Incontinence-Associated Dermatitis (IAD) in a Long Term Acute Care (LTAC) Facility: Completion of 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 have been no published reports regarding IAD in long term acute care.  The results from a pilot study performed at the facility 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 was collected prospectively for twelve consecutive weeks on the LTAC units at the facility utilizing a modified Sage data collection form that incorporates components of Brown’s perineal dermatitis grading scale (Brown, 1993).  Data collection ended November 15, 2008.
Statistics:  In Aim 1, the prevalence of IAD or PUs was summarized by descriptive statistics of frequency.  In Aim 2, the development of IAD or PUs was assessed using a Kaplan-Meier survival curve.  On admission, IAD prevalence was 23.4% and PU prevalence was 35.7%.  After admission, 10 cases of IAD and 5 cases of PU developed.  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 were performed using a SAS version 9.1 software (SAS, Cary, NC) package.  P-values <0.05 will be considered statistically significant.  Data for this Aim will be available at presentation deadline.