title: [Reducing the Incidence of Incontinence Associated Dermatitis in Intensive Care Unit Diarrhea Patients].
abstract: OBJECTIVE
  Incontinence associated dermatitis (IAD) is a common skin disorder in critical patients who suffer from fecal incontinence. Symptoms of IAD include pain, redness, swelling, and, in some cases, secondary infections. IAD is thus a major problem faced in critical nursing care. The incidence of incontinence associated dermatitis averaged 34.72% at the intensive care unit in our hospital from October to December 2013. The factors that we identified as associated with IAD included: (1) Nurses: incorrect nursing care and insufficient IAD-related knowledge among nurses; (2) DEVICES: lack of skin barrier products and the use of diapers with poor air ventilation; (3) Regulations: lack of IAD care standards and lack of auditing oversight; (4) Patient problems: skin edema, incontinence, and medication use.
  
  
  OBJECTIVE
  To decrease the incidence of IAD from 34.72% to 22%.
  
  
  METHODS
  The authors searched the Cochrane, PubMed, CINAHI, and Nursing Reference Center databases for relevant articles that were published from 2000 to 2014. Fifty studies were identified and four evidence-based references were selected for follow-up assessment. Levels of evidence were at levels 2 and 3. We designed an intervention that: (1) set a high-risk notice to increase awareness; (2) held six in-service training programs; (3) developed nursing standards and designed e-learning education lessons that specifically targeted reducing the incidence of IAD; (4) established a regular audit system.
  
  
  RESULTS
  The incidence of IAD decreased from 34.72% pretest to 19.8% posttest (posttest period: April - October 2014).
  
  
  CONCLUSIONS
  This project effectively reduced the incidence of IAD in high-risk patients in our intensive care unit. The authors established evidence-based interventions that significantly improved patient outcomes.
authors.affiliation: MSN, RN, Head Nurse, Department of Nursing and Burn Center, Kaohsiung Medical University Hospital, Taiwan, ROC.
authors.forename: Tsai-Rung
authors.initials: TR
authors.lastname: Lin
authors.affiliation: BSN, RN, Head Nurse, Department of Nursing and Neurology Intensive Care Unit, Kaohsiung Medical University Hospital, Taiwan, ROC.
authors.forename: Miin-Rong
authors.initials: MR
authors.lastname: Hwang
authors.affiliation: BSN, RN, Department of Nursing and Burn Center, Kaohsiung Medical University Hospital, Taiwan, ROC.
authors.forename: Hui-Hsien
authors.initials: HH
authors.lastname: Nien
authors.affiliation: BSN, RN, Department of Nursing and Medical Intensive Care Unit, Kaohsiung Medical University Hospital, Taiwan, ROC.
authors.forename: Chia-Chi
authors.initials: CC
authors.lastname: Liu
authors.affiliation: MSN, Administrator, Quality Management, Department of Medical Quality Control Room, Kaohsiung Medical University Hospital, Taiwan, ROC.
authors.forename: Pei-Shan
authors.initials: PS
authors.lastname: Shie
authors.affiliation: MSN, RN, Supervisor, Department of Nursing, Kaohsiung Medical University Hospital, Taiwan, ROC. 850049@ms.kmuh.org.tw.
authors.forename: Sue-Huei
authors.initials: SH
authors.lastname: Chen
mesh_terms: D003872:Dermatitis / Q000209:etiology / Q000517:prevention & control*; D003967:Diarrhea / Q000150:complications*; D005242:Fecal Incontinence / Q000150:complications*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units
keywords: diarrhea; incontinence associated dermatitis; skin care