Effect of Nursing Interventions in Prevention and Healing of Incontinence-Associated Dermatitis among Critical Care Patients

Abstract

Incontinence is a common problem among hospitalised patients and has been associated with multiple health complications, including incontinence-associated dermatitis (IAD) and hospitalacquired pressure ulcers (HAPUs). IAD is one of the clinical manifestations of moisture- associated skin damage (MASD). IAD is a common problem in aged patients with faecal and/or urinary incontinence. In this study it was sought to reduce the incidence of IAD among critically ill patients admitted in ICU from 5.94 rate to <2.00 by implementing Nursing Interventions of IAD protocol. A one group pre-test post-test design was selected using consecutive sampling technique. The data was obtained by using an audit checklist prior and post-interventions. Results showed that the compliance to IAD protocol increased from 37.94 percent to 77.33 percent. Incidence of IAD reduced from 5.94 to 2.02 in the last 3 months. Healing status of IAD was 100 percent in June & July 2017. Thus nursing interventions are effective in the prevention and healing of IAD among critical care patients. To conclude incontinence associated dermatitis is a prevalent but under-recognised form of skin damage in the critically ill patients with urinary or fecal incontinence. Prevention and treatment focus on treatment of underlying incontinence and protection of skin exposed to urine or stool-based on a structure skin care regimen.

Incontinence-Associated Dermatitis in Older Intensive Care Patients: A Review and Case Report

“…The literature review shows that interventions in assessing IAD patients in older ICU units, early prevention, intervention management of risk factors, skin cleansing, and drying, use of skin protectants, and personnel training can be effective. 1,[23][24][25][26][27][28][29]37,39 In particular, in the context of skin cleansing, much literature lists the steps of skin cleansing in detail. 23,32 Using skin protectants to protect the skin before IAD development is effective for skin management of IAD.…”

“…Skin damage is a sensitive quality indicator closely related to patient safety, posing significant challenges in clinical practice. 23 IAD patients often feel uncomfortable and experience pain, burning, itching, or tingling in the infected skin area. 2 Skin lesions associated with IAD are susceptible to infection due to impaired barrier function.…”

“…Clean the skin as soon as possible when it is contaminated is the first recommendation to reduce skin irritation and damage caused by excreta components. 23,29 In addition, the whole body should be cleansed at least once a day. 19 The cleaning method should not increase the friction of the skin surface and damage the cuticle as a principle.…”

“…In the same way, the cleaning method should be washing or drying, and rough rubbing should be avoided. 23,31 After cleansing, the skin should be gently patted to dry the skin's surface. 19 Soap is not recommended for skin cleansing products.…”

What is the evidence on skin care for maintaining skin integrity and prevention of wounds? An integrative review

“…Both studies found reduced incidence of IAD in the intervention group or 'post' groups, compared to earlier or 'pre' groups receiving routine care. 69,70 Other studies looked at factors influencing implementation of evidence-based skin care. A validation study involving 14 nurse specialists, identified 32 activities.…”