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Deprez J, Ohde N, Eilegård Wallin A, Bååth C, Hommel A, Hultin L, Josefson A, Kottner J, Beeckman D. Prognostic factors for the development of incontinence-associated dermatitis (IAD): A systematic review. Int Wound J 2024; 21:e14962. [PMID: 39016196 PMCID: PMC11253026 DOI: 10.1111/iwj.14962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/18/2024] Open
Abstract
Incontinence-associated dermatitis (IAD) is an irritant contact dermatitis from prolonged contact with urine or faeces, which can significantly impact patient comfort and quality of life. The identification of prognostic factors for the development of IAD has the potential to enhance management, support preventive measures and guide future research. The objective of this systematic review was to summarize the empirical evidence of prognostic factors for the development of IAD. This study included prospective and retrospective observational studies or clinical trials that described prognostic factors associated with IAD. There were no restrictions on setting, time, language, participants or geographical regions. Exclusion criteria included reviews, editorials, commentaries, methodological articles, letters to the editor, cross-sectional and case-control studies, and case reports. Searches were conducted from inception to April 2024 on MEDLINE, CINAHL, EMBASE and the Cochrane Library. The studies were assessed by two independent reviewers using the QUIPS and the CHARMS-PF for data extraction. A narrative synthesis approach was employed due to study heterogeneity and using the 'vote counting based on direction' method and the sign test. The overall certainty of evidence was assessed using adapted GRADE criteria. The review included 12 studies and identified 15 potential predictors. Moderate-quality evidence suggests that increased stool frequency, limited mobility and friction/shear problems are risk factors for IAD development. Female sex, older age, vasopressor use and loose/liquid stool are risk factors supported by low-quality evidence. Increased stool frequency, limited mobility and friction/shear problems seem to be risk factors for the development of IAD. There is insufficient evidence to support the predictive validity of female sex, older age, loose/liquid stool and vasopressor use. There is substantial methodological variability across studies, making it challenging to make comparisons. Large-scale cohort studies in different settings that incorporate our review findings should be conducted in the future.
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Affiliation(s)
- Julie Deprez
- Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
| | - Nils Ohde
- Institute of Clinical Nursing ScienceCharité UniversitätsmedizinBerlinGermany
| | - Alexandra Eilegård Wallin
- Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Carina Bååth
- Department of Health SciencesFaculty of Health, Science and Technology, Karlstad UniversityKarlstadSweden
- Faculty of Health, Welfare and OrganisationØstfold University CollegeHaldenNorway
| | - Ami Hommel
- Department of Care ScienceMalmö UniversityMalmöSweden
| | - Lisa Hultin
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
| | - Anna Josefson
- School of Medical Sciences, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
- Department of DermatologyÖrebro University HospitalÖrebroSweden
| | - Jan Kottner
- Institute of Clinical Nursing ScienceCharité UniversitätsmedizinBerlinGermany
| | - Dimitri Beeckman
- Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
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Fan S, Jiang H, Shen J, Lin H, Yang L, Yu D, Chen L. Risk factors of incontinence-associated dermatitis in older adults: a protocol for systematic review and meta-analysis. BMJ Open 2023; 13:e078375. [PMID: 38135331 DOI: 10.1136/bmjopen-2023-078375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Due to their ageing skin, older adults are more likely to develop incontinence-associated dermatitis (IAD). Although previous attempts to look at the risk factors for IAD in older adults were done, methodological barriers hindered an in-depth understanding. By investigating risk factors for IAD in the ageing population, the development of precise clinical interventions and guidance could be facilitated, which in turn would enhance patient care standards for incontinence management in this target group. To address this knowledge gap, this systematic review with meta-analysis aims to explore the major risk elements linked to IAD among older adults. METHODS AND ANALYSIS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols are adhered to in this systematic review and meta-analysis. To achieve its objectives, a comprehensive search strategy PubMed, Embase, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Medline, Chinese Scientific Journal Database (VIP database), WanFang Data Knowledge Service Platform, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, along with other relevant sources published until 18 July 2023 in both English and Chinese languages will be performed. The screening of articles, data abstraction and risk of bias evaluation will be done by two impartial reviewers. RevMan V.5.3 software will be used for data synthesis. The quality of the included study will be assessed using the Newcastle-Ottawa Quality Assessment tool and the Agency for Healthcare Research and Quality. The I 2 test will identify the heterogeneity. ETHICS AND DISSEMINATION There is no need for ethical approval. Individual patient information or the rights of participants will not be compromised by this protocol. The findings will either be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42023442585.
