Decreasing Incontinence-Associated Dermatitis in the Surgical Intensive Care Unit: A Quality Improvement Project.

PURPOSE: The purpose of this quality improvement (QI) project was to determine if use of an algorithm focusing on skin care in patients with fecal and urinary incontinence reduces the rate of hospital-acquired incontinence-associated dermatitis (IAD) over a period of 4 months. PARTICIPANTS AND SETTING: The QI setting was an 18-bed surgical intensive care unit (SICU) in an acute care urban hospital located in the southeastern United States. Two hundred eleven patients participated in this pre/postintervention QI project. APPROACH: The algorithm for skin care used evidence-based bundled interventions for patients with fecal and urinary incontinence. The project comprised education of the SICU nursing staff in January 2018 and implementation of the algorithm from February 5, 2018, to June 5, 2018. Weekly chart reviews were conducted to determine algorithm compliance, documentation of fecal and urinary incontinence, and accuracy of IAD documentation. Descriptive statistics were used to determine the rate of hospital-acquired IAD, algorithm compliance, and average length of time from admission to the onset of hospital-acquired IAD. OUTCOMES: Seventy-nine individuals with incontinence were included in the 3-month preintervention period and 132 individuals with incontinence in the 3-month postintervention period. We observed a 24% reduction in the rate of hospital-acquired IAD following implementation of the algorithm (29% vs 5%). The average length of time from admission to the onset of hospital-acquired IAD increased from 15 days in February 2018 to 25 days in May 2018. IMPLICATIONS FOR PRACTICE: Our experience with this QI project suggest that IAD can be identified and managed at the bedside by first clinical nursing staff without expertise in skin assessment and wound care.

Does colostomy irrigation affect functional outcomes and quality of life in persons with a colostomy?

BACKGROUND: Colostomy irrigation may be used by patients with colostomies to regulate bowel evacuations by stimulating emptying of the colon at regularly scheduled times. OBJECTIVE: This Evidence-Based Report Card reviews the effect of colostomy irrigation on frequency of bowel evacuation, flatus production, odor, and health-related quality of life. SEARCH STRATEGY: We systematically reviewed the literature for studies that evaluated health-related quality of life in persons aged 18 years or older with colostomies of the sigmoid or descending left colon. A professional librarian performed the literature search, which yielded 499 articles using the search terms "colostomy," "colostomies," "therapeutic irrigation," "irrigation," and "irrigator." Following title and abstract reviews, we identified and retrieved 4 studies that met inclusion criteria. FINDINGS: Colostomy irrigation reduces the frequency of bowel evacuations when compared to spontaneous evacuation and containment using a pouching system. Regular irrigation is associated with reductions in pouch usage. This change in bowel evacuation function frequently results in absence of bowel evacuations for 24 hours or longer, enabling some to discontinue ongoing use of a pouching system. Subjects using CI report reductions in flatus and odors associated with presence of a colostomy. One study was identified that found persons using CI reported higher health-related quality of life than did those who managed their colostomies with spontaneous evacuation using the Digestive Disease Quality of Life-15, but no differences were found when health-related quality of life was measured using the more generic instrument, the Medical Outcomes Study: Short Form-36. CONCLUSION: Instruction on principles and techniques of colostomy irrigation should be considered when managing patients with a permanent, left-sided colostomy.

Incontinence-associated dermatitis in a long-term acute care facility.

PURPOSE: The objectives of this study were to (1) measure the prevalence of incontinence-associated dermatitis (IAD) and pressure ulcers (PUs) on admission to a long-term acute care (LTAC) facility; (2) identify factors associated with IAD and PU on admission to an LTAC facility; and (3) measure the incidence of incontinence and PUs in LTAC patients. DESIGN: This was a longitudinal, repeated-measures study; data were collected over a 12-week period. SUBJECTS AND SETTING: One hundred seventy-one patients, with a median age of 55 years. Fifty-four women and 117 men were evaluated. The sample comprises all patients admitted to the 4 LTAC units at the Drake Center in Cincinnati, Ohio. METHODS: Patients were examined using the "Hospital Survey on Incontinence and Perineal Skin Injury" instrument within 24 hours of admission and they were reevaluated weekly using the same tool until discharge. All data were collected by the Drake Center Advanced Wound Team. Prevalence was defined as the frequency of PUs or IAD identified at admission. Incidence was calculated using the formula: the number of new IAD cases/the number of patients without IAD on admission. Pressure ulcer incidence was measured using 2 formulas: (1) the number of patients with new PUs/the number of all patients who did not have PU on admission and (2) the number of patients with new PUs or a PU in a new location/the number of all patients. RESULTS: Thirty-nine out of 171 patients had IAD on admission, yielding a prevalence of 22.8%. Sixty of 171 patients had a PU on admission, yielding a prevalence of 35.1%. Ten of 132 patients who did not have IAD at admission developed IAD during follow-ups, yielding a 7.6% incidence. Two PU incidence rates were measured; those patients without PUs on admission 3.6% (4/111) and all patients 8.2% (14/171). CONCLUSION: The LTAC admission PU prevalence rate in this study was greater than that reported previously in acute or long-term care settings. The LTAC PU incidence rate was less than those reported for both acute and long-term care settings. The LTAC IAD admission prevalence rate closely reflected the acute care rate but was substantially higher than the long-term care rate.