Incontinence and Incontinence-Associated Dermatitis
University of North Dakota College of Nursing, Grand Forks, USA. Advances in skin & wound care
(Impact Factor: 1.11).
03/2011; 24(3):126-40; quiz 141-2. DOI: 10.1097/01.ASW.0000395037.28398.6c
PURPOSE: To enhance the learner's competence in prevention and treatment of incontinence-associated dermatitis (IAD). TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to: 1. Relate the pathophysiology of IAD to the development of signs and symptoms. 2. Use assessment and intervention tools in the care of patients with IAD. 3. Construct an effective plan of care for patients with IAD. ABSTRACT: Incontinence is a prevalent problem and can lead to many complications. Both urinary and fecal incontinence can result in tissue breakdown, now commonly referred to as incontinence-associated dermatitis. This article addresses the types of incontinence, its etiology and pathophysiology, assessment, prevention and treatment, and the latest research.
Available from: Sue Woodward
- "Incontinence can lead to numerous complications. One of the most common complications is perineal skin breakdown (Gray, 2010; Langemo et al, 2011). The terminology used to describe perineal skin breakdown caused by incontinence is heterogeneous and rather confusing; more than 18 different terms occur, ranging from incontinence-associated dermatitis to skin maceration, perineal dermatitis, incontinence dermatitis, diaper dermatitis, napkin dermatitis, napkin rash and napkin erythema (Beeckman et al, 2009). "
Available from: unimaas.nl
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ABSTRACT: The aim of this study was to examine interrater reliability and agreement of the diagnosis of moisture lesions as defined by the European Pressure Ulcer Advisory Panel.
Differentiation between superficial pressure ulcers and moisture-related skin damages is difficult. To enhance the precision of the identification of moisture lesions, the European Pressure Ulcer Advisory Panel provided wound- and patient-related characteristics. Empirical evidence regarding interrater reliability and agreement among nurses for the detection of moisture-related skin damages in clinical practice is lacking.
Home care clients (n = 339) were independently assessed twice by trained nurses. A head to toe skin inspection was conducted.
For the diagnosis of moisture lesion (yes/no), nurses exactly agreed in 95% of all assessed clients. Interrater reliability was intraclass correlation coefficient (1,1) = 0.67 (95% CI 0.61-0.73).
Nurses were able to differentiate between home care clients with and without moisture lesions but assessment results contained a high degree of measurement error. It seems that the descriptions for the identification of moisture lesions provided by the European Pressure Ulcer Advisory Panel do support the diagnostic process but reliability must be enhanced.
Because of low interrater reliability, it is questionable whether the diagnosis of moisture lesions in clinical practice is valid. Measurement error is too high to make adequate inferences for individuals. Definitions and descriptions provided by the European Pressure Ulcer Advisory Panel, provisions of a single training and images are not sufficient to achieve acceptable interrater reliability in clinical practice.
Available from: Diane L Krasner
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ABSTRACT: Deficiencies in the current pressure ulcer classification system create the impetus for the current discourse on the clinical, legal, and economic implications of staging and considering shifting the paradigm in pressure ulcer description and assessment.
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