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Affiliation(s)
- Siyue Fan
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Hongzhan Jiang
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jiali Shen
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Huihui Lin
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Liping Yang
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Doudou Yu
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Lijuan Chen
- Department of General Surgery, Zhongshan Hospital Xiamen University, Xiamen, China
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Sanaeifar N, Limam D, Zettl S, Vechter O, Porsch S, Kesselmeier R. Nurses' perspectives and preferences on MoliCare Premium Elastic products for incontinence management. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:1078-1085. [PMID: 38060398 DOI: 10.12968/bjon.2023.32.22.1078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND With the wide range of absorbent incontinence products available, it is crucial to select the most suitable product for individuals with incontinence, ensuring that their expectations are met and their quality of life is not compromised. AIM This study aimed to assess the key features of the newly introduced MoliCare Premium Elastic product by nurses working with residents with incontinence in nursing homes and compare the product characteristics with those of the previous design. METHODS Forty-three nurses from five nursing homes in Germany were asked to complete a questionnaire focusing on key product performance aspects to elicit their views on the use of MoliCare Premium Elastic products. FINDINGS All performance features of the new product design received positive ratings from most nurses: 84% considered the overall acceptance of the new design as 'Good', and 52% preferred the new MoliCare Premium Elastic. CONCLUSIONS The new MoliCare SkinGuard absorbent core technology performed well on each performance characteristic, demonstrating the high quality of the product and its ability to meet the needs of people with incontinence.
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Affiliation(s)
- Niuosha Sanaeifar
- Manager, Clinical Application Studies, Paul Hartmann AG, Heidenheim, Germany
| | - Deniz Limam
- Global Senior Manager, Product Marketing, Paul Hartmann AG, Heidenheim, Germany
| | - Simone Zettl
- Global Manager, Product Marketing, Paul Hartmann AG, Heidenheim, Germany
| | - Olga Vechter
- Global Senior Manager, Product Development, Paul Hartmann AG, Heidenheim, Germany
| | - Simon Porsch
- Global Manager, Product Development, Paul Hartmann AG, Heidenheim, Germany
| | - Rüdiger Kesselmeier
- Global Vice President, Product and Solution Innovations, Paul Hartmann AG, Heidenheim, Germany
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Yüceler Kaçmaz H, Kaplan Ö, Kaplan A, Şahin MG, Cetinkaya A, Avci A. Incontinence-Associated Dermatitis: Prevalence in Intensive Care Units and Knowledge, Attitudes, and Practices of Nurses. J Nurs Care Qual 2023; 38:354-360. [PMID: 36947830 DOI: 10.1097/ncq.0000000000000707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND Incontinence-associated dermatitis (IAD) is a major concern among hospitals, especially in intensive care units (ICUs). PURPOSE To describe ICU nurses' knowledge, attitudes, and practices of IAD and to examine the relationships with IAD prevalence in the ICU setting. METHODS A descriptive correlational design was used including the Knowledge, Attitudes and Practices of Incontinence-Associated Dermatitis Questionnaire and 1-month IAD prevalence data. RESULTS The prevalence of IAD in ICUs was 6.89%. A positive correlation was found between IAD prevalence and nurses' IAD knowledge and attitudes. Nurses working in the ICU for more than 7 years, caring for patients at high risk for or having IAD, and thinking IAD-related nursing practices were sufficient had significantly higher IAD knowledge, attitudes, and practices. CONCLUSIONS Findings indicate that ICU nurses learned about IAD through clinical experience and have inadequate training on IAD. A standardized evidence-based care protocol for IAD should be developed.
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Affiliation(s)
- Hatice Yüceler Kaçmaz
- Department of Nursing, Health Science Faculty, Erciyes University, Kayseri, Turkey (Drs Yüceler Kaçmaz and Özlem Kaplan); First and Emergency Aid Program, İncesu Ayşe and Saffet Arslan Health Services Vocational School, University of Kayseri, Kayseri, Turkey (Dr Ali Kaplan); Department of Women's Health Nursing, Erciyes University, Kayseri, Turkey (Ms Şahin); Ministry of Health, Kayseri City Hospital, Kayseri, Turkey (Ms Şahin); and Departments of Internal Medicine (Mr Cetinkaya) and Dermatology (Mr Avci), Health Science University Kayseri City Hospital, Kayseri, Turkey
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Guerrero JG, Mohammed H, Pingue-Raguini M, Cordero RP, Aljarrah I. A Multicenter Assessment of Nurses' Knowledge Regarding Pressure Ulcer Prevention in Intensive Care Units Utilizing the PUKAT 2.0. SAGE Open Nurs 2023; 9:23779608231177790. [PMID: 37273548 PMCID: PMC10233595 DOI: 10.1177/23779608231177790] [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: 02/15/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 06/06/2023] Open
Abstract
Introduction Pressure ulcer (PU) care is pivotal in the practice of nurses working in intensive care units (ICUs). Therefore, nurses must possess adequate knowledge about the potential risks leading to the development of PUs, as well as managing complications that worsen patient conditions. Objective To evaluate the level of knowledge of ICU nurses concerning PU prevention in tertiary hospitals in Saudi Arabia. Methods In this cross-sectional study, the researchers recruited 320 ICU nurses from four tertiary hospitals using convenience sampling. Nurses' knowledge regarding PU prevention was assessed using the revised and updated version of the Pressure Ulcer Knowledge Assessment Tool (PUKAT) 2.0. Data were collected between May and June 2022. The CROSS checklist was observed for reporting. Results The mean scores of nurses' level of knowledge regarding PU prevention according to the themes of the revised and updated version of the PUKAT 2.0 were as follows-etiology: 62.81 ± 23.77; classification and observation: 50.86 ± 23.28; risk assessment: 31.19 ± 24.26; nutritious diet: 46.04 ± 25.96; prevention: 22.36 ± 12.41; and specific patient groups: 14.84 ± 22.88. Furthermore, the score for nurses' overall level of knowledge of PU prevention was 39.55 ± 8.84 out of 100, interpreted as low based on the 60% cutoff; the minimum knowledge score was 0. Notably, knowledge of PU etiology, classification, observation, and specific patient groups differed based on the hospital of affiliation. Interestingly, gender was the only demographic characteristic based on which nurses' knowledge regarding specific patient groups differed. Conclusion This study identified insufficient knowledge among ICU nurses regarding PU prevention, which can lead to complications among patients. Simulation scenarios related to PU prevention and management will be an effective way to help nurses gain appropriate knowledge that can be applied in clinical practice.
