Reducing Hospital-Acquired Pressure Ulcers by Preventing Incontinence Associated Dermatitis

Background.  Both urinary and fecal incontinence are common problems for hospitalized patients, and are risk factors for the development of incontinence associated dermatitis (IAD).  In addition to the added discomfort and treatment cost associated with IAD, it has been identified as a risk factor for hospital-acquired pressure ulcers (HAPU).    Since the Centers for Medicare and Medicaid Services (CMS) stopped reimbursing hospitals for HAPU’s Stage III or greater, the prevention of IAD is quickly becoming increasingly more important.

Purpose.  The purpose of this study was to measure the impact of a new skin care protocol on the occurrence of IAD and HAPU in a critically ill patient population. 

Methods.  In October, 2014 our current skin care products were evaluated. Different products were brought to support our new skin care protocol, including pre-packaged bathing cloths and Dimethicone-impregnated cream cloths for incontinence cleanup and skin protection. We did one day point prevalence studies on a 35-bed critical care unit before and after the implementation of the new skin care protocol, and assessed all incontinent patients for IAD.  We also reviewed the number of HAPU’s for each of the years 2014 and 2015.

Results. Before the new skin care protocol, the one day point prevalence for IAD was 82% (14/17).  The point prevalence repeated two weeks after the initiation of the new skin care protocol was 0% (0/19).  The total number of HAPU’s in 2014 was 93 (rate 0.70) and 2015 year-to-date is 53 (mean rate 0.55), representing a rate reduction of 0.15.  Each quarter of 2015 the rate has continued to decrease (Q1=0.75, Q2=0.47, Q3=0.39).

Conclusions. The initiation of the new skin care protocol resulted in a measurable reduction of both IAD and HAPU.  Including the cost of additional products, we expect to realize a total HAPU treatment savings over $1,000,000 for 2015.