Authors (including presenting author) :
Chung SP (1), Chong HM (2), Chan CH (3), Lam MS (4)
Affiliation :
(1) Wound Care Team, New Territories West Cluster (2) Department of Surgery, New Territories West Cluster (3) Department of Medical & Geriatrics, New Territories West Cluster (4) Nursing Services Division, Pok Oi Hospital & Tin Shui Wai Hospital
Keyword 1: :
Incontinence-Associated Dermatitis
Keyword 2: :
Pressure Injury Prevention
Keyword 3: :
Guideline Implementation
Keyword 5: :
Clinical Audit
Keyword 6: :
Quality Improvement
Introduction :
Incontinence-Associated Dermatitis (IAD) is a significant, modifiable risk factor for hospital-acquired Pressure Injuries (PI), impacting patient outcomes and resource use. IAD damages the skin’s natural barrier, increasing its susceptibility to pressure, shear, and moisture, thereby creating a direct pathway for the development of full-thickness PIs. A persistent gap remains between evidence-based guidelines and consistent bedside practice. Recognising the pivotal role of supporting staff in delivering fundamental care and early detection, Tin Shui Wai Hospital launched a hospital-wide implementation programme in October 2025, which was led by the cluster Wound Care Team, to standardise IAD prevention across Medical, Surgical, Oncology, Emergency Medical, and Day Wards.
Objectives :
This initiative aimed to: 1) Systematically translate IAD prevention guidelines into standardised, actionable protocols for supporting staff; 2) Achieve and sustain a high level of adherence, targeting a compliance rate of ≥95% in structured audits; 3) Establish a monitoring framework to evaluate impact on clinical practice and trends in IAD and PI incidence.
Methodology :
The programme was structured around the Plan-Do-Check-Act (PDCA) cycle. In the Plan phase, guidelines were converted into practical resources: an instructional video integrating key components such as correct barrier cream application, repositioning, and infection control, and a one-page clinical guide designed for supporting staff’s easy reference. The Do phase involved a train-the-trainer workshop for designated link nurses, who then conducted mandatory ward-based training for all supporting staff. The Check phase comprised a rigorous audit schedule (initial, then annual and for new staff), conducted by link nurses under the mentorship of specialist Stoma/Wound and Gerontology Nurse Consultants. The Act phase involved escalating audit results and feedback to nursing leadership to guide targeted refinements.
Result & Outcome :
Preliminary data from the initial implementation phase are promising. Training Participation was high, with 93% of targeted supporting staff completing the programme (7% absent due to leave/ward duty). Practice Compliance, as measured by the first audit cycle, was exceptional: all 82 supporting staff audited demonstrated 100% compliance with documented IAD prevention practices. Regarding System Impact, the PDCA framework has established a functional feedback mechanism, confirming high-fidelity protocol implementation and providing a clear baseline for ongoing monitoring. The ultimate impact on PI incidence remains under longitudinal surveillance.