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Affiliation(s)
- Jefferson Garcia Guerrero
- Fakeeh College for Medical
Sciences, Abdul Wahab Naib Al Haram, Al-Hamra'a, Jeddah, Saudi
Arabia
- King Khalid University, College of
Nursing, Abha, Saudi Arabia
| | - Heba Mohammed
- Fakeeh College for Medical
Sciences, Abdul Wahab Naib Al Haram, Al-Hamra'a, Jeddah, Saudi
Arabia
- King Abdulaziz Hospital, Nursing
Department, Mecca, Saudi Arabia
| | - Minerva Pingue-Raguini
- Fakeeh College for Medical
Sciences, Abdul Wahab Naib Al Haram, Al-Hamra'a, Jeddah, Saudi
Arabia
| | | | - Imad Aljarrah
- Jadara University, College of Nursing,
Irbid, Jordan
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Jiang H, Shen J, Lin H, Xu Q, Li Y, Chen L. Risk factors of incontinence-associated dermatitis among critically ill patients: A systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1146697. [PMID: 37113614 PMCID: PMC10126239 DOI: 10.3389/fmed.2023.1146697] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
Objectives Incontinence-associated dermatitis (IAD) is increasingly found among critically ill patients, but the risk factors for IAD in these patients are currently unclear. The purpose of this meta-analysis was to identify the risk factors of IAD in critically ill patients. Methods Web of Science, PubMed, EMBASE, and Cochrane Library were systemically searched until July 2022. The studies were selected based on inclusion criteria, and data were independently extracted by two researchers. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. Odds ratios (ORs) and their associated 95% confidence intervals (CIs) were used to identify significant differences in the risk factors. The I 2 test was used to estimate the heterogeneity of studies, and Egger's test was used to assess the potential publication bias. Results A total of 7 studies enrolling 1,238 recipients were included in the meta-analysis. Age ≥ 60 (OR = 2.18, 95% CI: 1.38~3.42), female sex (OR = 1.76, 95% CI: 1.32~2.34), dialysis (OR = 2.67, 95% CI: 1.51~4.73), fever (OR = 1.55, 95% CI: 1.03~2.33), vasoactive agent (OR = 2.35, 95% CI: 1.45~3.80), PAT score ≥ 7 (OR = 5.23, 95% CI: 3.15~8.99), frequency of bowel movement > 3times/d (OR = 5.33, 95% CI: 3.19~8.93), and liquid stool (OR = 2.61, 95% CI: 1.56~4.38) were the risk factors of IAD among critically ill patients. Conclusions Many risk factors are related to IAD among critically ill patients. Nursing staff should pay more attention to evaluating the risk of IAD and enhance the care of high-risk groups.
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Affiliation(s)
- Hongzhan Jiang
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jiali Shen
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Huihui Lin
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Qiuqin Xu
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yuanchan Li
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Lijuan Chen
- Department of General Surgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen, China
- *Correspondence: Lijuan Chen
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Domingues BW, Souza TMPD, Wojastyk LDMC, Santos VLCDG, Nogueira PC. DERMATITE ASSOCIADA À INCONTINÊNCIA: PREVALÊNCIA E FATORES ASSOCIADOS EM UNIDADE DE TERAPIA INTENSIVA. ESTIMA 2022. [DOI: 10.30886/estima.v20.1281_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objetivo:Analisar a prevalência pontual de dermatite associada à incontinência (DAI) e os fatores associados em pacientes adultos internados em unidades de terapia intensiva (UTIs). Método: Estudo transversal, observacional, retrospectivo, realizado com 105 pacientes em UTI de três hospitais universitários localizados no estado de São Paulo. As variáveis demográficas, clínicas e de DAI foram coletadas do banco de dados do projeto de pesquisa “Prevalência de lesão por pressão em Unidade de Terapia Intensiva”, composto por informações extraídas dos prontuários e de exames físicos. Os dados foram analisados por meio de estatística descritiva e inferencial. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Instituição proponente. Resultados: Dos 105 pacientes, 58 (55,2%) eram do sexo masculino, com média de idade de 55,76 anos (desvio padrão = 16,4), 105 (91,3%) estavam com cateter urinário e 89,4% usavam fraldas. Dez pacientes apresentaram DAI, com prevalência pontual de 9,5%. O fator associado à DAI foi a admissão por trauma (p = 0,02). Conclusão: Estudos sobre DAI são fundamentais para uma assistência de enfermagem de qualidade, bem estruturada e fundamentada, sobretudo no cuidado aos pacientes críticos.
