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Independent risk factors for the development of Incontinence-Associated Dermatitis (category 2) in critically ill patients with fecal incontinence: A cross-sectional observational study in 48 ICU units

Nele Van Damme UGent, Els Clays UGent, Sofie Verhaeghe UGent, Ann Van Hecke UGent and Dimitri Beeckman UGent (2018) International Journal of Nursing Studies.
abstract
Background. Critically ill patients suffering from fecal incontinence have a major risk of developing incontinence-associated dermatitis (IAD). The presence of moisture and digestive enzymes (lipase, protease) negatively influences skin barrier function. Additional risk factors will make some patients even more vulnerable than others. In order to provide (cost) effective prevention, this specific patient population should be identified timely. Objectives. To identify independent risk factors for the development of IAD category 2 (skin loss) in critically ill patients with fecal incontinence. Design. A cross-sectional observational study. Setting and participants. The study was performed in 48 ICU wards from 27 Belgian hospitals. Patients of 18 years or older, with fecal incontinence at the moment of data collection, were eligible to participate. Patients with persistent skin redness due to incontinence (IAD category 1) were excluded. Methods. Potential risk factors were carefully determined based on literature and expert consultations. Data were collected over a period of eight months by trained researchers using patient records and observation of skin care practices. At the time a patient was included in the study, all relevant data from the past six days, or since admission at the ICU, were recorded. Simultaneously, direct skin observations were performed and high definition photographs were ratified by an expert IAD researcher. A multiple binary logistic regression model was composed to identify independent risk factors. Variables with P < 0.25 in single binary logistic regression analyses were added to the multiple model using a forward procedure. A cut-off value of P < 0.1 was established to retain variables in the final model. Nagelkerke’s R² and Hosmer- Lemeshow statistic were calculated as measures of model fit. ACCEPTED MANUSCRIPT 3 Results. The sample comprised of 206 patients, of which 95 presented with IAD category 2, and 111 were free of IAD. Seven independent risk factors were identified: liquid stool [odds ratio (OR) 4.69; 95% confidence interval (CI) 2.28–9.62], diabetes (OR 2.89; 95% CI 1.34– 6.27), age (OR 1.05; 95% CI 1.02-1.08), smoking (OR 2.67; 95%CI 1.21-5.91), non-use of diapers (OR 2.97; 95% CI 1.39-6.33), fever (OR 2.60; 95% CI 1.23-5.53), and low oxygen saturation (OR 2.15; 95% CI 1.03-4.48). Nagelkerke’s R² was 0.377. The Hosmer-Lemeshow statistic indicated no significant difference between the observed and expected values (p = 0.301). Conclusions. Liquid stool, diabetes, age, smoking, non-use of diapers, fever, and low oxygen saturation were independently associated with IAD category 2 in critically ill patients with fecal incontinence.
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author
organization
year
type
journalArticle (original)
publication status
in press
subject
keyword
critical illness, fecal incontinence, incontinence-associated dermatitis, intensive care units, perineal dermatitis, nursing, predictor, risk
journal title
International Journal of Nursing Studies
DOI
https://doi.org/10.1016/j.ijnurstu.2018.01.014
language
English
UGent publication?
yes
classification
U
copyright statement
I don't know the status of the copyright for this publication
id
8547959
handle
http://hdl.handle.net/1854/LU-8547959
date created
2018-02-06 10:27:53
date last changed
2018-03-15 10:59:00
@article{8547959,
  abstract     = {Background. Critically ill patients suffering from fecal incontinence have a major risk of
developing incontinence-associated dermatitis (IAD). The presence of moisture and digestive
enzymes (lipase, protease) negatively influences skin barrier function. Additional risk factors
will make some patients even more vulnerable than others. In order to provide (cost) effective
prevention, this specific patient population should be identified timely.
Objectives. To identify independent risk factors for the development of IAD category 2 (skin
loss) in critically ill patients with fecal incontinence.
Design. A cross-sectional observational study.
Setting and participants. The study was performed in 48 ICU wards from 27 Belgian
hospitals. Patients of 18 years or older, with fecal incontinence at the moment of data collection,
were eligible to participate. Patients with persistent skin redness due to incontinence (IAD
category 1) were excluded.
