WOUND CARE Effect of a Structured Skin Care Regimen on ...

Copyright © 2014 by the Wound, Ostomy and Continence Nurses Society™ J WOCN ■ January/February 2014 1

Copyright © 2014 Wound, Ostomy and Continence Nurses Society. Unauthorized reproduction of this article is prohibited.

J Wound Ostomy Continence Nurs. 2014;41(1):1-7. Published by Lippincott Williams & Wilkins

WOUND CARE

Effect of a Structured Skin Care Regimen on Patients With Fecal Incontinence A Comparison Cohort Study

Kyung Hee Park � Keum Soon Kim

■ ABSTRACT

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 incon-tinence, Bristol stool form 5, 6, and 7, and Braden Scale score of 16 or less in the intensive care units (ICUs) at Sam-sung 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 sur-gery, and neurosurgical ICUs. A structured skin care regi-men 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 occur-rence of pressure ulcers daily over a 7-day period. RESULTS: Patients in the intervention group had signifi -cantly lower IADS scores ( t = 4.836, P < .001) than sub-jects in the control group and were less likely to develop a pressure ulcer than were patients in the control group (5 vs 19, χ 2 = 11.936, P = .001). Patients with higher IADS scores were signifi cantly more likely to develop a pres-sure 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. KEY WORDS: fecal incontinence , incontinence-associated dermatitis , Incontinence Associated Dermatitis and its Severity (IADS) instrument , pressure ulcer , skin care .

■ Introduction

Incontinence-associated dermatitis (IAD) is defi ned as ery-thema of the skin when exposed to urine or stool; it is often accompanied by erosion of the skin and cutaneous candidiasis. 1 A pressure ulcer (PU) is defi ned as localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure or pressure in combination with shear according to joint guideline from National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. 2 The etiology of IAD differs from that of a PU, 1 but these conditions often coexist. 3 Maklebust and Magnan 4 reported the frequencies of risk factors in 270 patients with PUs. Among the 270 patients with PUs, 153 patients (56.7%) had fecal incontinence, which was the second most frequent risk factor after im-paired mobility (235/270, 87%). Analysis revealed that persons with fecal incontinence were 22 times more likely to develop a PU as compared to persons without fecal in-continence. The nature of the relationship between IAD and PU is not well understood, but existing research sug-gests that skin exposed to urine, stool, or affected by IAD is less tolerant to pressure, friction, and shear. 5 , 6 Based on knowledge of this association, clinical practice guidelines for PU prevention include implementation of a structured skin care program. Several studies have shown that imple-mentation of a regular program reduces the incidence of PU on the sacrum and buttocks. 7 - 9

� Kyung Hee Park, MSN, RN, CWOCN, KGNP, Director of Samsung Medical Center International Wound Ostomy Continence Nursing Educational Program, Department of Nursing, Samsung Medical Center, Seoul, South Korea. � Keum Soon Kim, PhD, RN, Professor, College of Nursing, Seoul National University. Seoul, South Korea. The authors declare no confl ict of interest. Correspondence: Kyung Hee Park, MSN, RN, CWOCN, KGNP, Samsung Medical Center International Wound Ostomy Continence Nursing Educational Program, Department of Nursing, Samsung Medical Center, 50 Ilwon-dong, Gangnam-gu, Seoul, South Korea 135-710 ( [email protected] ).

DOI: 10.1097/WON.0000000000000005

JWOCN-D-12-00072R1.indd 1JWOCN-D-12-00072R1.indd 1 11/12/13 5:03 PM11/12/13 5:03 PM

Copyright © 2014 Wound, Ostomy and Continence Nurses Society™. Unauthorized reproduction of this article is prohibited.

2 Park and Kim J WOCN ■ January/February 2014

While the prevalence of incontinence among inten-sive care unit (ICU) patients is high, this issue is often rel-egated to a lower priority owing to the critical nature of other issues. 10 We observed a similar pattern of prioritiza-tion at the Samsung Medical Center. In 2011, the chief WOC nurse at Samsung Medical Center (KHP) developed and implemented a structured skin care program for pa-tients in the ICU who were experiencing fecal inconti-nence; this program incorporated evaluation via the Incontinence-Associated Dermatitis and its Severity (IADS) Instrument. 11 The aims of this study were to evaluate (1) effect of a structured skin care regimen on the develop-ment and severity of IAD, (2) effect of the structured skin care program on PU development, and (3) the relationship between IADS scores and PU incidence.

