Risk assessment tool for incontinence-associated dermatitis in elderly patients combining tissue tolerance and perineal environment predictors: a prospective clinical study

Abstract

Background: Elderly patients with incontinence are at risk of developing incontinenceassociated dermatitis (IAD). Although perineal risk factors of IAD have been identified, the contribution of tissue tolerance to IAD remains poorly understood. Objective: This study aimed to identify predictors of IAD development in three categories of potential risk factors: perineal environment, tissue tolerance, and toileting ability. Methods: This was a prospective clinical study, conducted at a long-term medical facility in Japan between November 2011 and April 2012. The subjects were elderly female patients with urine and/or fecal incontinence, and constantly wearing absorbent products. The patients were monitored during 42 days for the onset of IAD and the emergence of potential risk factors of IAD related to tissue tolerance (skin hydration status, maceration, erythema index [EI], etc), perineal environment (urination, stool properties, etc), and toileting ability (mobility and cognitive awareness). The risk factors were identified by univariate and multiple logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the predictive validity of the risk factors. Results: Among the 46 patients enrolled, IAD developed in 25 (54.3%). The factors significantly associated with IAD development were loose or liquid stools (odds ratio [OR]: 20.612, 95% confidence interval [CI]: 1.118-379.852, P=0.042), malodorous urine (OR: 37.094, 95% CI: 3. P=0.003), and EI $46 (OR: 35.191,, P , 0.001). The ROC curve analysis identified EI $46 as the most reliable predictor of IAD (sensitivity: 0.92, specificity: 0.81). These factors were integrated into a new risk assessment tool for the development of IAD in elderly patients with incontinence. Conclusion: This study demonstrates that EI constitutes a more valid predictor than perineal factors to monitor patients in clinical settings and to prevent the development of IAD.

An Exploratory Study of the Effects of the pH of Synthetic Urine on Skin Integrity in Healthy Participants

“…However, when combined with other factors skin damage, inflammation and IAD can occur. In particular, the presence of bacteria in urine is commonly found in patients with urinary incontinence [61], and indeed, bacteria contaminated urine has been recognized as a risk factor for IAD [62]. Therefore, future studies need to examine the mechanisms of IAD following combined exposure of skin to urine and common uropathogens associated with IAD, including Pseudomonas aeruginosa and Proteus mirabilis , which can also contribute to pH elevation due to its high urease activity [63].…”

Relationship between maceration and wound healing on diabetic foot ulcers in Indonesia: a prospective study

“…Besides exudate, maceration may also be caused by urinary incontinence . In normal healthy healing, MMPs are regulated by the tissue inhibitors of metalloproteinases (TIMPs) so that MMPs are produced equally; however, the production of MMPs in chronic and acute wounds is different: wound fluids in chronic wounds contain high concentrations of enzymes, or MMPs levels are increased, and TIMP levels are decreased .…”

Risk Determinants of Incontinence associated dermatitis among Critically Ill Patients.

“…After relevant literature reviewing (Bergstrom, 1988;Nix, 2002;Borchert et al, 2010;Beeckman et al, 2011;Savik, Thorson, 2011;Ichikawa-Shigeta et al, 2014;Chance et al, 2017;Damme et al, 2018;NHS, 2019;Van Yates, 2020;Behairy& El-Mokadem, 2021;Fisher, 2020;and Millard, 2019). "Risk Determinants of IAD tool", developed by the researcher after reviewing the related literature to pinpoint the risk determines of IAD between critically ill patients which include three parts:…”

“…Decrease frequency to change absorbent pads and duration of contact skin to faeces or urine, being immobile with disturbed level of consciousness, and limited range of motion of the lower extremities may impaired ability to control toilet ability. Prolonged attached to invasive devices such as mechanical ventilator associated with impaired of cognition function may impaired ability for control toileting (Ichikawa-Shigeta et al, 2014;Millard, 2019).…”