Van Damme N, Clays E, Verhaeghe S, Van Hecke A, Beeckman D, et al.
International journal of nursing studies. Date of publication 2018 May 1;volume 81():30-39.
1. Int J Nurs Stud. 2018 May;81:30-39. doi: 10.1016/j.ijnurstu.2018.01.014. Epub
2018 Feb 2.
Independent risk factors for the development of incontinence-associated
dermatitis (category 2) in critically ill patients with fecal incontinence: A
cross-sectional observational study in 48 ICU units.
Van Damme N(1), Clays E(2), Verhaeghe S(3), Van Hecke A(4), Beeckman D(5).
Author information:
(1)Skin Integrity Research Group (SKINT), University Centre for Nursing and
Midwifery, Department of Public Health, Ghent University, UZ Gent, 5K3, Corneel
Heymanslaan 10, B-9000 Ghent, Belgium.
(2)Epidemiology and Prevention Unit, Department of Public Health, Ghent
University, UZ Gent, 5K3, Corneel Heymanslaan 10, B-9000 Ghent, Belgium.
(3)University Centre for Nursing and Midwifery, Department of Public Health,
Ghent University, UZ Gent, 5K3, Corneel Heymanslaan 10, B-9000 Ghent, Belgium;
Department Health Care, VIVES University College, Wilgenstraat 32, B-8800
Roeselare, Belgium.
(4)University Centre for Nursing and Midwifery, Department of Public Health,
Ghent University, UZ Gent, 5K3, Corneel Heymanslaan 10, B-9000 Ghent, Belgium;
Nursing Department, Ghent University Hospital, UZ Gent, 11K12, Corneel
Heymanslaan 10, B-9000 Ghent, Belgium.
(5)Skin Integrity Research Group (SKINT), University Centre for Nursing and
Midwifery, Department of Public Health, Ghent University, UZ Gent, 5K3, Corneel
Heymanslaan 10, B-9000 Ghent, Belgium; School of Health Sciences, University of
Surrey, Guilford, UK; School of Nursing and Midwifery, Royal College of Surgeons
in Ireland, Dublin, Ireland. Electronic address: Dimitri.Beeckman@UGent.be.
BACKGROUND: Critically ill patients suffering from fecal incontinence have a
major risk of developing incontinence-associated dermatitis (IAD). The presence
of moisture and digestive enzymes (lipase, protease) negatively influences skin
barrier function. Additional risk factors will make some patients even more
vulnerable than others. In order to provide (cost) effective prevention, this
specific patient population should be identified timely.
OBJECTIVES: To identify independent risk factors for the development of IAD
category 2 (skin loss) in critically ill patients with fecal incontinence.
DESIGN: A cross-sectional observational study.
SETTING AND PARTICIPANTS: The study was performed in 48 ICU wards from 27
Belgian hospitals. Patients of 18 years or older, with fecal incontinence at the
moment of data collection, were eligible to participate. Patients with
persistent skin redness due to incontinence (IAD category 1) were excluded.
METHODS: Potential risk factors were carefully determined based on literature
and expert consultations. Data were collected over a period of eight months by
trained researchers using patient records and observation of skin care
practices. At the time a patient was included in the study, all relevant data
from the past six days, or since admission at the ICU, were recorded.
Simultaneously, direct skin observations were performed and high definition
photographs were ratified by an expert IAD researcher. A multiple binary
logistic regression model was composed to identify independent risk factors.
Variables with P < .25 in single binary logistic regression analyses were added
to the multiple model using a forward procedure. A cut-off value of P < .1 was
established to retain variables in the final model. Nagelkerke's R2 and
Hosmer-Lemeshow statistic were calculated as measures of model fit.
RESULTS: The sample comprised of 206 patients, of which 95 presented with IAD
category 2, and 111 were free of IAD. Seven independent risk factors were
identified: liquid stool [odds ratio (OR) 4.69; 95% confidence interval (CI)
2.28-9.62], diabetes (OR 2.89; 95% CI 1.34-6.27), age (OR 1.05; 95% CI
1.02-1.08), smoking (OR 2.67; 95% CI 1.21-5.91), non-use of diapers (OR 2.97;
95% CI 1.39-6.33), fever (OR 2.60; 95% CI 1.23-5.53), and low oxygen saturation
(OR 2.15; 95% CI 1.03-4.48). Nagelkerke's R2 was 0.377. The Hosmer-Lemeshow
statistic indicated no significant difference between the observed and expected
values (p = .301).
CONCLUSIONS: Liquid stool, diabetes, age, smoking, non-use of diapers, fever,
and low oxygen saturation were independently associated with IAD category 2 in
critically ill patients with fecal incontinence.
Copyright © 2018 Elsevier Ltd. All rights reserved.
DOI: 10.1016/j.ijnurstu.2018.01.014
PMID: 29428583 [Indexed for MEDLINE]