■ Methods

Data were collected using a nonrandomized comparison cohort design. The intervention was a structured skin care regimen. The main study outcomes were mean IADS score and PU development. The comparison group was man-aged by the institutions’ standard skin care protocol, which did not address the prevention and treatment pro-tocols of incontinence-associated dermatitis for fecal in-continence patients.

Subjects were recruited from 5 ICUs within Samsung Medical Center, located in Seoul, South Korea, between April and July 2011. Inclusion criteria were fecal inconti-nence with Bristol stool form 12 5, 6, or 7 and no IAD and PU on baseline skin evaluation. Study procedures were re-viewed and approved by the institutional review board of Samsung Medical Center. To avoid confusion, the experi-mental group and the control groups were assigned to dif-ferent ICUs. Thirty-eight patients in the experimental group were enrolled from medical ICU, and 38 patients from the cardiac care unit, thoracic surgery unit, and neu-rosurgical ICUs composed the comparison group.

Intervention A preliminary skin care protocol was developed based on literature search. Content validation was performed by 2 WOC nurses, 1 critical care nurse, and 1 dermatologist. Each member reviewed the protocol and assigned a score from 1 to 5 to the action items; a content validity ratio was then calculated using Lawshe’s method. 13

The fi nal protocol ( Table 1 ) was limited to items with a score of 4 or higher scores out of 5 in the validity test were included into the structured skin care protocol used for the experimental group. The preliminary skin care protocol comprised 31 items; 1 item with a content valid-ity ratio less than 0.99 was discarded. The skin care proto-col (intervention) included assessment of stool consistency and perianal skin, use of a no-rinse skin cleanser (Elta Cleansing Foam, Swiss-American Products, Inc, Carrollton, Texas), generic (nonbranded) moisturizer,

TABLE 1.

The Structured Skin Care Regimen for Incontinent ICU Patients

Assessments

1. Regular skin assessment on admission

2. Regular skin assessment at repositioning

3. Regular skin assessment at Braden Scale scoring

4. Special skin assessment of high-risk patients (high-frequency diarrhea, etc)

5. Special skin assessment of patients with deteriorating skin condition

6. Feces assessment: Assessment of feces: Bristol stool type, frequency

Interventions

7. Avoid wrapping the buttocks with diaper or brief when patients are on bed

8. Frequent change of linen

9. Use absorptive pad

10. No massage on erythema

11. Do not lie on the side of erythema

12. Initiate structured skin care immediately after incontinence

13. Mild washing: minimize friction damage. No scrubbing

14. Disposable wet tissue instead of cloth towel

15. Cleanse perineal skin with Elta cleansing foam

16. Gentle drying in case water and disposable tissue are used for washing

17. Apply moisturizer within 2-3 min after bathing

18. Avoid moisturizer with high concentrations of humectants (urea, glycerin, a-hydroxy acids, lactic acid)

19. Apply moisture barrier

20. Keep skin care products bedside to improve compliance

21. Use Anal Plug and FlexiSeal immediately before any skin damage occurs

22. Use Anal Plug to patient with Bristol stool type 5 and 6

23. Use FlexiSeal to patients with Bristol stool type 7

24. Minimize diarrhea with the consult with nutritionist and doctors

25. Mild erosion: apply liberal amount of skin protectant to cover the affected skin area

26. Treat areas of cutaneous candidiasis with antifungal agent followed by skin protectant

27. Erosion with exudate: Apply hydrocolloid paste with “border foam dressing”

28. Consult with expert when no improvement is made in 1 week

29. Educate all care providers on structured skin care regimen

30. Avoid the risk of cross contamination: write patient's name on products not to be used in other patients

Abbreviation: ICU, intensive care unit.


Amorgen

강조

Amorgen

강조

Amorgen

강조

Amorgen

강조


J WOCN ■ Volume 41/Number 1 Park and Kim 3

and a skin protectant (Elta SEAL Moisture Barrier, Swiss-American Products, Inc, Carrollton, Texas). Adult con-tainment briefs were not included in the protocol in order to minimize moisture exposure. Liquid fecal incontinence was immediately addressed with a containment device (Anal Plug, Coloplast A/S, Humlebak, Denmark) or stool diversion system (FlexiSeal, ConvaTec, Greensboro, North Carolina).

