Incontinence-Associated Dermatitis (IAD) in a Long Term Acute Care (LTAC) Facility: A Prospective Study

Introduction/Significance:  Many wounds classified as Stage I and Stage II pressure ulcers may actually be attributable to IAD and not to pressure.  There are reports of IAD prevalence in both acute care (Junkin, 2005; Gray, 2006) and in nursing homes (Bliss, 2006).  However, there are no published reports regarding IAD in long term acute care.  In 2007, the Drake Center Advanced Wound Team performed a cross sectional pilot study among LTAC patients.  The results from this pilot study suggested the need for additional investigation.
Purpose/Aim:  This study has three specific aims:
1.      Describe the prevalence of IAD and PUs.
2.      Describe the nosocomial incidence of IAD and PUs.
3.      Describe factors associated with development of IAD and PUs.
Method Summary:  The study utilizes an observational repeated measured design.  Data will be collected prospectively for twelve consecutive weeks on the LTAC units at Drake Center utilizing a modified Sage data collection form that incorporates components of Brown’s perineal dermatitis grading scale (Brown, 1993).  Data collection ends November 15, 2008.
Planned Statistics:  In Aim 1, the prevalence of IAD or PUs will be summarized by descriptive statistics of frequency.  In Aim 2, the development of IAD or PUs will be assessed using a Kaplan-Meier survival curve.  In Aim 3, two or more survival curves recognized by a risk factor will be assessed and compared using log-rank tests.  Multiple Cox proportional hazard models will be used to assess the association of development of IAD or PUs to multiple risk factors and their interactions.  Statistical analyses will be performed using a SAS version 9.1 software (SAS, Cary, NC) package.  P-values <0.05 will be considered statistically significant.