Incontinence, Incontinence-Associated Dermatitis, and Pressure Injuries in a Health District in Australia: A Mixed-Methods Study : Journal of Wound Ostomy & Continence Nursing

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Incontinence, Incontinence-Associated Dermatitis, and Pressure Injuries in a Health District in Australia

A Mixed-Methods Study

Barakat-Johnson, Michelle; Barnett, Catherine; Lai, Michelle; Wand, Timothy; White, Kathryn

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Journal of Wound, Ostomy and Continence Nursing 45(4):p 349-355, July/August 2018. | DOI: 10.1097/WON.0000000000000446



This purpose of this study was to measure the prevalence of incontinence, incontinence-associated dermatitis (IAD), and pressure injuries (PIs) in a local health district in Australia. We also aimed to determine associated evidence-into-practice gaps.


Multisite mixed-methods study.


The sample comprised 250 adult patients in 12 units across 4 hospitals; their mean age was 73 years. Nurses caring for the patient at the time of the audit were questioned on nursing practice for patients with incontinence.


A 2-page audit tool was developed and used to capture demographic data, continence and mobility status, IAD and PI, incontinence products, nursing practice observations, and nurses' comments. Each patient was assessed by 2 senior nurses. Quantitative analysis included descriptive statistics and bivariate analysis using a χ2 test to examine the association between mobility and incontinence and a Fisher exact test to examine the association between IAD and PI. Content analysis was used to analyze qualitative data and develop themes.


Almost half of patients had incontinence (n = 111/250), 20.7% of patients with incontinence (n = 23/111) had IAD, and 6.3% (n = 7/111) had hospital-acquired PI. There was a significant association between incontinence and mobility, and between IAD and PIs. In addition, 22.3% of patients who were continent (31/139) were wearing an incontinence product. Analysis of qualitative data found that both incontinence management and language used to refer to incontinence pads were incompatible with current best practices.


The prevalence of incontinence among patients observed in this study was similar to rates reported internationally, but the prevalence of IAD was slightly lower. The association between IAD and PIs, as well as incontinence and mobility, was statistically and clinically significant. Nurses commonly used interventions with little or no evidence. Hospitals should put measures in place to improve nurses' knowledge of incontinence, IAD, and PI practices.

© 2018 by the Wound, Ostomy and Continence Nurses Society

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