The protocol also included a pictorial description of Bristol stool type 5 (soft blobs with clear-cut edges, passed easily), 6 (fl uffy pieces with ragged edges, a mushy stool),

and 7 (watery, no solid pieces, entirely liquid) 12 to aid nurses in assessment of the stool. The treatment of the skin ero-sion was described in the protocol. Self-adherent foam dressings (Mepilex Border, Mölnlycke Healthcare, Gothenburg, Sweden; Allevyn Thin, Smith & Nephew Medical Ltd, Hull, England) were applied to the eroded skin area and paste (Stomahesive Paste, ConvaTec, Greensboro, North Carolina) was applied to the edge of the dressing to prevent contamination by stool. Antifungal agent (Canesten Powder, Bayer Korea, Seoul, Korea) was applied to IAD suspected of the complication with candidiasis. The

FIGURE 1. The identifying Incontinence-Associated Dermatitis (IAD) and its Severity instrument. 11 Reprinted with permission. All copyright requests should be made to the copyright holder.


Amorgen

강조



PowerPoint presentation, demonstrations of the products and devices, and oral explanations of the protocol. The knowledge of the ICU nurses was tested with 5 example cases and was appropriate to carry out the structured skin care protocol.

Ten primary wound care nurses (PWNs), 5 for the ex-periment group and 5 for the control group, were edu-cated on how to score the IADS instrument and to assess feces based on Bristol Stool Scale. Interrater reliabilities of IADS scores and Bristol Stool Scale of the 10 PWNs were 0.987 and 0.939, respectively, on 5 computer-presented cases. Wound care nurses, who are institutionally qualifi ed nurses by completing middle-level courses of wound care are giving primary wound cares at their units under the supervision of WOC nurses.

The structured skin care protocol was attached to the nursing cart and its implementation was marked on a card by the ICU charge nurse. Wound care nurses or the princi-pal investigator (K.H.P.) completed the IADS and checked for a new PU once a day for 7 days. The highest IADS scores and PU stage documented during the 1-week period were used for data analysis.

■ Statistical Analysis

Data were analyzed using Predictive Analytics SoftWare version 18.0 (SPSS Inc, Chicago, Illinois). Subject charac-teristics, IAD, and PU risk factors in the experimental group were compared with the standard care group using χ 2 or independent t -test. The IADS scores of the experimental (intervention) group were compared with those of control group using the independent t -test. Pressure ulcer develop-ment in experiment and control groups was compared using the χ 2 test. The relationship between IADS scores and PU development was analyzed with logistic regression. Receiver operating characteristic (ROC) curve analysis was performed to determine whether IADS scores could be used to predict PU development.

■ Results

The mean age of subjects was 68 ± 14 years (mean ± SD); 67% were aged 65 years or older. Slightly more than half (n = 40; 53%) were male. Most subjects (60.5%) had Bristol stool form 7. All 76 subjects had Braden Scale score of 13 or less, indicating that all participants were at risk for PU development.

Homogeneity of the experimental and control subjects was tested by comparing demographic characteristics, IAD risk factors, and PU risk factors in the 2 groups using χ 2 or independent t -test. No signifi cant differences were found between the groups ( Tables 2 and 3 ).

Analysis of Intervention The structured skin care protocol reduced the severity of IAD in the structured skin care group compared with that of the

skin and fecal incontinence of the subjects were assessed every 2 hours.

The preexisting protocol was operationally defi ned for this study as standard care. The standard care protocol did not address frequency or specifi c focus of skin assessment in incontinence patients. It did not specify interventions for managing diarrhea, although treatment suggestions for man-aging skin erosion were suggested in the protocol. When this study was initiated, the majority of ICU patients were man-aged with adult containment briefs. The use of fecal contain-ment devices, fecal management systems, skin protectants, or moisturizers was based on nursing staff preference.

