Lin Tsai-Rung, Hwang Miin-Rong, Nien Hui-Hsien, Liu Chia-Chi, Shie Pei-Shan, Chen Sue-Huei
MSN, RN, Head Nurse, Department of Nursing and Burn Center, Kaohsiung Medical University Hospital, Taiwan, ROC.
BSN, RN, Head Nurse, Department of Nursing and Neurology Intensive Care Unit, Kaohsiung Medical University Hospital, Taiwan, ROC.
Hu Li Za Zhi. 2015 Dec;62(6):81-9. doi: 10.6224/JN62.6.81.
BACKGROUND & PROBLEMS: Incontinence associated dermatitis (IAD) is a common skin disorder in critical patients who suffer from fecal incontinence. Symptoms of IAD include pain, redness, swelling, and, in some cases, secondary infections. IAD is thus a major problem faced in critical nursing care. The incidence of incontinence associated dermatitis averaged 34.72% at the intensive care unit in our hospital from October to December 2013. The factors that we identified as associated with IAD included: (1) Nurses: incorrect nursing care and insufficient IAD-related knowledge among nurses; (2) DEVICES: lack of skin barrier products and the use of diapers with poor air ventilation; (3) Regulations: lack of IAD care standards and lack of auditing oversight; (4) Patient problems: skin edema, incontinence, and medication use.
To decrease the incidence of IAD from 34.72% to 22%.
The authors searched the Cochrane, PubMed, CINAHI, and Nursing Reference Center databases for relevant articles that were published from 2000 to 2014. Fifty studies were identified and four evidence-based references were selected for follow-up assessment. Levels of evidence were at levels 2 and 3. We designed an intervention that: (1) set a high-risk notice to increase awareness; (2) held six in-service training programs; (3) developed nursing standards and designed e-learning education lessons that specifically targeted reducing the incidence of IAD; (4) established a regular audit system.
The incidence of IAD decreased from 34.72% pretest to 19.8% posttest (posttest period: April - October 2014).
This project effectively reduced the incidence of IAD in high-risk patients in our intensive care unit. The authors established evidence-based interventions that significantly improved patient outcomes.
失禁相关性皮炎（IAD）是重症监护病房中患有大便失禁的患者常见的皮肤疾病。IAD的症状包括疼痛、发红、肿胀，在某些情况下还会出现继发感染。因此，IAD是重症护理中面临的一个主要问题。2013年10月至12月，我院重症监护病房失禁相关性皮炎的发病率平均为34.72%。我们确定的与IAD相关的因素包括：（1）护士：护士护理不当以及与IAD相关的知识不足；（2）设备：缺乏皮肤屏障产品以及使用透气性差的尿布；（3）规章制度：缺乏IAD护理标准以及缺乏审核监督；（4）患者问题：皮肤水肿、失禁以及药物使用。
将IAD的发病率从34.72%降至22%。
作者检索了考克兰图书馆、PubMed、CINAHI和护理参考中心数据库，查找2000年至2014年发表的相关文章。共识别出50项研究，并选择了4篇循证参考文献进行后续评估。证据级别为2级和3级。我们设计了一项干预措施：（1）设置高风险警示以提高认识；（2）举办了6次在职培训课程；（3）制定护理标准并设计专门针对降低IAD发病率的电子学习教育课程；（4）建立定期审核系统。
IAD的发病率从测试前的34.72%降至测试后的19.8%（测试后时期：2014年4月至10月）。
该项目有效降低了我院重症监护病房高危患者IAD的发病率。作者建立了循证干预措施，显著改善了患者的治疗效果。
