Transcript Controlled Group

Exploration of the Effect of
Standardized Skin Care Model on
Incontinence Associated Dermatitis of
Critically Ill Patients
Tao-Fen Shiung, RN, MSN.1
Ji-Han Chen, RN, MSN.2
Shin-Shang Chou, RN, MBA, DNS.3
1 & 2 Intensive Care Unit, Taipei Veterans General Hospital, Taipei, Taiwan
3 Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
Background
‫ ﻪ‬Incontinent critical ill patients are at high risk for
incontinence-associated dermatitis (IAD).
‫ ﻪ‬Because of IAD, skin may bleed, progress to painful
ulceration, finally result in secondary infection. All
symptoms cause patients’ discomfort and increase
treatment costs.
‫ ﻪ‬Skin is the first defense system. It is vital to keep it
intact.
‫ ﻪ‬It is a daily challenge for healthcare professionals to
maintain a healthy skin in patients with incontinence. 2
Objective
‫ ﻪ‬The purpose of this study was
to test an evidence-based skin care model
for critically ill patients.
3
Methods
Design
A quasi-experimental study design
Setting
42-bed medical surgical ICU in a medical
center in Taiwan.
Data collection
From May till December 2011
4
Methods-Subjects
‫ ﻪ‬The inclusion criteria were
‫ ﻩ‬Aged > 18
‫ ﻩ‬Incontinent of urine or/and fecal
‫ ﻪ‬The exclusion criteria were
‫ ﻩ‬The patients admitted with Incontinence
Associated Dermatitis (IAD).
‫ ﻩ‬Patients with any Dermatologic diagnosis.
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Methods
‫ ﻪ‬Phase 1 (May - August)
‫ ﻪ‬Controlled group
‫ ﻪ‬Usual skin care by the ICU nurses based on their
experiences. (cleanser and zinc oxide barrier)
‫ ﻪ‬Phase 2 (September - December)
‫ ﻪ‬Experimental group
‫ ﻪ‬Standardized skin care (no-rinse cleanser and
dimethicone barrier)
6
Methods
Data collection
Patients’demographic data
Assessment :The Perineal Assessment Tool, PAT
the type of irritant
the duration of contact
the condition of the perineal skin
the total number of contributing factors
Daily checklist of patients’skin and incontinence condition
Data collection period：1-14 day or transfer to ward
7
Data Collection Period
O1+O2
X1
O2
(Day1-14)
O1+O2
X2
O2
(Day1-14)
X1: Current Skin Care
X2: Standardized Skin Care Model
O1：Patients’ Demographic information
O2：Perineal Assessment Tool ( PAT) and Daily Checklist of
Skin and Incontinence Condition
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Standardized Skin Care
‫ ﻪ‬PAT ≦ 6
‫ ﻩ‬Preventive interventions
‫ ﻯ‬Clean skin with no-rinse skin cleanser for non-IAD
patients
‫ ﻪ‬PAT > 6 or IAD
‫ ﻩ‬Protective interventions
‫ ﻯ‬IAD patients with non skin breakdown : No-rinse skin
cleanser and skin barrier cream (Dimethicone).
‫ ﻯ‬IAD patients with skin breakdown: No-rinse skin cleanser
and no sting barrier spray(Hexamethyldisiloxane).
