Examining the relationship between IAD and patient demographics, clinical characteristics, and pressure injuries using International Pressure Ulcer Prevalence™ Survey data

PURPOSE: Incontinence associated dermatitis (IAD) is a type of irritant contact dermatitis in patients with fecal incontinence (FI) and/or urinary incontinence (UI). Limited evidence exists for IAD risk factors and how IAD relates to pressure injuries (PIs). The International Pressure Ulcer Prevalence™ Survey (IPUP) provides a large database from a variety of care settings and patient populations. This work explores patient and clinical characteristics associated with IAD and the relationship between IAD and PIs.

METHODS: The 2016 annual IPUP survey included a new IAD question, asking whether a patient had IAD or not. A logistic regression was used to examine risk factors of IAD. Chi-squared tests were used to explore the relationship between IAD and PIs. Study exempt status was determined by Schulman IRB (201605347).

RESULTS: The 2016 IPUP survey data (n=117,988) was filtered for subjects with complete valid range data in North America (n=49,917) and limited to patients with UI, FI or a Fecal Management System (n=12,286). IAD prevalence was 17.4%. Regression analysis demonstrated significant relationships between IAD and the following factors: age, unit type, weight, longer LOS, more linen layers, low Braden score, and bed-restricted mobility (p<0.05). Patients with FI or FI and UI were more likely to have IAD than patients with UI alone (p<0.01). Chi-squared tests indicate that patients with IAD were more likely to have a PI (p<0.001).

DISCUSSION: This work represents the largest evaluation of IAD factors using a robust statistical model. IAD and PIs are challenging to differentiate but require distinct treatment strategies. Risk factors that are known to be associated with PIs were also found to be risk factors for IAD. Moreover, our data demonstrates that patients with IAD are more likely to also suffer from PIs. This work highlights the importance of exploring causal relationships between IAD and PIs.