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Domingues BW, Souza TMPD, Wojastyk LDMC, Santos VLCDG, Nogueira PC. INCONTINENCE-ASSOCIATED DERMATITIS: PREVALENCE AND ASSOCIATED FACTORS IN INTENSIVE CARE UNIT. ESTIMA 2022. [DOI: 10.30886/estima.v20.1281_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To analyze the point prevalence of incontinence-associated dermatitis (IAD) and associated factors in adult patients admitted to Intensive Care Units (ICUs). Method: A cross-sectional, observational, retrospective study carried out with 105 patients in the ICU of three university hospitals located in the state of São Paulo. The demographic and clinical variables and IAD come from the database of the research project “Prevalence of pressure injuries in the Intensive Care Unit,” composed of information from medical records and physical examination. Data were analyzed using descriptive and inferential statistics. The study was approved by the Research Ethics Committee of the proposing institution. Results: Of the 105 patients, 58 (55.24%) were male, with a mean age of 55.76 years (SD = 16.39), 105 (91.3%) had a urinary catheter and 89.4% wore diapers. Ten patients had IAD, with a point prevalence of 9.52%. The factor associated with IAD was admission due to trauma (p = 0.02). Conclusion: Studies on IAD are essential for quality, well-structured and grounded nursing care, especially in the care of critically ill patients.
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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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Zhang Q, Li X, Zhang K, Lv L, Jin Y. Psychometric properties of the Chinese version of the knowledge, attitudes and practices of the incontinence‐associated dermatitis questionnaire (C‐KAP‐IAD‐Q) used with Chinese nurses. Int J Nurs Pract 2022:e13107. [DOI: 10.1111/ijn.13107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Qi Zhang
- School of Nursing Peking University Beijing China
| | - Xintong Li
- Faculty of Nursing Fenyang College of Shanxi Medical University Lvliang China
| | - Ke Zhang
- Faculty of Education Science and Technology Shanxi Datong University Datong China
| | - Lijun Lv
- Department of Nursing The Affiliated Hospital of Changzhi Chinese Medicine Research Institute Changzhi China
| | - Yi Jin
- Department of Nursing Tianjin Huanhu Hospital Tianjin China
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Tezcan B, Eraydın C, Karabacak BG. Evaluating the Scales Used To Diagnose Incontinence-Associated Dermatitis: A Systematic Review. Adv Skin Wound Care 2022; 35:1-9. [PMID: 35442923 DOI: 10.1097/01.asw.0000823988.56640.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the scales used in the diagnosis of incontinence-associated dermatitis (IAD), including the risk factors included in the scales, their reliability and validity, and in which patient groups the scales have been applied. DATA SOURCES The relevant studies were screened retrospectively using five MeSH (Medical Subject Headings) keywords in various combinations. Seven international databases were screened between March and July 2019. In total, 2,908 studies published between 2009 and 2019 were evaluated. STUDY SELECTION Inclusion criteria for studies were as follows: written in English, published between 2009 and 2019, and investigated a scale developed to diagnose IAD (quantitative studies, randomized controlled studies, or meta-analyses). Studies were excluded if they did not examine scales for diagnosing IAD or were not in English. Nine studies were included in this review: five studies on scale development, one scale revision, one scale reliability study, and two Turkish validity and reliability studies. DATA EXTRACTION The study methods, sample characteristics, interventions, validity and reliability analyses, risk factors in the scales, and subdimensions of the scales were examined for each of the nine included studies. DATA SYNTHESIS Study samples were composed of nurses, healthcare professionals, patients, or individuals living in a nursing home and ranged in size from 9 to 823 participants. Most data were collected from hospital-wide clinics. The scales used investigated redness, rash, skin loss, incontinence type, infection symptoms, skin color, edema, patient experience, pain, and perineal care habits. Both validity and reliability of the scales were examined in eight of the studies; in one study, only reliability was examined because the scale validity was shown in previous research. Moreover, sensitivity and specificity were indicated in one study. CONCLUSIONS There are several competent scales in the literature with proven validity and reliability that can be used to diagnose IAD.
