Incontinence-Associated Dermatitis in Nursing Homes

Boronat‐Garrido, Xavier; Kottner, Jan; Schmitz, Gabriela; Lahmann, Nils

doi:10.1097/won.0000000000000282

Cited by 37 publications

(32 citation statements)

References 20 publications

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“…However, other study data suggest that IAD is not a result of age alone 15. A few multivariable regression analyses examining IAD factors have not found a statistically significant relationship with age when controlling for other factors correlated with age such as mobility 8,9…”

Section: Introductionmentioning

confidence: 99%

“…Some have posited that patients in long-term care settings are at greater risk of IAD because they are older and are more likely to be incontinent 7,8. In a study of German long-term care facilities, 5.2% of the overall patient population was found to have IAD while prevalence among the incontinent sample was 21% 9. In a study of long-term care facilities in the United States the overall prevalence of IAD was 5.7%; prevalence among the incontinent population was not reported 8.…”

Section: Introductionmentioning

confidence: 99%

“…Risk factors for IAD related to patient characteristics include increased age,11 higher body mass index,4,9,12 female gender,9 and diabetes 12. It has been posited that increased age is positively associated with IAD because the skin's ability to act as a moisture barrier degrades over time 13,14.…”

Section: Introductionmentioning

confidence: 99%

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

Kayser

Phipps²,

VanGilder³

et al. 2019

Journal of Wound, Ostomy &Amp; Continence Nursing

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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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Kayser

Phipps²,

VanGilder³

et al. 2019

Journal of Wound, Ostomy &Amp; Continence Nursing

View full text Add to dashboard Cite

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“…In both studies, researchers used indirect indicators for IAD because the MDS and Practitioners databases do not specifically query data regarding this prevalent and clinically relevant form of skin damage. Boronat-Garrido and colleagues 6 evaluated 3406 German nursing home residents with urinary, fecal, or dual incontinence and reported an IAD point prevalence of 5.2%.…”

Section: Introductionmentioning

confidence: 99%

Incontinence-Associated Dermatitis, Characteristics and Relationship to Pressure Injury

Gray

Giuliano

2018

Journal of Wound, Ostomy &Amp; Continence Nursing

141

111

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PURPOSE:The purpose of this study was to measure the prevalence of incontinence-associated dermatitis (IAD) among incontinent persons in the acute care setting, characteristics of IAD in this group, and associations among IAD, urinary, fecal, and dual incontinence, immobility, and pressure injury in the sacral area.DESIGN:Descriptive and correlational analysis of data from a large database of IAD, and pressure injuries of sacral area and heels.SUBJECTS AND SETTING:The sample comprised 5342 adult patients in acute care facilities in 36 states representing all regions of the United States. Facilities used a variety of products for prevention of IAD and sacral area pressure injuries.METHODS:Data were collected for use in a national quality improvement study evaluating current practices related to the prevention of IAD and pressure injuries affecting the sacral area and heels. Data were exported to a spreadsheet, and triple checked for accuracy before being imported to a statistical analysis software program. Descriptive statistics were used to describe prevalence rates for incontinence, types of incontinence, IAD, characteristics of IAD, and pressure injuries. Multivariate logistic regression analysis was conducted on the end point of facility-acquired sacral/buttock pressure injury and the risk factors of immobility and type of incontinence.RESULTS:More than one-third of patients (n = 2492 of 5342 patients; 46.6%) were incontinent of urine, stool, or both. The overall prevalence rate of IAD was 21.3% (1140/5342); the prevalence of IAD among patients with incontinence was 45.7% (1140/2492). Slightly more than half of the IAD was categorized as mild (596/1140, 52.3%), 27.9% (318/1140) was categorized as moderate, and 9.2% (105/1140) was deemed severe. In addition, 14.8% (169/1140) of patients with IAD also had a fungal rash. The prevalence of pressure injury in the sacral area among individuals with incontinence was 17.1% (427/2492), and the prevalence of full-thickness pressure injury in this population was 3.8% (95/2492). Multivariate analysis revealed that both presence of IAD (odds ratio [OR], 4.56; 95% confidence interval [CI], 3.68-5.65) and immobility (OR, 3.56; 95% CI, 2.73-4.63) was associated with a significantly increased likelihood of developing a sacral pressure injury. Multivariate analysis also revealed that presence of IAD (OR, 2.65; 95% CI, 1.74-4.03) and immobility (OR, 6.05; 95% CI, 3.14-11.64) was associated with a significantly increased likelihood of developing full-thickness sacral pressure injury.CONCLUSION:Our study findings are consistent with prior research, supporting a clinically relevant association between IAD and pressure injury of the sacral area. This risk persists even after controlling for presence of immobility, suggesting that IAD functions as an independent risk factor for pressure injury occurrence.

