Gray M, Giuliano KK, et al.
Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy an.... Date of publication 2018 Jan 1;volume 45(1):63-67.
1. J Wound Ostomy Continence Nurs. 2018 Jan/Feb;45(1):63-67. doi:
10.1097/WON.0000000000000390.
Incontinence-Associated Dermatitis, Characteristics and Relationship to Pressure
Injury: A Multisite Epidemiologic Analysis.
Gray M(1), Giuliano KK.
Author information:
(1)Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAAN, FAANP, Department of
Urology, School of Medicine, and Department of Acute and Specialty Care, School
of Nursing, University of Virginia, Charlottesville, Virginia. Karen K.
Giuliano, PhD, RN, FAAN, Sage Products, LLC, Cary, Illinois, and Hallmark
Health, Medford, Massachusetts.
PURPOSE: The purpose of this study was to measure the prevalence of
incontinence-associated dermatitis (IAD) among incontinent persons in the acute
care setting, characteristics of IAD in this group, and associations among IAD,
urinary, fecal, and dual incontinence, immobility, and pressure injury in the
sacral area.
DESIGN: Descriptive and correlational analysis of data from a large database of
IAD, and pressure injuries of sacral area and heels.
SUBJECTS AND SETTING: The sample comprised 5342 adult patients in acute care
facilities in 36 states representing all regions of the United States.
Facilities used a variety of products for prevention of IAD and sacral area
pressure injuries.
METHODS: Data were collected for use in a national quality improvement study
evaluating current practices related to the prevention of IAD and pressure
injuries affecting the sacral area and heels. Data were exported to a
spreadsheet, and triple checked for accuracy before being imported to a
statistical analysis software program. Descriptive statistics were used to
describe prevalence rates for incontinence, types of incontinence, IAD,
characteristics of IAD, and pressure injuries. Multivariate logistic regression
analysis was conducted on the end point of facility-acquired sacral/buttock
pressure injury and the risk factors of immobility and type of incontinence.
RESULTS: More than one-third of patients (n = 2492 of 5342 patients; 46.6%) were
incontinent of urine, stool, or both. The overall prevalence rate of IAD was
21.3% (1140/5342); the prevalence of IAD among patients with incontinence was
45.7% (1140/2492). Slightly more than half of the IAD was categorized as mild
(596/1140, 52.3%), 27.9% (318/1140) was categorized as moderate, and 9.2%
(105/1140) was deemed severe. In addition, 14.8% (169/1140) of patients with IAD
also had a fungal rash. The prevalence of pressure injury in the sacral area
among individuals with incontinence was 17.1% (427/2492), and the prevalence of
full-thickness pressure injury in this population was 3.8% (95/2492).
Multivariate analysis revealed that both presence of IAD (odds ratio [OR], 4.56;
95% confidence interval [CI], 3.68-5.65) and immobility (OR, 3.56; 95% CI,
2.73-4.63) was associated with a significantly increased likelihood of
developing a sacral pressure injury. Multivariate analysis also revealed that
presence of IAD (OR, 2.65; 95% CI, 1.74-4.03) and immobility (OR, 6.05; 95% CI,
3.14-11.64) was associated with a significantly increased likelihood of
developing full-thickness sacral pressure injury.
CONCLUSION: Our study findings are consistent with prior research, supporting a
clinically relevant association between IAD and pressure injury of the sacral
area. This risk persists even after controlling for presence of immobility,
suggesting that IAD functions as an independent risk factor for pressure injury
occurrence.
DOI: 10.1097/WON.0000000000000390
PMCID: PMC5757660
PMID: 29300291 [Indexed for MEDLINE]