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Affiliation(s)
- Bilge Tezcan
- Bilge Tezcan, MSc, RN, is PhD Student, Murat State Hospital, Edirne, Turkey; Canan Eraydın, MSc, RN, is PhD Student, Zonguldak Bulent Ecevit University Faculty of Health Sciences, Department of Nursing Fundamentals, Zonguldak, Turkey; and Bilgi Gülseven Karabacak, PhD, is Assistant Professor, Marmara University Faculty of Health Sciences, Department of Nursing Fundamentals, Istanbul, Turkey. The authors have disclosed no financial relationships related to this article. Submitted April 30, 2021; accepted in revised form July 6, 2021
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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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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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14
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Coyer F, Campbell J, Doubrovsky A. Efficacy of Incontinence-Associated Dermatitis Intervention for Patients in Intensive Care: An Open-Label Pilot Randomized Controlled Trial. Adv Skin Wound Care 2021; 33:375-382. [PMID: 32544117 DOI: 10.1097/01.asw.0000666904.35944.a3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the feasibility of an adequately powered trial testing a long-acting cyanoacrylate skin protectant to prevent incontinence-associated dermatitis in critically ill patients. METHODS This open-label pilot randomized controlled feasibility study was conducted in the adult ICU of an Australian quaternary referral hospital. Patients were allocated to either an intervention group or a control group (usual care). The intervention was the application of a skin protectant (a durable, ultra-thin, transparent, waterproof, no-removal barrier film). Data collected by trained research nurses included demographic and clinical variables, skin assessment, and incontinence-associated dermatitis presence and severity. Data were analyzed using descriptive and inferential statistics. RESULTS Of the 799 patients screened, 85% were eliminated because of a short ICU stay or other exclusion criteria. The mean proportion of patients not meeting any of the exclusion criteria was 22% on each screening day. Protocol fidelity was followed for 90% of intervention participant study days. Retention of participants was 86% (31 participants out of 36), 15 in the intervention group and 16 in the control group. Enrolled patients had a mean age of 59 years, 50% were obese, 67% were male, and 36% were smokers. Two patients (11%) in the intervention group developed incontinence-associated dermatitis, compared with three (17%) in the control group. CONCLUSIONS This study reports no significant findings between the two groups. Difficulty in recruitment and feasibility issues might be overcome with changes to inclusion criteria and study design.
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Affiliation(s)
- Fiona Coyer
- At the Queensland University of Technology in Brisbane, Queensland, Australia, Fiona Coyer, PhD, MSc, RN, is Professor of Nursing, Joint Appointment Intensive Care Services, Royal Brisbane and Women's Hospital and School of Nursing; Jill Campbell, PhD, RN, Grad Dip (Wound Care), is Visiting Fellow, School of Nursing; and Anna Doubrovsky, MPH, BSc (Hons), is Data Analyst and Research Assistant, School of Nursing. Acknowledgments: The authors thank the research nurses (Fiona Boch and Stacey Watts) and all patients who participated. The study was sponsored by 3M, which provided funding for research assistants, the investigational product, and training to two authors on the product application. The authors have disclosed no other financial relationships related to this article. Submitted May 20, 2019; accepted in revised form August 29, 2019
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15
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Glass GF, Goh CCK, Cheong RQ, Ong ZL, Khong PCB, Chan EY. Effectiveness of skin cleanser and protectant regimen on incontinence-associated dermatitis outcomes in acute care patients: A cluster randomised trial. Int Wound J 2021; 18:862-873. [PMID: 33960676 PMCID: PMC8613386 DOI: 10.1111/iwj.13588] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/04/2021] [Accepted: 03/09/2021] [Indexed: 01/13/2023] Open
Abstract
Skin cleansers and protectants protect skin from incontinent matter to reduce the risk of incontinence-associated dermatitis (IAD), but their effectiveness treating established IAD in the tropics is unknown. We conducted an open-label cluster randomised trial to compare the effectiveness of a combined regimen of (1) specialised skin cleansers with disposable body wipes and (2) either an acrylic terpolymer (T1) or zinc oxide (T2) skin protectant against disposable body wipes and zinc oxide protectant (control) in promoting IAD healing and reducing the risk of deterioration. Eighty-four patients were recruited in a tertiary hospital in Singapore between April 2019 and January 2020 (T1: n = 23; T2: n = 37; Control: n = 24). Although not statistically significant, patients treated with T1 and T2 were 1.5 times as likely to experience IAD healing within seven days compared with the control (P = .66). Healing was more pronounced in participants with skin loss treated with T1 or T2. No treatment was superior in preventing IAD deterioration, the prevalence of which remained small (8%-14%). While skin cleaning and protectants reduced the overall risk of skin deterioration, the addition of skin cleansers enhanced IAD healing within a short period, an important consideration for future research examining IAD treatment in acute care.
