Decreasing Incontinence-Associated Dermatitis in the Surgical Intensive Care Unit

Abstract

PURPOSE: The purpose of this quality improvement (QI) project was to determine if use of an algorithm focusing on skin care in patients with fecal and urinary incontinence reduces the rate of hospital-acquired incontinence-associated dermatitis (IAD) over a period of 4 months. PARTICIPANTS AND SETTING: The QI setting was an 18-bed surgical intensive care unit (SICU) in an acute care urban hospital located in the southeastern United States. Two hundred eleven patients participated in this pre/postintervention QI project. APPROACH: The algorithm for skin care used evidence-based bundled interventions for patients with fecal and urinary incontinence. The project comprised education of the SICU nursing staff in January 2018 and implementation of the algorithm from February 5, 2018, to June 5, 2018. Weekly chart reviews were conducted to determine algorithm compliance, documentation of fecal and urinary incontinence, and accuracy of IAD documentation. Descriptive statistics were used to determine the rate of hospital-acquired IAD, algorithm compliance, and average length of time from admission to the onset of hospital-acquired IAD. OUTCOMES: Seventy-nine individuals with incontinence were included in the 3-month preintervention period and 132 individuals with incontinence in the 3-month postintervention period. We observed a 24% reduction in the rate of hospital-acquired IAD following implementation of the algorithm (29% vs 5%). The average length of time from admission to the onset of hospital-acquired IAD increased from 15 days in February 2018 to 25 days in May 2018. IMPLICATIONS FOR PRACTICE: Our experience with this QI project suggest that IAD can be identified and managed at the bedside by first clinical nursing staff without expertise in skin assessment and wound care.

Moisture-Associated Skin Damage

“…One of the key interventions for successful treatment of IAD is to institute and follow a structured skin care regimen or algorithm using quality products 85,94. The fundamental principles for prevention and treatment of IAD are similar 95.…”

“…One of the key interventions for successful treatment of IAD is to institute and follow a structured skin care regimen or algorithm using quality products. 85,94 The fundamental principles for prevention and treatment of IAD are similar. 95 Treatment of IAD includes prompt cleansing of urine and feces from the skin using a product that does not raise skin pH and gentle, thorough drying of the skin.…”

Establishment of incontinence‑associated dermatitis rat models and assessment of the therapeutic effects of zinc oxide, painless skin protective film and silicone dressing

“…Currently, the prevention and treatment of IAD include: i) Correcting the causes of diarrhea and incontinence; ii) reducing urine and stool irritation; iii) correct cleaning, moisturizing and skin care; iv) maintaining the skin pH; and v) regular observation and evaluation (7)(8)(9). Since the presence of high moisture and corrosive enzymes in the intestinal juice can cause destructive damage to the skin, leading to peeling and erosion of the cortex, barrier products such as petrolatum, polydimethylsiloxane and zinc oxide ointment are necessary to protect patients with IAD (10).…”

Incontinence-Associated Dermatitis

“…21 There are several studies showing the effects of training programs, evidence-based practices, and protocols provided to nurses in reducing IAD. [25][26][27][28][29][30] As such, literature reveals the importance of nurses in preventing and managing IAD. There is no research in the literature evaluating the relationship between nurses' knowledge, attitudes, and practices of IAD, with the prevalence of IAD.…”

“…Although nurses' knowledge and attitude toward evidence-based practices enable them to decide and apply the correct clinical practices related to IAD,23,24 nurses' knowledge gaps, negative attitudes, and inappropriate practices seriously affect the integration of evidence into practice 21. There are several studies showing the effects of training programs, evidence-based practices, and protocols provided to nurses in reducing IAD 25–30. As such, literature reveals the importance of nurses in preventing and managing IAD.…”