Authors: (including presenting author): :
Chan YY(1), Chu MW(1), Li KY(1), Poon SW(1), Ng SY(1), Cheng HY(1)
Affiliation: :
(1) Convalescence, Department of Rehabilitation and Extended Care, Wong Tai Sin Hospital
Keyword 1: :
Incontinence Associated Dermatitis
Keyword 3: :
Prevention and Management
Keyword 4: :
Incontinence Care
Keyword 5: :
Geriatric Nursing
Introduction: :
IAD is a global health problem which is commonly affecting hospitalized patients especially in weak, long-term geriatric care due to prolonged exposure to the urine and faeces (Kottner & Dissemond, 2025). The risk of occurrence of IAD among geratric patients is 35.4% to 47.7 worldwide (Grden et al.,2020). The prevalence of IAD ranges from 4.3% to 52% and incidence rate ranges from 3.4% to 50% (Ferreira et al., 2020). The skin damage from IAD increased the risk of pressure injuries development, catheter-related urinary tract infection (CAUTI) and even prolonged their length of stay or readmission in hospital which may increase the financial burden on healthcare cost (Kayser, Koloms, Murray, Khawar & Gray, 2021). Wong Tai Sin Hospital (WTSH) convalescent ward is an extended care unit which receives step-down cases from acute hospitals including Kwong Wah Hospital (KWH) and Queen Elizabeth Hospital (QEH). Over 90% of patients under care were fragile geriatric elderly patients with double incontinence which is the risk factor of developing IAD. 6-18% of patients had IAD upon admission but nursing staff are not familiar with the IAD classification and management technique. Also, IAD and pressure injury were frequently misclassified by healthcare workers (Ousey et al., 2017). Healthcare staff and carers’ knowledge in IAD care is the key component to prevent IAD development and worsening. The aim of this program is to assess the knowledge regarding IAD and improve the IAD care among Nurses, Patient Care Assistants (PCAs), and fill up the practice gap in managing IAD. A pilot study “Prevention and Management Program of IAD” has been launched in one convalescence ward.
Objectives: :
1. Enhance nurses’ and PCAs knowledge in IAD care and early detection of IAD 2. Establish structured clinical workflow in managing IAD patient 3. Educate patient relatives or carers in knowledge in IAD care 4. Prevent IAD development and minimize deterioration of IAD in patient 5. Enhance staffs' satisfaction in managing IAD patient
Methodology: :
The pilot program was set up in Mar 2024, and literature searching was done through three electronic databases including PubMed, MEDLINE, and Cumulative Index of Nursing and Allied Health Literature (CINAHL). A global assessment tool was adopted “The Ghent Global IAD Categorisation Tool (GLOBIAD)” for categorizing IAD grades (Beeckman et al., 2017). The program implementation was started from May 2024 to Feb 25, convenience sampling was adopted and a total of 46 inpatient data was collected in the program implementation. A 10 minutes powerpoint education talk was given to all the current nursing staff and PCAs to introduce the IAD care workflow, IAD categories assessment and management of different IAD grades, significance of preventing IAD. Also, an IAD care information folder was prepared for the newly joined staff to understand the knowledge and workflow of IAD care. A pre-post 10-questions mandatory questionnaire was given before and after the education talk to evaluate the participants’ knowledge and satisfaction in IAD management. A total of 20 nurses and 14 PCAs were recruited. A clinical workflow of IAD care was established including adding remarks of IAD with staging on Clinical Dash Board (CDB) and taking clinical photos routinely. Reminded nurses and PCAs to report if any newly developed IAD or worsening and could seek advice from ward 2nd Tier wound nurse or CMO to review. An individual IAD care tray with selected suitable incontinence care products was given to patients with IAD and put on top of the patient locker. A signage was posted on each napkin trolley to illustrate the steps of care and the skills of applying incontinence products in different grades of IAD. An education leaflet of IAD care was designed and introduced to the relatives or carers, enhancing their knowledge and involvement in continuous IAD care and enclosing it in the patient discharge file for reference.
Result & Outcome: :
A total of 46 IAD samples were collected from May 2024 to Feb 2025 under IAD care program. After the program, 15 (33%) patients’ IAD was healed, 22 (48%) patients’ IAD was improved. Patients whose IAD conditions remained the same are mainly due to short length of stay under the interventions. One IAD worsened case was collected due to condition deteriorated and certified dead. There were 20 nurses and 14 PCAs recruited in the questionnaires. For nurses, 4 questions of IAD categorization showed a significant improvement of staff knowledge towards IAD categories by adopting GLOBIAD tools with the average score raised from 73.8% to 100% after the program. In 6 questions of IAD management knowledge, it showed a minor change from average score raised from 93.3% to 100% after the program. For PCAs, 8 questions about IAD management, a significant improvement of staff knowledge including risk factors, IAD care principles procedure with average score raised from 76.8% to 97.1%. Most PCAs did not hear of IAD care regime before the program. Overall, the staff satisfaction of IAD care is overall high after the program. All nurses and PCAs reported between agree and strongly agree the program could increase their confidence, knowledge in IAD care and create a better patient care outcome. In this program, several outcomes were achieved: 1. The knowledge of IAD care among nurses and PCAs were improved, and nurses were able to categorize IAD and early detection of IAD. 2. Concrete workflow of IAD care was formulated and applied as ward routine regularly. 3. Patient’s relatives or carers’ knowledge of IAD care were enhanced and increased their involvement and participation in continuous IAD care in the future. 4. The majority of patients with IAD were improved and deterioration was minimized after the program. 5. The overall satisfaction in IAD management among staff increased.
