandt A, Jacobson M, Funk T, Beckman A, Larson R. Incidence and Predictors of Incontinence-Associated Skin Damage in Nursing Home Residents With New-Onset Incontinence. J Wound Ostomy Continence Nurs 2017; 44:165-171. [PMID: 28267124 DOI: 10.1097/won.0000000000000313] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to determine the incidence and predictors of incontinence-associated dermatitis (IAD) in nursing home residents. METHODS Records of a cohort of 10,713 elderly (≥65 years) newly incontinent nursing home residents in 448 nursing homes in 28 states free of IAD were followed up for IAD development. Potential multilevel predictors of IAD were identified in 4 national datasets containing information about the characteristics of individual nursing home residents, nursing home care environment, and communities in which the nursing homes were located. A unique set of health practitioner orders provided information about IAD and the predictors of IAD prevention and pressure injuries in the extended perineal area. Analysis was based on hierarchical logistical regression. RESULTS The incidence of IAD was 5.5%. Significant predictors of IAD were not receiving preventive interventions for IAD, presence of a perineal pressure injury, having greater functional limitations in activities of daily living, more perfusion problems, and lesser cognitive deficits. CONCLUSION Findings highlight the importance of prevention of IAD and treatment/prevention of pressure injuries. A WOC nurse offers expertise in these interventions and can educate staff about IAD predictors, which can improve resident outcomes. Other recommendations include implementing plans of care to improve functional status, treat perfusion problems, and provide assistance with incontinence and skin care to residents with milder as well as greater cognitive deficits.
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Affiliation(s)
- Donna Z Bliss
- Donna Z. Bliss, PhD, RN, FAAN, FGSA, University of Minnesota School of Nursing, Minneapolis, Minnesota. Michelle A. Mathiason, MS, University of Minnesota School of Nursing, Minneapolis, Minnesota. Olga Gurvich, MS, University of Minnesota School of Nursing, Minneapolis, Minnesota. Kay Savik, MS, University of Minnesota School of Nursing, Minneapolis, Minnesota. Lynn E. Eberly, PhD, School of Public Health Division of Biostatistics, Minneapolis, Minnesota. Jessica Fisher, BSN, RN, University of Minnesota School of Nursing, Minneapolis, Minnesota. Kjerstie R. Wiltzen, BSN, BA, RN, University of Minnesota School of Nursing, Minneapolis, Minnesota. Haley Akermark, BSN, RN, University of Minnesota School of Nursing, Minneapolis, Minnesota. Amanda Hildebrandt, BA, University of Minnesota School of Nursing, Minneapolis, Minnesota. Megan Jacobson, BSN, RN, University of Minnesota School of Nursing, Minneapolis, Minnesota. Taylor Funk, BSN, RN, University of Minnesota School of Nursing, Minneapolis, Minnesota. Amanda Beckman, BSN, RN, University of Minnesota School of Nursing, Minneapolis, Minnesota. Reed Larson, BSN, RN, University of Minnesota School of Nursing, Minneapolis, Minnesota
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