title: A Prospective, Descriptive, Quality Improvement Study to Decrease Incontinence-Associated Dermatitis and Hospital-Acquired Pressure Ulcers.
abstract: Incontinence is a common problem among hospitalized patients and has been associated with multiple health complications, including incontinence-associated dermatitis (IAD) and hospital-acquired pressure ulcers (HAPUs). A prospective, descriptive study was conducted in 2 acute care neurology units to 1) assess the prevalence of incontinence and incidence of IAD and HAPUs among incontinent patients, and 2) evaluate the effect of caregiver education and use of a 1-step cleanser, moisturizer, barrier product on the development of IAD and HAPUs among patients with incontinence. During a period of 1 month, the incontinence status of admitted patients was recorded and skin was assessed for the presence/absence of IAD and HAPUs twice per day. After the 1-month data collection, all clinicians on the study units completed a facility-based online education program about IAD, HAPUs, and skin care followed by the implementation of a 1-step cleanser/barrier product for skin care of all patients with incontinence. Data collection procedures remained the same. Data were collected using a paper/pencil instrument and entered into a spreadsheet for analysis. Descriptive statistics were calculated and prevalence and incidence rates were compared between the pre-intervention and post-intervention phase using Fisher's exact analysis. During the first phase of the study, 17 of 40 admitted patients (42.5%) were incontinent. Of those, 5 (29.4%) developed IAD and all of these patients developed HAPUs (5 of 40 admitted, 29.4%) during an average length of stay of 7.3 (range: 2-14) days. In the intervention phase of the study, 25 of 46 (54.3%) patients were incontinent and none developed IAD or a HAPU during an average length of stay of 7.4 (range: 2-14) days. The average Braden scale score was 14.14 in the pre-intervention group of patients with incontinence and 12.74 in the intervention group. The prevalence of incontinence among patients admitted to acute care neurology units and the rate of IAD in these populations is high. After educating clinicians and implementing incontinence care procedures with a 1-step product, the rate of HAPUs decreased significantly but the rate of IADs remained the same. Clinicians should consider the results of this and other studies when developing incontinence-care protocols. Controlled clinical studies utilizing more detailed IAD assessments will help elucidate these observations.
authors.affiliation: Carilion Clinic, Roanoke, VA.
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Hall
authors.affiliation: Carilion Clinic, Roanoke, VA.
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Clark
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003872:Dermatitis / Q000453:epidemiology / Q000517:prevention & control*; D005242:Fecal Incontinence / Q000150:complications*; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D058996:Quality Improvement; D017592:Skin Care; D063465:Skin Cream / Q000627:therapeutic use*; D014549:Urinary Incontinence / Q000150:complications*; D055815:Young Adult