Abstract: Incontinence-Associated Dermatitis (IAD) in a Long Term Acute Care (LTAC) Facility: Findings from a 12 Week Prospective Study (43rd Annual Conference (June 4-8, 2011))
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5011 Incontinence-Associated Dermatitis (IAD) in a Long Term Acute Care (LTAC) Facility: Findings from a 12 Week Prospective Study

Mary Arnold-Long, MSN, RN, CRRN, CWOCN-AP, ACNS-BC, Drake Center, Clinical Nurse Specialist, Mason, OH, LuAnn Reed, MSN, RN, C, CRRN, WCC, The Drake Center, Wound Care Program Manager, Cincinnati, OH, Kari Dunning, PhD, PT, Department of Rehabilitation Services -University of Cincinnati/Drake Center, Assistant Professor - Epidemiologist/Director of Clinical Research, Cincinnati, OH and Jun Ying, PhD, Institute for the Study of Health, University of Cincinnati, Bistatistician, Assistant Professor, Cincinnati, OH
Introduction/Significance:  IAD prevalence has been reported in acute care (Junkin, 2005; Gray, 2006) and nursing homes (Bliss, 2006).  Prior to our 2006 pilot study, there were no published reports of LTAC IAD prevalence (Arnold-Long, 2008).  This study received WOCN Center for Clinical Investigation’s 2007 Sage Grant.

 Purpose/Aim: 

  1. Describe IAD and PU prevalence in one LTAC.
  2. Describe IAD and PU facility-acquired incidence in one LTAC.
  3. Describe factors associated with IAD and PU development in one LTAC.

 Method/Measurement Summary:  The study utilized a prospective design to follow LTAC patients up to 12 weeks post-admission.  IAD and PU at admission and/or during follow up, along with risk factors, were observed. A modified Sage data collection form incorporating components of Brown’s perineal dermatitis grading scale (Brown, 1993) was utilized.  171 patients were studied September 1 – November 30, 2008. Prevalence was IAD or PU rate at admission.  Incidence was the rate of newly developed IAD or PU. Prevalence and incidence were summarized using frequencies (in %’s).  Their associations to risk factors were assessed using logistical regression models.

 Results:  IAD prevalence was 22.8%.  PU prevalence was 35.1%.  After admission, 10 cases of IAD (incidence 7.6%) and 6 cases of PU (incidence 5.3%) developed with medians of 13.5 days and 6.5 days to develop IAD and PU respectively.  In addition to urinary and fecal incontinence, use of tube feeding and incontinence pads were found associated to new development of IAD (p-values<0.05).  Urinary incontinence and incontinence pad use were marginally associated with development of PU (p-values <0.01).

 Conclusions:  This LTAC’s admission IAD prevalence (22.8%) is less than reported acute care prevalence (27%) but quadruple reported nursing home prevalence (5.7%).  This LTAC’s facility-acquired IAD incidence (7.6 %) is more than twice reported nursing home incidence (3.4%).  Analysis will be complete by 2011 WOCN Conference.

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