Methods. Potential risk factors were carefully determined based on literature and expert
consultations. Data were collected over a period of eight months by trained researchers using
patient records and observation of skin care practices. At the time a patient was included in the
study, all relevant data from the past six days, or since admission at the ICU, were recorded.
Simultaneously, direct skin observations were performed and high definition photographs were
ratified by an expert IAD researcher. A multiple binary logistic regression model was composed
to identify independent risk factors. Variables with P {\textlangle} 0.25 in single binary logistic regression
analyses were added to the multiple model using a forward procedure. A cut-off value of P {\textlangle}
0.1 was established to retain variables in the final model. Nagelkerke{\textquoteright}s R{\texttwosuperior} and Hosmer-
Lemeshow statistic were calculated as measures of model fit.
ACCEPTED MANUSCRIPT
3
Results. The sample comprised of 206 patients, of which 95 presented with IAD category 2,
and 111 were free of IAD. Seven independent risk factors were identified: liquid stool [odds
ratio (OR) 4.69; 95\% confidence interval (CI) 2.28--9.62], diabetes (OR 2.89; 95\% CI 1.34--
6.27), age (OR 1.05; 95\% CI 1.02-1.08), smoking (OR 2.67; 95\%CI 1.21-5.91), non-use of
diapers (OR 2.97; 95\% CI 1.39-6.33), fever (OR 2.60; 95\% CI 1.23-5.53), and low oxygen
saturation (OR 2.15; 95\% CI 1.03-4.48). Nagelkerke{\textquoteright}s R{\texttwosuperior} was 0.377. The Hosmer-Lemeshow
statistic indicated no significant difference between the observed and expected values (p =
0.301).
Conclusions. Liquid stool, diabetes, age, smoking, non-use of diapers, fever, and low oxygen
saturation were independently associated with IAD category 2 in critically ill patients with fecal
incontinence.},
  author       = {Van Damme, Nele and Clays, Els and Verhaeghe, Sofie and Van Hecke, Ann and Beeckman, Dimitri},
  journal      = {International Journal of Nursing Studies},
  keyword      = {critical illness,fecal incontinence,incontinence-associated dermatitis,intensive care units,perineal dermatitis,nursing,predictor,risk},
  language     = {eng},
  title        = {Independent risk factors for the development of Incontinence-Associated Dermatitis (category 2) in critically ill patients with fecal incontinence:  A cross-sectional observational study in 48 ICU units },
  url          = {http://dx.doi.org/https://doi.org/10.1016/j.ijnurstu.2018.01.014},
  year         = {2018},
}

Chicago
Van Damme, Nele, Els Clays, Sofie Verhaeghe, Ann Van Hecke, and Dimitri Beeckman. 2018. “Independent Risk Factors for the Development of Incontinence-Associated Dermatitis (category 2) in Critically Ill Patients with Fecal Incontinence:  A Cross-sectional Observational Study in 48 ICU Units .” International Journal of Nursing Studies.
APA
Van Damme, Nele, Clays, E., Verhaeghe, S., Van Hecke, A., & Beeckman, D. (2018). Independent risk factors for the development of Incontinence-Associated Dermatitis (category 2) in critically ill patients with fecal incontinence:  A cross-sectional observational study in 48 ICU units . International Journal of Nursing Studies.
Vancouver
1.
Van Damme N, Clays E, Verhaeghe S, Van Hecke A, Beeckman D. Independent risk factors for the development of Incontinence-Associated Dermatitis (category 2) in critically ill patients with fecal incontinence:  A cross-sectional observational study in 48 ICU units . International Journal of Nursing Studies. 2018;
MLA
Van Damme, Nele, Els Clays, Sofie Verhaeghe, et al. “Independent Risk Factors for the Development of Incontinence-Associated Dermatitis (category 2) in Critically Ill Patients with Fecal Incontinence:  A Cross-sectional Observational Study in 48 ICU Units .” International Journal of Nursing Studies (2018): n. pag. Print.