Barakat-Johnson Michelle, Lai Michelle, Wand Timothy, Coyer Fiona, White Kathryn
Faculty of Medicine and Health, University of Sydney, Camperdown, Australia.
Faculty of Medicine and Health, University of Sydney;and Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, Australia.
Ostomy Wound Manage. 2018 Dec;64(12):16-28.
Incontinence-associated dermatitis (IAD) is a common, painful, difficult-to-treat skin condition.
A 2-part, quasi-experimental, post-test study was conducted to evaluate the impact of prevention initiatives on IAD prevalence and incontinence practices.
In part 1, from May 2017 to November 2017, a quasi-experimental post-test study design was conducted in a health district in Australia. Following an audit of IAD prevalence and identification of evidence practice gaps in 4 hospitals in a local health district (12 wards, 250 patients), an implementation science approach was used to implement evidence-based initiatives. An IAD committee was formed, staff were educated about correct incontinence pad sizing, washable and disposable underpads and plastic sheets were removed from the care setting, and barrier cream cloths for cleansing, moisturizing, and protecting skin were introduced. Patients admitted to 1 of the 12 wards who were ≥18 years of age were recruited for participation and evaluation in the post-intervention implementation IAD and incontinence care practices audit. Post-intervention data were entered into a software program and compared to pre-implementation data using descriptive and bivariate statistics. In part 2, nurses from the 12 wards were asked to participate in 1 of 6 focus groups to share their impressions about the barrier cream cloths. Discussions were transcribed verbatim and analyzed using descriptive content analysis.
The rate of incontinence among audited patients (N= 259, 132 men, 124 women; mean age 73.2 ± 16.8 years) was 47.2% (119/252) and 2/259 (0.8%) had a pressure injury (PI). IAD prevalence was significantly lower in the post- than in the pre-implementation audit (6/259 vs 23/250, P = .015), as was hospital-acquired pressure injury (9/250 [3.6%] vs 2/259 [0.08%]) and the use of bed protection layers (154/238 vs 6/259; P <.01). The focus groups included 31 nurses (25 women, 6 men). Four (4) themes emerged: 1) benefits to the patient (eg, improved skin condition), 2) usability (eg, fewer steps), 3) problems encountered (eg, not seeing the barrier in place), and 4) related factors. Patient comfort was cited frequently as an important benefit.
Evidence-based initiatives led to a significant reduction in IAD prevalence and improved incontinence care practices. .
失禁相关性皮炎（IAD）是一种常见、疼痛且难以治疗的皮肤疾病。
开展一项分为两部分的准实验性事后测试研究，以评估预防措施对IAD患病率和失禁护理实践的影响。
在第1部分中，从2017年5月至2017年11月，在澳大利亚的一个卫生区进行了一项准实验性事后测试研究设计。在对当地卫生区4家医院的IAD患病率进行审计并确定循证实践差距（12个病房，250名患者）后，采用实施科学方法来实施循证举措。成立了一个IAD委员会，对工作人员进行了正确失禁垫尺寸选择的培训，从护理环境中移除了可清洗和一次性的床垫保护垫以及塑料床单，并引入了用于清洁、保湿和保护皮肤的屏障乳膏布。招募了入住12个病房中1个病房且年龄≥18岁的患者参与干预后实施的IAD和失禁护理实践审计并进行评估。将干预后的数据录入一个软件程序，并使用描述性和双变量统计方法与实施前的数据进行比较。在第2部分中，邀请了12个病房的护士参加6个焦点小组中的1个，以分享他们对屏障乳膏布的看法。讨论内容逐字记录，并使用描述性内容分析法进行分析。
接受审计的患者（N = 259，132名男性，124名女性；平均年龄73.2±16.8岁）的失禁率为47.2%（119/252），2/259（0.8%）有压疮（PI）。干预后的IAD患病率显著低于实施前的审计结果（6/259对23/250，P = 0.015），医院获得性压疮（9/250 [3.6%]对2/259 [0.08%]）以及床保护层的使用情况（154/238对6/259；P <0.01）也是如此。焦点小组包括31名护士（25名女性，6名男性）。出现了四个主题：1）对患者的益处（如皮肤状况改善），2）可用性（如步骤更少），3）遇到的问题（如看不到屏障就位），4）相关因素。患者舒适度经常被提及为一项重要益处。
循证举措导致IAD患病率显著降低，并改善了失禁护理实践。