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Affiliation(s)
| | | | - Run Qi Cheong
- Nursing Research Unit, Tan Tock Seng Hospital, Singapore, Singapore
| | - Zhi Lei Ong
- Nursing Research Unit, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Ee-Yuee Chan
- Nursing Research Unit, Tan Tock Seng Hospital, Singapore, Singapore.,Alice Lee Centre of Nursing Studies, National University of Singapore, Singapore
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16
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Zhang Q, Zhang K, Wang Y, Jia Y, Gu J, Li X, Li M. Psychometric properties of the Chinese version of the attitude towards the prevention of incontinence-associated dermatitis (C-APrIAD) among Chinese nurses. J Tissue Viability 2021; 30:421-426. [PMID: 33820693 DOI: 10.1016/j.jtv.2021.03.006] [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: 11/17/2020] [Revised: 02/28/2021] [Accepted: 03/23/2021] [Indexed: 12/26/2022]
Abstract
AIM Nurses' attitude is a significant determinant of incontinence-associated dermatitis (IAD) prevention, and a positive attitude may benefit quality improvement projects. This research aimed to translate the attitude towards the prevention of incontinence-associated dermatitis instrument (C-APrIAD) into Chinese and test the reliability and validity among Chinese nurses. METHODS The C-APrIAD was translated into Chinese using a standard procedure of backward-forward translation and cross-cultural adaption. Totally 170 nurses were recruited through the convenience sampling method from three tertiary hospitals in Tianjin, Shandong, and Heilongjiang province of China. Reliability (internal consistency, stability) and validity (content validity, structure validity, and convergent validity), were assessed. Convergent Validity was evaluated by correlation with the General Self-Efficacy Scale (GSES). RESULTS Of the 170 completed questionnaires, 158 (93%) were suitable for analysis. The item-total correlation coefficients ranged from 0.39 to 0.80. The content validity of C-APrIAD was 0.96. A factor analysis indicated the construct of a 14-item instrument in a four factors solution: (1) beliefs about the impact of IAD on patients, (2) beliefs about team responsibility to prevent IAD, (3) beliefs about personal responsibility to prevent IAD, and (4) beliefs about the effectiveness of IAD prevention products and procedures. The correlation coefficient between the GSES and C-APrIAD was 0.49 (P < 0.01). For the total instrument, the Cronbach's α coefficient was 0.87 and the test-retest reliability was 0.99. CONCLUSION The C-APrIAD is reliable and valid. The C-APrIAD may benefit nursing research as well as clinical practice to optimize interventions to improve IAD prevention.
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Affiliation(s)
- Qi Zhang
- School of Nursing, Peking University, Beijing, China
| | - Ke Zhang
- Faculty of Education Science and Technology, Shanxi Datong University, Datong, Shanxi Province, China
| | - Yuxin Wang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yibo Jia
- Department of Nursing, Tianjin Chest Hospital, Tianjin, China
| | - Jiaxin Gu
- School of Nursing, Peking University, Beijing, China
| | - Xintong Li
- School of Nursing, Fenyang College of Shanxi Medical University, Lvliang, China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China.
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Coyer F. Moisture-associated skin damage: A timely report of an oft forgotten clinical problem. Intensive Crit Care Nurs 2020; 61:102944. [PMID: 33127215 DOI: 10.1016/j.iccn.2020.102944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Fiona Coyer
- Joint Appointment Intensive Care Services, Royal Brisbane and Women's Hospital and School of Nursing, Queensland University of Technology, Australia; Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK.
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Zhang Y, Leng M, Guo J, Duan J, Wang Z. The effectiveness of faecal collection devices in preventing incontinence-associated dermatitis in critically ill patients with faecal incontinence: A systematic review and meta-analysis. Aust Crit Care 2020; 34:103-112. [PMID: 32646766 DOI: 10.1016/j.aucc.2020.04.152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 03/25/2020] [Accepted: 04/07/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The objective of this study was to investigate the effects of different types of faecal collection devices on incontinence-associated dermatitis (IAD) in critically ill patients with faecal incontinence. REVIEW METHOD USED This was a systematic review and meta-analysis. DATA SOURCES A comprehensive electronic literature search was performed in PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Cochrane library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wanfang, and WeiPu. All the databases were searched from their inception to July 31, 2019, and the data were updated on November 2, 2019. REVIEW METHODS Randomised controlled trials (RCTs) and quasi-experimental studies were included. Participants were critically ill patients with faecal incontinence, and the interventions involved care with faecal collection devices. Comparisons were usual care, and the outcome was the incidence of IAD. Odds ratios (ORs) were used to calculate the pooled effect sizes. Heterogeneity was tested using the inconsistency index (I2) method. RESULTS Nineteen studies were included in this systematic review including 16 RCTs and three quasi-experimental studies. Twelve RCTs were included in the meta-analysis, which showed that the use of faecal collection devices significantly reduced the incidence of IAD. Subgroup analyses based on device type showed significant effects for anal pouch collection devices (OR, 0.14; 95% confidence interval [CI], 0.07-0.26; P < 0.00001), anal pouch connected to negative-pressure suction devices (OR, 0.18; 95% CI, 0.08-0.42; P < 0.00001), anal catheter/tube collection devices (OR, 0.24; 95% CI, 0.13-0.44; P < 0.00001), and anal catheter/tube connected to negative-pressure suction devices (OR, 0.20; 95% CI, 0.07-0.59, P < 0.00001). CONCLUSIONS Faecal collection devices can reduce the incidence of IAD in critically ill patients with faecal incontinence. It is suggested that when using a device to care for critically ill patients with faecal incontinence, an anal pouch connected to continuous low-negative-pressure suction device should be preferred. Further high-quality research is still needed regarding anal catheter/tube collection devices and anal catheter/tube connected to continuous low-negative-pressure suction devices.
