Ruzehaji, Sevara. Reducing incontinence associated dermatitis in an intensive care stepdown unit: a quality improvement project. Retrieved from https://doi.org/doi:10.7282/t3-m8tn-z532
DescriptionPurpose: The purpose of this project was to evaluate the effects of an evidence-based incontinence associated dermatitis (IAD) algorithm on the occurrence rate of incontinence associated dermatitis among stepdown intensive care units in an academic tertiary care hospital.
Methodology: This project used a pre-and post-intervention design and was conducted on an 8-bed stepdown unit over a total of 16-weeks. Chart reviews were conducted (8-weeks pre- and 8-weeks post-intervention) to determine the occurrence rate of IAD and to monitor compliance to IAD prevention interventions. The intervention consisted of attendance at 30-minute educational sessions on the prevention and management of incontinence associated dermatitis for all staff nurses and completion of a 10 question pre- and post-education assessment. An IAD algorithm was developed based on evidence-based recommendations made by experts in the field and found in the literature and was introduced during the educational session. The algorithm consisted of three main categories including assessing the skin, cleansing the skin with pH balanced cloth wipes, and protecting the skin with barrier cream or film and limited linen layers under the patient.
Results: Thirteen staff members participated in the educational sessions. There was a statistically significant improvement in assessment scores between the pre and post assessments (t=6.5; p=<0.001). A total of 35 patients met the inclusion criteria with 23 in the pre-intervention phase and 12 in the post-intervention phase. The percentage change in the rate of incontinence associated dermatitis was -3.84%, from 52% in the pre-intervention to 50% in the post-intervention. This change was not statistically significant (x2= 0.015; p=0.903). Compliance to IAD strategies improved only slightly evidenced by 0.438% increase in the use of cloth wipes, an 0.847% increase in the use of barrier cream. However, a 123% increase in the use of barrier film. None of these were statistically significant in Chi-Square analysis. Compliance to linen layers of three or less under patients increased by 60% between the pre and post intervention time periods.
Implications: The findings from this project supported the implementation of a standardized approach to the prevention and management of IAD through the use of an evidence-based algorithm which resulted in small improvements in clinical practice. Based on these results, it is recommended at the facility level that this intervention by disseminated to other nursing units and be incorporated into the standard of care for the prevention and management of IAD.