Instruments The IADS instrument was used to evaluate incontinence-associated dermatitis ( Figure 1 ). This tool requires the nurse to assess erythema, rash, and skin loss in 13 loca-tions including the perianal, perineal, perigenital skin, and inner thighs. The IADS instrument has undergone initial validation; in addition, initial intraclass correlation was .98. 11 We obtained approval for the use of the IADS instrument from Borchert and colleagues. 11

Pressure ulcer occurrence and staging were based on the taxonomy of the National Pressure Ulcer Advisory Panel. 14 Pressure ulcers were defi ned as stage 1, 2, 3, 4, suspected deep tissue injury, and unstageable. The Bristol Stool Scale was used to aid nurses to assess stool consis-tence and accurately identify diarrhea. 12 The instrument classifi es stool consistency based on 7 categories. Types 1 and 2 indicate hard stools. Type 3 and 4 indicate normal stools. Types 5, 6, and 7 indicate liquid stool with or with-out smaller formed or semiformed fecal content.

Study Procedures Four 1-hour long educational sessions on the structured skin care protocol were provided for nurses who assessed and cared for patients. Educational techniques included a

TABLE 2.

Subject Characteristics

VariablesExperimental

(n = 38)Control (n = 38) P (N = 76)

Gender, n (%)

Male 18 (47.4) 22 (57.9) .358

Female 20 (52.6) 16 (42.1)

Age, M ± SD, y 66.2 ± 15.2 69.7 ± 13.6 .286

1st major problem for ICU admission, n (%)

Respiratory 19 (50) 8 (21.1)

Neurovascular 11 (28.9) 11 (28.9)

Cardiovascular 2 (5.3) 12 (31.6)

Digestive 6 (15.8) 7 (18.4)

Abbreviation: ICU, intensive care unit.




TABLE 3.

Comparison of Pertinent Clinical Characteristics of IAD and PU in the Structured Skin Care Regimen (Experimental) and Standard Care (Control) Groups

VariablesExp (n = 38),

M ± SD or N (%)Con (n = 38),

M ± SD or N (%) P (N = 76)

Urinary

Continence 5 (13.2) 8 (21.1)

Incontinence with indwelling catheter 33 (86.8) 30 (78.9) .361

Average intensity of fecal irritant a

Type 5 7 (18.4) 6 (15.8)

Type 6 8 (21.1) 17 (44.7) .082

Type 7 23 (60.5) 15 (39.5)

Average frequency of fecal incontinence (per day)

6 times ≤ 26 (68.4) 17 (44.7)

3 times ≤ , ≤ 5 times 10 (26.3) 20 (52.6) .062

≤ 2 times 2 (5.3) 1 (2.6)

Antibiotics 33 (86.8) 36 (94.7) .43

Tube feeding 23 (60.5) 16 (42.1) .108

Clostridium diffi cile 5 (13.2) 8 (21.1) .361

Cardiac arrest 2 6 .262

Vasopressive medication for > 48 h 16 15 .815

Shock b 10 13 .454

Surgical procedure > 8 h 0 1 1

General edema/weeping 16 9 .087

Morbid obesity 0 1 1

Malnutrition c 34 33 1

Bed rest 32 31 .761

Liver failure 6 10 .26

Diabetes mellitus 15 23 .066

Age > 65 years old 22 29 .087

Sedatives/paralytics > 48 h 6 12 .105

Mechanical ventilation > 48 h 26 15 .011

Quadriplegia or spinal cord injury 8 17 .028

Nitric oxide ventilation 11 10 .798

Past history of pressure ulcers 2 2 1

Heart drive lines 1 1 1

Braden Scale score 11.8 ± 2.1 12.7 ± 2.2 .084

BMI 22.4 ± 3.5 21.9 ± 4.1 .535

Serum hemoglobin (g/dL) 9.6 ± 1.8 10.1 ± 1.7 .229

Serum albumin (g/dL) 2.8 ± 0.5 2.9 ± 0.5 .318

Total lymphocyte count (/mm3) 926 ± 598 1069 ± 691 .336

Steroid 19 (50) 14 (36.8) .247

Abbreviations: BMI, body mass index; IAD, Incontinence-associated dermatitis; PU, pressure ulcer. a Bristol Stool scale. b Septic, hypovolemic, cardiogenic shock. c Pre-albumin < 20 (mg/dL), albumin < 2.5 (g/dL) or NPO greater than 3 days.




reported a 36% incidence rate among 45 patients with fecal incontinence. These differences may, in part, be related to differences in the instruments used to measure IAD. The IADS instrument recognizes the slightest redness such as pink as IAD and gives a score while the instrument used in Driver’s study 10 identifi ed IAD only when the skin was red, weepy, and denuded. Likewise the Perineal Skin Assessment Tool utilized in Bliss’s study 16 also failed to identify mild erythema as IAD. Subjects in our study who were exposed to loose stool and demonstrated minimum redness identi-fi ed as having IAD. The second reason of the high incidence of IAD in this study may be related to characteristics of study participants. Subjects in our study tended to have liquid stools ranked as Bristol stool forms 5, 6, and 7.

