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

• Published in: Chronic wound care management and research 2014-10, Vol.1 (Issue 1), p.41-47
• Main Authors: Ichikawa-Shigeta, Yoshie, Yusuf, Saldy, Sugama, Junko, Supriadi, Supriadi, Sanada, Hiromi, Konya, Chizuko
• Format: Article
• Language: English
• Subjects: Dermatitis; Elderly; Fecal incontinence; Feces; Hydration; Incontinence; Nurses; Nursing; Older people; Ostomy; Patients; Researchers; Risk assessment; Risk factor; Skin; Urinary tract diseases; Urinary tract infections; Urine; Urogenital system; Wound healing
• ISSN: 2324-481X; 2324-481X
• DOI: 10.2147/CWCMR.S71122

Background: Elderly patients with incontinence are at risk of developing incontinence-associated 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: 3.480–395.399, P=0.003), and EI ≥46 (OR: 35.191, 95% CI: 5.254–235.729, 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.