Associations between individual characteristics and incontinence-associated dermatitis: A secondary data analysis of a multi-centre prevalence study
Introduction
Maintaining and enhancing skin integrity of patients and residents is an internationally and nationally widely agreed upon goal within acute and long term care. During the last years the phenomenon of incontinence-associated dermatitis in the adult population gained increasing attention in clinical practice and research (Defloor et al., 2005, Ersser et al., 2005, Farage et al., 2007). There is emerging evidence that incontinence-associated dermatitis is highly prevalent especially in high risk settings like intensive care units or in geriatric care (Beeckman et al., 2011, Borchert et al., 2010, Junkin and Selekof, 2007, Long et al., 2012). Incontinence-associated dermatitis is a term characterising inflammation and tissue damage to the vulva, perineum, perianal region and buttocks in persons with urinary and/or faecal incontinence. Dermatitis severity varies from inflamed erythematous skin to severe painful partial thickness wounds with or without infection (Gray, 2010). Prolonged exposures of the skin to urine and/or stool are the causal factors but the exact aetiology and pathophysiology are not fully understood. There is convincing evidence that overhydration of the stratum corneum, increased skin surface pH, faecal enzyme activity, increased bacterial colonisation and physical irritation in the form of frequent cleansing and friction contribute to incontinence-associated dermatitis development (Ersser et al., 2005, Farage et al., 2007, Gray et al., 2012).
On the other hand it is evident that not everybody who is incontinent of urine and/or stool is necessarily affected by incontinence-associated dermatitis. Comparable to other complex health problems predisposing factors to develop this condition are not entirely clear. Identifying incontinent persons at high risk for incontinence-associated dermatitis development might be beneficial in order to implement adequate preventive measures. Targeted incontinence and skin care might help to allocate interventions and resources more purposeful. Therefore the aim of the current investigation was to identify person and health-related variables most strongly associated with incontinence-associated dermatitis development in persons who are incontinent.
Section snippets
Study design and settings
This was a secondary data analysis of two nationwide cross-sectional studies in The Netherlands and Austria conducted in 2012 (Halfens et al., 2012, Lohrmann et al., 2012). Both studies were part of the International Prevalence Measurement of Care Problems (LPZ) project organised at the University Maastricht (Halfens et al., 2013, van Nie-Visser et al., 2013). In Austria data were obtained from hospital patients and nursing home residents. In The Netherlands hospital patients, care home
Participants
The flow of subjects is shown in Fig. 1. In The Netherlands n = 24.225 and in Austria n = 5866 person were considered eligible for the LPZ prevalence studies. Approximately 36% met the inclusion criteria for this analysis. The mean age was 74 (SD 17) years. Thirty seven per cent were affected by urinary and/or faecal incontinence. Proportions of subjects being only incontinent of urine or stool or both were lower (Table 1). Incontinence-associated dermatitis prevalence in the total sample was 2.3%.
Discussion
The objective of this study was to identify person characteristics most strongly associated with incontinence-associated dermatitis development. Based on a large sample of two European countries we identified that incontinent subjects with incontinence-associated dermatitis are more often male, are more often faecal incontinent, have more often diabetes mellitus, have a higher mean BMI and are overall more care dependent and show larger degrees of functional and psychical impairments. The
Limitations
The largest limitation of this research was the study design. Due to the cross-sectional nature we were unable to establish causal relationships. Due to voluntary participation of institutions and patients, residents, and clients, possible selection and non-response bias might have occurred. On the other hand we included all incontinent subjects from all settings and two countries that might support the generalizability of our findings. Available evidence suggests internal and external validity
Conclusions
Compared to previous evidence we analysed the largest sample of incontinent subjects so far. Given the comparability to previous findings our results provide consistent evidence that increased BMI, the presence of diabetes mellitus and faecal incontinence, moist skin and friction and shear problems place incontinent individuals at high risk for incontinence-associated dermatitis development. It is recommended to target preventive skin care interventions like gentle skin cleansing and skin
Conflict of interest
There are no conflicts of interest to report.
Funding
The data analysis and the manuscript preparation were conducted by the authors without any source of external funding. All authors are affiliated to universities.
Ethical approval
Not required. This is a secondary data analysis.
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