9
Methods
Conducting the study
Education program for all nursing staff
Implement the standardized skin care into
daily practice
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Results
11
Results-Demographic characteristics
Experimental
N=61
N %
Control
N=50
N %
Gender
Male
40 (65.6)
34 (68.0)
Female
21 (34.4)
16 (32.0)
Incontinence
Fecal
Fecal&Urine
53 (86.9)
44 (88.0)
8 (13.1)
6 (12.0)
χ2
p
.26
.787
.03
.86
12
Results-Demographic characteristics
Experimental
N=61
Mean (SD)
Control
N=50
Mean (SD)
Age
65.2 (18.0)
APACHE II
t
p
68.1 (18.2)
.083
.41
21.2 (7.7)
21.2 (6.6)
-.04
.97
ICU stay
8.93 (3.4)
9.78 (3.6)
1.28
.204
Albumin
2.5 (0.5)
2.3 (0.6)
-1.68
.095
PAT score
6.98 (2.61)
6.73 (2.59) -1.54
.124
Chronic disease
1.9 (1.2)
1.9 (1.3)
.24
.81
13
Results-Demographic characteristics
Experimental
N=541(day/person)
Control
N=483(day/person)
N %
N %
Conscious
Clear
296 (54.7)
257 (68.0)
Unclear
245 (45.3)
226 (32.0)
Limb edema
No
214 (39.6)
267 (55.3)
Yes
327 (60.4)
216 (44.7)
χ2
p
.23
.63
25.33
.000
14
Results- IAD incidence rates
Experimental
N=61
Control
N=50
N %
N %
IAD incidence
Yes
No
19 (31.1)
26 (52.0)
42 (68.9)
24 (48.0)
χ2
p
4.957
.026
15
Results – IAD Severity
Experimental
N=95
N %
Control
N=159
N %
IAD redness
Mild
92 (96.8)
121 (76.1)
Moderate
3 (3.2)
36 (22.6)
Sever
0 (0)
10-20cm
p
18.95
.000
8.275
.004
2 (1.3)
IAD area
<10cm
χ2
92 (96.8)
136 (85.5)
3 (3.2)
23 (14.5)
16
Subjects Collected at 1-14 Day (Person/Day)
Days
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Total
Controlled
Group
50
50
50
49
45
43
36
33
27
25
22
20
18
15
483
Experimental
Group
61
61
61
61
54
49
42
37
27
26
21
18
13
10
541
Total
111
111 111 110
99
92
78
70
54
51
43
38
31
25
1024
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IAD Incidence Rate (Per Day)
Days
Controlled
group
Experimental
group
1
0
2
0.02
3
0.08
4
0.22
5
0.33
6
0.44
7
0.47
8
0.42
0
0.00
0.02
0.08
0.11
0.22
0.31
0.30
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Comparison of intervention effect between the two groups
variables
Regression
coefficient
Standard
error
IAD incidence
Experimental group
Controlled group
control(d2/d1)
control(d3/d1)
control(d4/d1)
control(d5/d1)
control(d6/d1)
control(d7/d1)
control(d8/d1)
.000000
.000000
0b
.020000
.080000
.224490
.333333
.441860
.472222
.424242
.053704
.072444
0
.075949
.075949
.076336
.078030
.078980
.083005
.085171
Difference of slopes from day1 to day2 between 2 groups
Difference of slopes from day1 to day3 between 2 groups
Difference of slopes from day1 to day4 between 2 groups
Difference of slopes from day1 to day5 between 2 groups
Difference of slopes from day1 to day6 between 2 groups
Difference of slopes from day1 to day7 between 2 groups
Difference of slopes from day1 to day8 between 2 groups
-.020000
-.063607
-.142523
-.222222
-.217371
-.162698
-.126945
.102452
.102452
.102739
.105467
.107447
.112639
.116257
t
p
.000
.000
.
.263
1.053
2.941
4.272
5.595
5.689
4.981
.
-.195
-.621
-1.387
-2.107
-2.023
-1.444
-1.092
1.000
1.000
.
.792
.292
.003
.000
.000
.000
.000
.
.845
.535
.166
.035
.043
.149
.275
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Discussion
‫ ﻩ‬50 patients was received usual skin care by the
ICU nurses based on their experiences, 26 patients
with IAD, the IAD incidence rate was 52%.
‫ ﻩ‬61 patients was received standardized skin care ,
19 patients with IAD, the IAD incidence rate was
31%.
‫ ﻩ‬Standardized skin care model can reduce the
incidence of IAD.
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Discussion
‫ ﻪ‬IAD did not develop in all patients with fectal
incontience, therefore, Zinc Oxide is playing a
role for preventing IAD.
‫ ﻪ‬When choosing skin protection product, ease of
use and efficacy should both be taken into
account.
‫ ﻪ‬No rinse cleanser, Dimethicone cream and spray
may be a better choice.
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Conclusions
This study results provide a strong
evidence for clinicians in reducing
IAD incidence by application
standardized skin care in critically
ills.
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Thanks for your attention
23