The occurrence of PU was also lower in the structure skin care versus standard care group ( P = .001). Based on this fi nding, we hypothesize that the experimental skin care protocol helped reduce the frequency of PU development by preventing IAD and its propensity to compromise toler-ance of pressure and shear forces in the sacral area. This

standard skin care group (5.19 ± 3.41 vs 14.13 ± 11.7, t = 4.836, P < .001), indicating that the experimental group had less severe IAD than control group ( Table 4 ). Patients man-aged by the structured skin care protocol were also found to have a lower PU occurrence rate than were the standard care group (13.2% vs 50%; χ 2 = 11.936, P = .001) ( Table 5 ).

Relationship Between IAD and PU Development Multivariate analysis also found a statistically signifi cant relationship between IADS scores and the development of PUs ( P < .001). Patients with higher IADS scores had a higher likelihood of developing PUs (OR = 1.168. 95%CI = 1.074–1.271) ( Table 6 ). The ROC curve analysis revealed an area under the curve of .761, suggesting that higher IADS scores are associated with an increased likelihood of developing a PU (sensitivity 70.8%, specifi city 6.7%, using a cut-off value of 7) ( Figure 2 ).

■ Discussion

Study fi ndings demonstrate that a structured skin care protocol signifi cantly reduced the severity of IAD in the experiment group when compared with standard care. This result is consistent with that of the study of Beeckman and colleagues, 15 who compared a soap and water regimen to a structure skin care protocol, using a 3-in-1 disposable wash-cloth that included a no-rinse skin cleanser, emollient-based moisturizer, and dimethicone-based skin protectant.

We observed that nearly all patients with fecal inconti-nence had some evidence of IAD based on the IADS instru-ment. In contrast, Driver 10 reported a 50% occurrence rate in 16 patients with fecal incontinence. Bliss and associates 16

FIGURE 2. Receiver operating characteristic curve of Incontinence-Associated Dermatitis and its Severity.

TABLE 4.

The IADS Scores in the Experiment and Control Group (N = 75)

Experiment (N = 37)M ± SD(N)

Control (N = 38)M ± SD(N) P-value

IADS Score 5.19 ± 3.41 14.13 ± 11.7 < .001

Abbreviations: IADS, Incontinence-Associated Dermatitis and its Severity; M, mean; SD, standard deviation.

TABLE 6.

Relationship Between the IADS Score and Pressure Ulcers development (N = 75)

B SE P OR 95% CI for OR

Constant − 2.311 .496 < .001 0.099

IADS Score .155 .043 < .001 1.168 1.074-1.271

Abbreviations: IADS, Incontinence-Associated Dermatitis and its Severity; CI, confi dence interval; OR, odds ratio; SE, standard error.

TABLE 5.

Pressure Ulcer Occurrence in Experimental and Control Groups (N = 76)

Group

Experimental Group (n = 38),

n (%)Control Group (n = 38), n (%) P

Developed pressure ulcer

Yes 5 (13.2%) 19 (50%) .001

No 33 (86.8%) 19 (50%)




2. National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel . Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Washington, DC : National Pressure Ulcer Advisory Panel ; 2009 .

3. Defl oor T , Schoonhoven L , Fletcher J , et al. Statement of the European Pressure Ulcer Advisory Panel-pressure ulcer clas-sifi cation: differentiation between pressure ulcers and mois-ture lesions . J Wound Ostomy Continence Nurs . 2005 ; 32 : 302-306 .

4. Maklebust J , Magnan MA . Risk factors associated with having a pressure ulcer: a secondary data analysis . Adv Wound Care. 1994 ; 7 ( 6 ): 27-28 .

5. Gray M , Bohacek L , Weir D , Zdanuk J . Moisture vs pressure: making sense out of perineal wounds . J Wound Ostomy Continence Nurs. 2007 ; 34 ( 2 ): 134-142 .

6. Junkin J , Selekof JL . Prevalence of incontinence and associated skin injury in the acute care inpatient . J Wound Ostomy Continence Nurs. 2007 ; 34 ( 3 ): 260-269 .

