title: An interventional skin care protocol (InSPiRE) to reduce incontinence-associated dermatitis in critically ill patients in the intensive care unit: A before and after study.
abstract: OBJECTIVE
  This study aimed to test the effectiveness of a bundle combining best available evidence to reduce the incidence of incontinence-associated dermatitis occurrences in critically ill patients.
  
  
  METHODS
  The study used a before and after design and was conducted in an adult intensive care unit of an Australian quartenary referral hospital. Data, collected by trained research nurses, included demographic and clinical variables, skin assessment, incontinence-associated dermatitis presence and severity. Data were analysed using descriptive and inferential statistics.
  
  
  RESULTS
  Of the 207 patients enrolled, 146 patients were mechanically ventilated and incontinent thus eligible for analysis, 80 with 768days of observation in the after/intervention group and 66 with 733days of observation in the before group. Most patients were men, mean age 53 years. Groups were similar on demographic variables. Incontinence-associated dermatitis incidence was lower in the intervention group (15%; 12/80) compared to the control group (32%; 21/66) (p=0.016). Incontinence-associated dermatitis events developed later in the intensive care unit stay in the intervention group (Logrank=5.2, p=<0.022).
  
  
  CONCLUSIONS
  This study demonstrated that the use of a bundle combining best available evidence reduced the incidence and delayed the development of incontinence-associated dermatitis occurrences in critically ill patients. Systematic ongoing patient assessments, combined with tailored prevention measures are central to preventing incontinence-associated dermatitis in this vulnerable patient group.
authors.affiliation: Joint Apointment with the School of Nursing, Queensland University of Technology and Intensive Care Services, Royal Brisbane and Women's Hospital, Victoria Park Rd., Kelvin Grove, Queensland, 4059, Australia. Electronic address: f.coyer@qut.edu.au.
authors.forename: Fiona
authors.initials: F
authors.lastname: Coyer
authors.affiliation: School of Nursing, Midwifery and Paramedicine (Signadou Campus), Australian Catholic University, PO Box 256, Dickson ACT, 2602, Australia. Electronic address: anne.gardner@acu.edu.au.
authors.forename: Anne
authors.initials: A
authors.lastname: Gardner
authors.affiliation: School of Nursing, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Queensland, 4059 Australia. Electronic address: anna.doubrovsky@qut.edu.au.
authors.forename: Anna
authors.initials: A
authors.lastname: Doubrovsky
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D015992:Body Mass Index; D015897:Comorbidity; D065187:Controlled Before-After Studies; D016638:Critical Illness / Q000451:nursing; D017453:Dermatitis, Irritant / Q000453:epidemiology / Q000451:nursing*; D005242:Fecal Incontinence / Q000150:complications* / Q000451:nursing; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000458:organization & administration / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment / Q000379:methods*; D064872:Patient Care Bundles / Q000592:standards / Q000706:statistics & numerical data; D017592:Skin Care / Q000451:nursing / Q000592:standards* / Q000706:statistics & numerical data; D014549:Urinary Incontinence / Q000150:complications* / Q000451:nursing
keywords: Critical illness; Incidence; Incontinence-associated dermatitis; Intensive care; Intervention