Francis Kathleen, Pang Sau Man, Cohen Brenda, Salter Helene, Homel Peter
Kathleen Francis, DNP, FNP-BC, CWOCN, Maimonides Medical Center, Brooklyn, New York. Sau Man Pang, MSN, RN, CWOCN, Maimonides Medical Center, Brooklyn, New York. Brenda Cohen, MS, CNS, CWOCN, Maimonides Medical Center, Brooklyn, New York. Helene Salter, BS, RN, CWON, Maimonides Medical Center, Brooklyn, New York. Peter Homel, PhD, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York.
J Wound Ostomy Continence Nurs. 2017 Jul/Aug;44(4):374-379. doi: 10.1097/WON.0000000000000337.
The primary purpose of our study was to determine if there is a difference in the occurrence of hospital-acquired pressure injuries (HAPIs) and incontinence-associated dermatitis (IAD) in incontinent adults using a disposable versus reusable absorptive underpads. We also compared hospital length of stay in the 2 groups.
Randomized controlled trial using cluster randomization based on inpatient care unit.
Four hundred sixty-two patients admitted to 4 medical-surgical study units participated in the study; 252 used reusable underpads (control group) and 210 subjects used disposable underpads (intervention group). The study setting was a 711-bed acute care hospital located in Brooklyn, New York.
Two units were randomly allocated to use disposable incontinence pads, and the remaining 2 units used standard, reusable incontinence pads. Data for PI and IAD occurrences were collected weekly by specially trained RNs (skin care champions) on the assigned units. A 2-level hierarchical linear model was used to analyze the effects of the intervention on primary and secondary outcomes separately from any effects of the unit of randomization.
HAPIs were significantly lower in the disposable underpads group: 5% versus 12% (P = .02). Rates of hospital IAD were not significantly different between the groups (P = .22). Analysis of a secondary outcome, hospital length of stay, was also lower in patients who used disposable underpads (6 days vs 8 days; P = .02).
Findings suggest that use of disposable incontinence pads reduces HAPI but not IAD occurrences. The effect of disposable, absorbent incontinence pads should be considered when initiating a hospital-wide skin and PI prevention and treatment plan.
我们研究的主要目的是确定使用一次性与可重复使用的吸收性尿垫的失禁成年人发生医院获得性压疮（HAPI）和失禁相关性皮炎（IAD）的情况是否存在差异。我们还比较了两组患者的住院时间。
基于住院护理单元进行整群随机分组的随机对照试验。
入住4个内科-外科研究单元的462例患者参与了本研究；252例使用可重复使用的尿垫（对照组），210例使用一次性尿垫（干预组）。研究地点是位于纽约布鲁克林的一家拥有711张床位的急症护理医院。
随机分配两个单元使用一次性失禁尿垫，其余两个单元使用标准的可重复使用的失禁尿垫。指定单元的经过专门培训的注册护士（皮肤护理负责人）每周收集PI和IAD发生情况的数据。使用二级分层线性模型分别分析干预对主要和次要结局的影响，独立于随机分组单元的任何影响。
一次性尿垫组的医院获得性压疮发生率显著更低：5% 对比12%（P = 0.02）。两组间医院获得性失禁相关性皮炎的发生率无显著差异（P = 0.22）。对次要结局住院时间的分析显示，使用一次性尿垫的患者住院时间也更短（6天对比8天；P = 0.02）。
研究结果表明，使用一次性失禁尿垫可降低医院获得性压疮的发生率，但不能降低失禁相关性皮炎的发生率。在启动全院范围的皮肤和压疮预防与治疗计划时，应考虑一次性吸收性失禁尿垫的作用。