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Affiliation(s)
- Yan Zhang
- Department of Critical Care Medicine, The Second Hospital of Shanxi Medical University, No. 382 of Wuyi Road, Xinghualing District, Taiyuan, 030001, China
| | - Minmin Leng
- School of Nursing, Peking University, Beijing, 100191, China; Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Beijing, 100191, China
| | - Jinli Guo
- Department of Nursing, The Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Junfang Duan
- Department of Critical Care Medicine, The Second Hospital of Shanxi Medical University, No. 382 of Wuyi Road, Xinghualing District, Taiyuan, 030001, China
| | - Zhiwen Wang
- School of Nursing, Peking University, Beijing, 100191, China; Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Beijing, 100191, China.
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Johansen E, Lind R, Sjøbø B, Petosic A. Moisture associated skin damage (MASD) in intensive care patients: A Norwegian point-prevalence study. Intensive Crit Care Nurs 2020; 60:102889. [PMID: 32536519 DOI: 10.1016/j.iccn.2020.102889] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 04/14/2020] [Accepted: 04/27/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Critically ill patients are at risk of developing moisture associated skin damage and pressure ulcers. These conditions may co-exist and be difficult to distinguish, but a simultaneous investigation may provide a true prevalence. OBJECTIVES To investigate the prevalence of moisture associated skin damage and associated factors among Norwegian intensive care patients. METHODS A multi-centre one-day point-prevalence study. RESULTS Totally, 112 patients participated in the study. Overall, 15 patients (13%, 15/112) had some type of moisture associated skin damage of which six cases (5%, 6/112) were related to faeces and/or urine (incontinence associated dermatitis). Skin breakdown occurred primarily in the pelvic area. Overall, 87% (97/112) had an indwelling urinary catheter. Stools were reported in 42% (47/112) of the patients on the study day, mostly liquid or semi-liquid. Overall, 11% (12/112) had a faecal management system. Only a few care plans for moisture associated skin damage prevention and care existed. CONCLUSION Patients in this study were vulnerable to skin breakdown in the pelvic area. Nevertheless, a low prevalence of skin breakdown existed. This may relate to intensive care nurses' qualifications, the 1:1 nurse-patient staffing, the high prevalence of urinary catheters and few patients having stools.
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Affiliation(s)
- Edda Johansen
- University of South-Eastern Norway, Faculty of Health and Social Sciences, Brønnbakken 42, 3038 Drammen, Norway.
| | - Ranveig Lind
- Department of Health and Care Sciences, Harstad, Faculty of Health Sciences, UiT - The Arctic University of Norway, Norway; University Hospital of North Norway, Intensive Care Unit, Tromsø, Norway
| | - Britt Sjøbø
- Department of Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Antonija Petosic
- Oslo University Hospital, Division of Emergencies and Critical Care, Department of Postoperative and Intensive Care, University of Oslo, Faculty of Medicine, Institute of Health and Society, Norway
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Exploring Incontinence-Associated Dermatitis in a Single Center Intensive Care Unit: A Longitudinal Point Prevalence Survey. J Wound Ostomy Continence Nurs 2020; 46:401-407. [PMID: 31513128 DOI: 10.1097/won.0000000000000571] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE The purpose of this study was to provide longitudinal prevalence rates of incontinence-associated dermatitis (IAD) in patients in an intensive care unit (ICU) and to identify patient characteristics associated with IAD development. DESIGN Prospective observational. SUBJECTS AND SETTING The sample comprised 351 patients aged 18 years and older in a major metropolitan public hospital ICU in Queensland, Australia. METHODS All consenting, eligible participants at risk of developing IAD underwent weekly skin inspections to determine the presence of IAD. Data were collected weekly for 52 consecutive weeks. Descriptive statistics described the study sample and logistic regression analysis was used to identify patient characteristics associated with development of IAD. RESULTS The weekly IAD prevalence ranged between 0% and 70%, with IAD developing in 17% (n = 59/351) of ICU patients. The odds of IAD developing increased statistically significantly with increasing age (odds ratio [OR]: 1.029, 95% confidence interval [CI]: 1.005-1.054, P = .016), time in the ICU (OR = 1.104; 95% CI: 1.063-1.147, P < .001), and Bristol Stool chart score (OR = 4.363, 95% CI: 2.091-9.106, P < .001). Patients with respiratory (OR = 3.657, 95% CI: 1.399-9.563, P = .008) and sepsis (OR = 3.230, 95% CI: 1.281-8.146, P = .013) diagnoses had increased odds of developing IAD. CONCLUSIONS These data show the high variability of IAD prevalence over a 1-year period. Characteristics associated with the development of IAD in patients in the ICU included older age, longer lengths of ICU stay, incontinent of liquid feces, and having respiratory or sepsis diagnoses.