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“…This trial will benefit individual patients and aged nursing home residents in general. According to the latest systematic reviews and researching [2, 3], the skin conditions of interest are frequent in this population: In German long-term and geriatric care facilities, the PU prevalence is approximately 4% [43–45], the prevalence of dry skin is approximately 53% [46] and associated pruritus up to 14% [46, 47], and the prevalence of IAD ranges from 4% to 11% [48, 49]. The incidence and severity of these skin conditions will be reduced; thus, patient safety will be enhanced.…”

Section: Discussionmentioning

confidence: 99%

Enhancing SKIN health and safety in aged CARE (SKINCARE Trial): a study protocol for an exploratory cluster-randomized pragmatic trial

Kottner

Hahnel

Genedy

et al. 2019

Trials

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Background Aged long-term care receivers are affected by various adverse skin conditions like pressure ulcers, incontinence-associated dermatitis, dryness, intertrigo, and many more. Prevention of these skin problems and the provision of general hygiene and skin care activities are key areas of nursing practice. Numerous condition-specific guidelines are available and are implemented separately. On the other hand, there is huge overlap in terms of etiology, pathogenesis, and prevention of the skin conditions mentioned above. This leads to fragmented practice neglecting shared etiologies and prevention and treatment principles. Methods The overall aims of this trial are to test the feasibility and to estimate possible effects of the implementation of a comprehensive skin care and prevention strategy targeting main nursing-relevant skin problems at the same time. A two-arm cluster-randomized controlled trial will be performed in 20 nursing homes randomly selected from the population of nursing homes of the state of Berlin, comparing skin care according to the skin care and prevention strategy with standard skin care. Discussion It is expected that the implementation of this evidence-based skin care and prevention strategy will reduce the incidence of pressure ulcers, incontinence dermatitis, and other skin problems frequently related to care dependency. This trial will benefit individual patients and aged nursing home residents in general given the high prevalence and incidence of the addressed skin conditions. Findings of this exploratory trial may lay the foundation for a change in the development and evaluation of clinical standards and practices in general as it moves the perspective from individual conditions to a more comprehensive view on overlapping or coexisting health problems, in this case common skin conditions, in old-age long-term care receivers. Trial registration The study is registered at the German Clinical Trials Register https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015680 (Deutsches Register Klinischer Studien, or DRKS; registration number: DRKS00015680 , date of registration: January 29, 2019) and ClincialTrials.gov (registration number: NCT03824886 , date of registration: January 31, 2019).

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Incontinence-Associated Dermatitis in Nursing Homes

Abstract: IAD is prevalent in nursing home residents. Knowledge about potential risk factors, for example higher body mass index, should be enhanced and integrated into planning of nursing interventions especially skin protection measures.

Cited by 37 publications

References 20 publications

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

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

Incontinence-Associated Dermatitis, Characteristics and Relationship to Pressure Injury

Enhancing SKIN health and safety in aged CARE (SKINCARE Trial): a study protocol for an exploratory cluster-randomized pragmatic trial

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