References
Incontinence-associated dermatitis in older adults in residential care settings: a point prevalence study
Abstract
Incontinence-associated dermatitis (IAD) is a skin inflammation caused by contact with urine or faeces or both. It has a negative effect on the patient's quality of life and is indicative of the care provided. However, globally there is a lack of empirical data on the prevalence of IAD. Aim: To identify, for the first time, the proportion of older adults in extended care settings in Ireland affected by IAD. Design: Cross-sectional, multisite, point prevalence survey, across three community extended care settings for older people in Ireland. Methods: Two clinical nurse specialists, using the Scottish Excoriation and Moisture Related Skin Damage Tool, identified the presence of IAD through clinical observation and visual skin inspection. IAD prevalence was calculated for the total population and incontinent population sets using percentages and confidence intervals (CI). Results: The prevalence of incontinence was 86.4% (n=165), a significantly higher proportion were female (P=0.003). The point prevalence of IAD across the total population and incontinent population was 11.5% (22/191; 95% CI, 7.4–19.9%) and 13.3% (22/164; 95% CI, 8.5–19.5%), respectively. Being incontinent was associated with being female, more dependent (Barthel), having possible cognitive impairment, poorer mobility (Braden and Waterlow) and a high risk of pressure ulcers (Waterlow). A logistic regression analysis found no predictor variables for IAD among the variables that met the cut-off point for this analysis. Conclusions: The study provides the first point prevalence empirical data on the occurrence of IAD in Ireland. It can inform decision-making on future planning and budgeting of new quality improvement projects and act as a benchmark for ongoing auditing of IAD.
Incontinence-associated dermatitis (IAD) is a common type of moisture-associated skin damage related to prolonged exposure to urine and faecal incontinence (Gray et al, 2011). Historically, a variety of terms were used to describe this condition, including moisture lesions, irritant dermatitis, perineal dermatitis and nappy rash (Gray et al, 2007; Beeckman et al, 2015; Ferreira et al, 2020) but IAD is the accepted terminology now used across the literature, defined as ‘a type of irritant contact dermatitis (inflammation of skin) found in people with urinary and or faecal incontinence’ (Beeckman et al, 2015) and as such can occur in any age group.
IAD is a top-down injury presenting as redness of the skin including oedema of the surface of the skin, and may be accompanied by blisters, serous exudate, epidermal erosion, and secondary cutaneous infection (Gray et al, 2012; Beeckman et al, 2016). The affected skin area may have varying depths of damage to the epidermis, be patchy or continuous with poorly defined edges, while affected intact skin may be firmer and warmer than adjacent unaffected areas (Beeckman et al, 2015). Histopathological analysis of IAD reveals inflammation of the upper dermis, resulting in erythema (Houwing et al, 2007; Mugita et al, 2015). Erosion is followed by dermal and epidermal proliferation as well as vascular occlusion, resulting in necrobiosis and partial tissue loss. In contrast, pressure injuries are largely caused by bottom-up damage when pressure or shear destroys deeper tissues such as muscle (Gray et al, 2012). Histopathological analysis of pressure injury indicates ischaemia as the major culprit (Houwing et al, 2007), and ultrasonic imaging reveals subdermal pockets of oedema near underlying bone (Quintavalle et al, 2006).
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