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Pitta MR, Campos FM, Monteiro AG, Cunha AGF, Porto JD, Gomes RR. Tutorial on Diarrhea and Enteral Nutrition: A Comprehensive Step-By-Step Approach. JPEN J Parenter Enteral Nutr 2019; 43:1008-1019. [PMID: 31544264 DOI: 10.1002/jpen.1674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/14/2019] [Accepted: 05/30/2019] [Indexed: 01/26/2023]
Abstract
This tutorial suggests a current strategy toward a multiprofessional therapy based upon a comprehensive step-by-step approach to the course of intensive care unit diarrhea episodes. Evidence published in the last 10 years, obtained through a database search (PubMed), shows that its prevalence is quite variable. Although multicausal, it is often erroneously associated with the supply of enteral nutrition. Several complications affect not only nutrition status but also the development of skin lesions, which can become the focus of infections, and the length of hospital stay. Here, we propose an early, objective, directed, and multimodal approach, aiming at optimizing care for these patients. In a dynamic walkthrough, the reader will find a guide for the general diagnosis and for colitis resulting from Clostridium difficile infections, as well as current instructions and recommendations for drug treatment and supportive therapy for these 2 modalities. We also bring together ways to prevent and treat associated skin lesions in this setting. Because it is neglected in the critical environment, diarrhea is still a poorly addressed disease, and its complications bring about a significant worsening in quality of life and hospital stay.
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De Meyer D, Gabriel S, Kottner J, Van Damme N, Van den Bussche K, Verhaeghe S, Van Hecke A, Beeckman D. Outcome measurement instruments for erythema associated with incontinence-associated dermatitis: Systematic review. J Adv Nurs 2019; 75:2393-2417. [PMID: 31197869 DOI: 10.1111/jan.14102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/21/2019] [Accepted: 04/02/2019] [Indexed: 01/28/2023]
Abstract
AIM To: (a) examine which outcome measurement instruments for erythema associated with incontinence-associated dermatitis (IAD) with supporting evidence about measurement properties are available; (b) evaluate the methodological quality of the studies and the quality of the measurement properties; and (c) identify eligible instruments to measure erythema in incontinence-associated dermatitis research. DESIGN Systematic review. DATA SOURCES MEDLINE, EMBASE, CINAHL and CENTRAL were systematically searched until July 2018 (update December 2018). Additional input was gathered from 151 incontinence-associated dermatitis experts. Cited and citing references of included studies were screened. REVIEW METHODS The COSMIN Risk of Bias checklist was applied to evaluate the methodological quality of the studies. Reported measurement properties were rated against criteria for good measurement properties. RESULTS Fourteen studies, describing 10 measurement instruments, were included. In five instruments, erythema was captured as a separate concept, two studies provided empirical evidence about the measurement properties. The most studied measurement properties were reliability (9 studies), measurement error (4 studies) and criterion validity (4 studies). In one study, internal consistency was examined. CONCLUSION No instrument measuring exclusively erythema associated with incontinence-associated dermatitis exists. There is no single composite incontinence-associated dermatitis measurement instrument that outperforms others. Development or adaption of an instrument to measure erythema associated with incontinence-associated dermatitis is one option to solve this challenge. IMPACT The evidence about measurement properties of instruments measuring erythema associated with incontinence-associated dermatitis has not been summarized to date. The lack of an instrument should trigger activities to measure this domain accurately in future clinical trials.
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Affiliation(s)
- Dorien De Meyer
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Sabrina Gabriel
- Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Kottner
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nele Van Damme
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Karen Van den Bussche
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Sofie Verhaeghe
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department Health Care, VIVES University College, Roeselare, Belgium
| | - Ann Van Hecke
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,School of Nursing and Midwifery, Royal College for Surgeons in Ireland, Dublin, Ireland.,School of Health Sciences, Örebro University, Örebro, Sweden.,Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,School of Nursing and Midwifery, Monash University, Melbourne, Australia
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Trapani J, Walker W. What's in this Issue. Nurs Crit Care 2018; 23:167-168. [PMID: 30134033 DOI: 10.1111/nicc.12361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Josef Trapani
- Lecturer in Nursing, Editorial Intern, Nursing in Critical Care
| | - Wendy Walker
- Reader in Acute and Critical Care Nursing, Editorial Intern, Nursing in Critical Care
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