Effect of a structured skin care regimen on patients with fecal incontinence: a comparison cohort study.

PURPOSE

The purpose of this study was to measure the effect of a structured skin care regimen for critically ill patients with fecal incontinence.

DESIGN

A nonrandomized, quasi-experimental research design (comparison cohort) was used for data collection.

SUBJECTS AND SETTING

Seventy-six patients with fecal incontinence, Bristol stool form 5, 6, and 7, and Braden Scale score of 16 or less in the intensive care units (ICUs) at Samsung Medical Center in Seoul, South Korea, participated in the study.

METHODS

Of the 76 subjects enrolled, 38 were assigned to the experimental group and 38 to the control group. Participants in the active intervention group were being cared for in an ICU; participants in the comparison group were cared for on cardiac, thoracic surgery, general surgery, and neurosurgical ICUs. A structured skin care regimen was developed and implemented, which included the regular use of a no-rinse skin cleanser, application of a skin protectant, and an indwelling fecal drainage system when indicated. Stool consistency was evaluated via the Bristol stool chart. Nurses trained in data collection determined Incontinence-Associated Dermatitis and its Severity (IADS) scores and assessed the perianal and sacral skin for occurrence of pressure ulcers daily over a 7-day period.

RESULTS

Patients in the intervention group had significantly lower IADS scores (t = 4.836, P < .001) than subjects in the control group and were less likely to develop a pressure ulcer than were patients in the control group (5 vs. 19, χ2 = 11.936, P = .001). Patients with higher IADS scores were significantly more likely to develop a pressure ulcer (OR = 1.168, 95% CI = 1.074-1.271).

CONCLUSION

A structured skin care regimen decreased IADS scores and occurrence of pressure ulcers. Higher IADS scores were associated with an increased risk for development of pressure ulcers.