Authors: (including presenting author): :
Kong KM(1), Tam WS(1), Chan CSS(1), Lui YL(1), Tse KYG(1)(2)
Affiliation: :
(1) Intensive Care Unit, Medicine and Geriatric Unit, Ruttonjee and Tang Shiu Kin Hospitals (2) Medicine and Geriatric Unit, Ruttonjee and Tang Shiu Kin Hospitals
Keyword 1: :
Incontinence-Associated Dermatitis
Introduction: :
Incontinence-associated dermatitis (IAD) is a form of irritant contact dermatitis commonly observed in Intensive Care Unit (ICU) due to immobility, malnutrition, and incontinence. IAD can cause severe skin barrier disruption, superficial skin damage, infection and significant discomfort which negatively affect patients’ quality of life. Currently, there are no standardized protocols for IAD nursing care and assessment in RTSKH ICU. This quality improvement project aimed to develop and implement an evidence-based standardized protocol for IAD prevention to reduce its prevalence among ICU patients.
Objectives: :
The project objectives are to (1) Enhance ICU nursing staff competency in recognizing, preventing, and managing IAD; (2) Strengthen interdisciplinary communication through standardized referral pathways and shared protocols; (3) Develop, implement, and evaluate an evidence-based nursing care protocol for IAD assessment; (4) Reduce the incidence of IAD in RTSKH ICU.
Methodology: :
Recent literature published within the past ten years on IAD care for critically ill patients was reviewed to identify current best practices. An IAD Nursing Care Algorithm was developed, incorporating the Bristol Stool Scale and Ghent Global IAD Categorization Tool (GLOBIAD). The algorithm emphasized multidisciplinary team collaboration involving doctors, ICU nurses, wound nurses and dietitians. To ensure adoption, all ICU nurses received face-to-face education printed and digital booklets. Cue cards displaying the algorithm were posted in the ward as quick reference. Nurses’ knowledge and competency were assessed using pre- and post-education quizzes while qualitative feedback was collected through semi-structured interviews. A six-month patient study using convenience sampling evaluated the effectiveness of the algorithm and nurses’ compliance.
Result & Outcome: :
Post-education quiz scores showed a significant average increase of 4.37 points on a 10-point scale (p-value < 0.001). Protocol compliance exceeded 90%, with nurses integrating the tools into daily practice and reporting the algorithm was practical and boosted their confidence in IAD care. The incidence of IAD decreased from 16.7% to 13.3%, demonstrating the algorithm’s effectiveness. The standardized algorithm enhanced consistency, quality of nursing care and multidisciplinary collaboration. To sustain the improvement, ongoing compliance monitoring and periodic updates based on emerging evidence are required.
