Risk Factors for Incontinence-Associated Dermatitis in Critically Ill Patients with Incontinence: A Systematic Review and Meta-analysis.

ABSTRACT

PURPOSE: This systematic review analyzed evidence related to risk factors for Incontinence Associated Dermatitis (IAD) in critically ill incontinent patients. METHOD: Systematic review and meta-analysis. SEARCH STRATEGY Eight databases, including PubMed, Embase, CINAHL, Cochrane Library, and Web of Science, were searched for studies published in the English language. The China National Knowledge Infrastructure, WanFang Data, and Chinese Scientific Journal Database were also searched for studies evaluating risk of IAD in critically ill incontinent patients published in the Chinese language. FINDINGS: Twenty-four studies with moderate-to-high methodological quality were included. Significant risk factors for developing IAD were being older [odds ratio (OR) = 1.06, 95% confidence interval (CI) 1.02-1.10, P = .007], fever (OR = 2.57, 95% CI 1.87-3.57, P < .00001), diagnosed with consciousness disorder (OR = 5.70, 95% CI 2.28-14.22, P = .0002), having higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR = 1.71, 95% CI 1.25-2.35, P = .0009), lower Braden score (OR = 0.73, 95% CI 0.56-0.96, P = .02), lower oxygen saturation (OR = 2.76, 95% CI 1.52-5.00, P = .0008), double incontinence (OR = 4.10, 95% CI 2.34-7.17, P < .00001), liquid stool (OR = 6.55, 95% CI 4.12-10.41, P < .00001), frequent incontinence (OR = 1.21, 95% CI 1.03-1.43, P = .02), and higher perineal assessment tool (PAT) score (OR = 3.18, 95% CI 1.76-5.76, P = .0001). IMPLICATIONS Findings of this systematic review and meta-analysis suggest that healthcare providers should consider risk factors such as older age, fever, consciousness disorder, higher APACHE II score, lower Braden score and double incontinence matter when developing strategies for the prevention and management of IAD in critically ill incontinent patients.