7. Lyder CH , Clemes-Lowrance C , Davis A , Sullivan L , Zucker A . A structured skin care regimen to prevent perineal dermatitis in the elderly . J ET Nurs . 1992 ; 12 : 12-16 .

8. Clever K , Smith G , Bowser C , Monroe K . Evaluating the effi -cacy of a uniquely delivered skin protectant and its effect on the formation of sacral/buttock pressure ulcers . Ostomy Wound Manage . 2002 ; 48 ( 12 ): 60-67 .

9. Cole L , Nesbitt CA . Three year multiphase pressure ulcer prev-alence/incidence study: a regional referral hospital . Ostomy Wound Manage. 2004 ; 50 ( 11 ): 32-40 .

10. Driver DS. Perineal dermatitis in critical care patients . Crit Care Nurse. 2007 ; 27 : 42-46 .

11. Borchert K , Bliss DZ , Savik K , Radosevich DM . The inconti-nence-associated dermatitis and its severity instrument: devel-opment and validation . J Wound Ostomy Continence Nurs . 2010 ; 37 ( 5 ): 527-535 .

12. Lewis SJ , Heaton KW . Stool Form Scale as a useful guide to in-testinal transit time . Scand J Gastroenterol. 1997 ; 32 ( 9 ): 920-924 .

13. Lawshe CH . A quantitative approach to content validity . Pers Psychol. 1975 ; 28 : 563-575 .

14. The National Pressure Ulcer Advisory Panel . NPUAP pressure ulcer stages/categories . http://www.npuap.org/resources/edu-cational-and-clinical-resources/npuap-pressure-ulcer-stages-categories/National . Accessed March 2012.

15. Beeckman D , Schoonhoven L , Verhaeghe S , Heyneman A , Defl oor T . Prevention and treatment of incontinence-associated dermatitis: literature review . J Adv Nurs . 2009 ; 65 ( 6 ): 1141-1154 .

16. Bliss DZ , Savik K , Thorson MA , et al. Incontinence-associated der-matitis in critically ill adults: time to development, severity, and risk factors . J Wound Ostomy Continence Nurs . 2011 ; 38 ( 4 ): 1-13 .

fi nding is consistent with statements of the European Pressure Ulcer Advisory Panel that IAD and PUs often coexist. 3 In addition, implementation of aggressive inter-ventions to reduce the exposure of the skin to stool, includ-ing the use of an anal plug, or fecal management system may have reduced likelihood of PU development.

Multivariate analysis revealed an association between higher IADS scores and development of a PU ( P < .001). Specifi cally, patients with higher IADS scores (indicating more severe IAD) had a higher chance of developing a PU (OR = 1.168, 95% CI = 1.074-1.271) ( Figure 2 ). ROC curve analysis revealed an area under the curve of .761, suggest-ing that IADS scores might be associated with an increased likelihood of development of a PU. Additional research is indicated to evaluate the relationship between IAD and PU risk.

■ Conclusion

A structured skin care program was developed for ICU pa-tients with fecal incontinence. Implementation of the structured regimen decreased IADS scores and the occur-rence of PU. Multivariate analysis revealed that higher IADS scores were associated with a greater likelihood of developing a PU.

■ ACKNOWLEDGMENTS

We thank K Borchert, MS, RN, CWOCN, ACNS-BC, for per-mitting the use of the IADS instrument for this study. We thank J. M. Hwang, RN, for the statistical analysis. We also thank J. H. Park, BSN, RN, CWON; K. M. Kwon, MSN, RN; E. S. Back, BSN, RN, CWOCN; M. S. Kim, MSN, RN; and K. D. Jung, MD, for participating in the expert group. We thank K. W. Baek, BSN, RN, COCN; H. J. Do, BSN, RN; M. J. Kim, MSN, RN, CWON; and W. I. Jung, BSN, RN, for assisting with data collection.

■ References 1. Gray M , Beeckman D , Bliss DZ, , et al. Incontinence-associated

dermatitis: a comprehensive review and update . J Wound Ostomy Continence Nurs . 2012 ; 39 ( 1 ): 61-74 .


WOUND CARE Effect of a Structured Skin Care Regimen on ...

Documents

Transcript of WOUND CARE Effect of a Structured Skin Care Regimen on ...