An interventional skin care protocol (InSPiRE) to reduce incontinence-associated dermatitis in critically ill patients in the intensive care unit: A before and after study

• Published in: Intensive & critical care nursing 2017-06, Vol.40, p.1-10
• Main Authors: Coyer, Fiona, Gardner, Anne, Doubrovsky, Anna
• Format: Article
• Language: English
• Subjects: Adult; Aged; Australia; Body Mass Index; Clinical assessment; Clinical nursing; Clinical variables; Comorbidity; Controlled Before-After Studies; Critical care; Critical illness; Critical Illness - nursing; Delayed; Dermatitis; Dermatitis, Irritant - epidemiology; Dermatitis, Irritant - nursing; Developmental delays; Epidemiology; Fecal incontinence; Fecal Incontinence - complications; Fecal Incontinence - nursing; Female; Humans; Incidence; Incontinence; Incontinence-associated dermatitis; Injuries; Intensive care; Intensive Care Units - organization & administration; Intensive Care Units - statistics & numerical data; Intensive treatment; Intervention; Length of Stay - statistics & numerical data; Male; Mechanical ventilation; Men; Middle Aged; Nursing; Nursing Assessment - methods; Ostomy; Patient Care Bundles - standards; Patient Care Bundles - statistics & numerical data; Patient satisfaction; Patients; Pressure ulcers; Prevention programs; Research nurses; Risk factors; Severity; Skin Care - nursing; Skin Care - standards; Skin Care - statistics & numerical data; Urinary Incontinence - complications; Urinary Incontinence - nursing; Urine
• ISSN: 0964-3397; 1532-4036
• DOI: 10.1016/j.iccn.2016.12.001

•Early and regular ongoing assessment for IAD assists early detection.•Correct identification of IAD results in correct differentiation of this condition form pressure injuries.•Evidence-based bundled prophylactic interventions are effective in prevention of IAD. This study aimed to test the effectiveness of a bundle combining best available evidence to reduce the incidence of incontinence-associated dermatitis occurrences in critically ill patients. The study used a before and after design and was conducted in an adult intensive care unit of an Australian quartenary referral hospital. Data, collected by trained research nurses, included demographic and clinical variables, skin assessment, incontinence-associated dermatitis presence and severity. Data were analysed using descriptive and inferential statistics. Of the 207 patients enrolled, 146 patients were mechanically ventilated and incontinent thus eligible for analysis, 80 with 768days of observation in the after/intervention group and 66 with 733days of observation in the before group. Most patients were men, mean age 53 years. Groups were similar on demographic variables. Incontinence-associated dermatitis incidence was lower in the intervention group (15%; 12/80) compared to the control group (32%; 21/66) (p=0.016). Incontinence-associated dermatitis events developed later in the intensive care unit stay in the intervention group (Logrank=5.2, p=