Multi-Disciplinary Approach: IAD Improvement Project

Purpose:

Incontinence is a common problem for intensive care unit patients. Incontinence associated dermatitis (IAD) is the skin inflammation response after exposure to urine or fecal secretion, which is also a kind of moisture-associated skin damage (MASD). After the occurrence of IAD, local skin prone to infection, such as Epidermis Candidiasis, especially occurred in elderly patients with immune compromised.

This unit is a 10-bed emergency ICU, over 50% patients were over 65 years old, most of them have urinary and fecal incontinence problem or with both. A preliminary investigation during May and June in 2014, the IAD incidence rate was 46.9%, higher than the incidence of the literature survey. Therefore we expect to design an evidence-based IAD care improvement project to improve the IAD occurrence.

Methods:

 IAD care improvement project:

According to the causes of IAD, members of this project developed IAD care standard refer evidence literature, include high risk assessment within 24 hours after admission, reminder card marked on the head of bed for IAD high-risk patients, and provide skin care in accordance with IAD grading. In addition, probiotics were prescribed to IAD high-risk patients for improving stool properties if they have no white blood count (WBC) lower than 500, not immune compromised or fasting.

 Project implementation:

After the development of IAD care standard, four times in-service education were held to make sure all staff of this unit attended at least one disseminating course. During the course, the IAD introduction and content of IAD care improvement project was disseminated to nursing staff. IAD assessment tool was also incorporated into new staff training program. The outcomes of this project were audited by team members of project monthly.

Results:

A total of seventy-five patients hospitalized, 49 males (65.3%), mean age 68.27±15.67 years old. Eight patients were occurred IAD during ICU stay, the incidence rate was 10.7 percent, lower than that before project execution significantly (χ² = 17.426, P = 0.000). There are relationships between IAD occurrence and patient age, nutrition status, IAD high risk assessment scores of immediate ICU admission, and disease severity. However, IAD incidence was significant related to IAD high risk reassessment scores one week later (t = 2.576, P = 0.014).

Conclusion:

IAD improvement project can effectively improve the incidence of IAD, and IAD did not significantly associated with the occurrence of high-risk assessment on admission, but there are significantly associated with the re-evaluation after a week, it may be due to multiple treatments, such as tube feeding diet and the use of antibiotics which increases the risk of incontinence. That is why reassessment scores one week after ICU admission is associated with and may predict IAD occurrence.