Examining Prevalence and Risk Factors of Incontinence-Associated Dermatitis Using the International Pressure Ulcer Prevalence Survey

Abstract

PURPOSE: To evaluate prevalence and risk factors of incontinence-associated dermatitis (IAD). DESIGN: Retrospective analysis of 2016 International Pressure Ulcer Prevalence survey data. SUBJECTS AND SETTING: Adult patients who were in acute care, long-term acute care, long-term care, and rehabilitation facilities in the United States and Canada. METHODS: IAD prevalence was calculated among all patients surveyed, among the incontinent patients only, across multiple care settings, and by incontinence type. A logistic regression examined risk factors for IAD in the incontinent population. RESULTS: Nearly 1 in 5 incontinent patients had IAD documented. Incontinence-associated dermatitis prevalence in the entire patient population was 4.3% while incontinence prevalence was 18%. Of incontinent patients, prevalence of IAD ranged from 8.4% in long-term care facilities to 19% in acute care facilities. Facilities with higher rates of incontinence did not necessarily have higher prevalence of IAD. Incontinence-associated dermatitis prevalence by incontinence type ranged from 12% for patients with urinary incontinence to 26% for patients with fecal management systems. Regression results support the association of the following factors with an increased likelihood of IAD documented: all types of incontinence, fecal management systems, higher body weight, diminished mobility, additional linen layers, longer length of stay, and lower Braden Scale scores. CONCLUSIONS: Incontinence-associated dermatitis remains a concern in acute care settings. Risk factors associated with IAD were similar to risk factors previously reported for hospital-acquired pressure injuries, such as limited mobility, longer lengths of stay, and additional linen layers. By consistently documenting IAD as well as pressure injury prevalence, facilities may benchmark overall skin prevention models.

Incontinence associated dermatitis in elderly people admitted to a university hospital

“…In this study, the condition of incontinence associated dermatitis (IAD) was in conformity with the global prevalence, which presents a wide variation, between 5.6% and 50% (8) , and was congruent with what had been evidenced by a study performed with 376 patients (average age of 62 years) from an Australian hospital, in which IAD was present in 10% of the elderly patients (20) . However, the current results showed a higher incidence when compared to the multicenter survey developed with 51,045 patients admitted to hospitals in the United States and Canada (average age was 65 years), which detected the condition in 4.1% of the elderly patients (15) .…”

“…The variability in the incidence of IAD can be attributed to the absence of an internationally approved method, as well as the difficulty in identifying it. Another obstacle is the shortage of epidemiological studies regarding IAD in the hospital setting (14,15) considering that most of those studies involving the subject are developed in Long Term Institutions for the Elderly (LTIE) (15) . Similar to other studies (13,21) , sociodemographic aspects such as skin color, gender and education were not associated to IAD.…”

“…Despite being considered an unpleasant event that causes discomfort and pain (1,7,11) , contributing significantly to the increase of hospitalization time and cost, especially in elderly patients (10,(14)(15) , IAD is preventable. Therefore, it is essential that the nursing staff identifies and monitors risk factors, as well as establishes prevention and treatment protocols.…”

Prevalencia de lesiones de piel asociadas a la dependencia física en geriátricos e instituciones de salud de Tunja

“…Las unidades donde hubo mayor prevalencia fueron: hospitalización, con un 0,60%, y la unidad de cuidados intensivos y rehabilitación con un 0,59% 12 . En los mismos países, la prevalencia por dermatitis asociada a la incontinencia (DAI), que hace parte de las LESCAH, fue del 4,3% 13 . Un estudio reveló una prevalencia del 10,8% en LPP específicamente para Australia 14 .…”

Management of incontinence‐associated dermatitis: A systematic review of monetary data

“…IAD is an underreported health condition 3,4 . Depending on the type of setting and population studied, prevalence ranges between 7.6% and 45.7% 5‐8 . IAD is not only a painful condition, it also increases the susceptibility to develop secondary skin infections (such as candidiasis and Pseudomonas aeruginosa ), and deep wounds such as pressure ulcers 9,10 .…”