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Incontinence-Associated Dermatitis (IAD)

Prevalence and Associated Factors in 4 Hospitals in Southeast Norway

Johansen, Edda; Bakken, Linda N.; Duvaland, Elisabeth; Faulstich, Jürgen; Hoelstad, Hanne L.; Moore, Zena; Vestby, Eva Marie; Beeckman, Dimitri

Journal of Wound Ostomy & Continence Nursing: November/December 2018 - Volume 45 - Issue 6 - p 527–531
doi: 10.1097/WON.0000000000000480
Continence Care

PURPOSE: The aim of this study was to investigate the prevalence and severity of incontinence-associated dermatitis (IAD) and associated factors in acute care settings in Southeast Norway.

DESIGN: Descriptive, multisite epidemiologic survey.

SUBJECTS AND SETTING: The study setting was 29 wards across 4 hospitals, in a hospital trust in the southeast of Norway. Data were collected from 340 patients (age ≥18 years). More than half (56.2%) were 70 years or older (median age category 70-79 years) and 53.3% were male.

METHODS: Data collection was conducted in parallel with a pressure injury prevalence study undertaken in 2016. A modified Pressure Injury Prevalence Minimum Data Set, including documentation of fecal or urinary incontinence, use of indwelling fecal collection system or urinary catheter, and presence of IAD, was completed. RNs participating in the study were trained by the researchers on skin assessment and data extraction from the electronic medical record. Descriptive statistics were used for prevalence figures; the Kruskal-Wallis and χ2 tests were used to determine associated factors.

RESULTS: Analysis revealed that 16.5% (56 out of 340) of the sample were incontinent. The prevalence of IAD in the total population was 7.6% (26 out of 340). The prevalence of IAD was 29% (16 out of 56) among patients with urinary or fecal incontinence. Of those identified with IAD, 5.2% (18 out of 340) had category 1 (red intact skin) and 2.4% (8 of 340) had category 2 (red skin with breakdown). Bivariate analysis revealed that fecal incontinence (P < .001), immobility (P < .01), and 70 years or older (P < .03) were associated with IAD.

CONCLUSIONS: The overall prevalence (patients with and without incontinence) of IAD was lower than reported in prior studies; frequent use of indwelling urinary catheters and a relatively low prevalence of incontinence may explain this finding. Similar to prior studies, almost 1 in 3 patients who were incontinent suffered from IAD, showing a need for evidence-based guidelines to prevent IAD in hospitalized patients. Findings suggest that particular attention should be given to prevent IAD among patients with fecal incontinence patients, 70 years and older, and those with immobility.

Edda Johansen, ProfDoc, RN, University of South-Eastern Norway, Drammen, Norway.

Linda N. Bakken, PhD, RN, University of South-Eastern Norway, Drammen, Norway.

Elisabeth Duvaland, RN, ICN, Drammen Hospital, Vestre Viken HF, Drammen, Norway.

Jürgen Faulstich, RN, ICN, Drammen Hospital, Vestre Viken HF, Drammen, Norway.

Hanne L. Hoelstad, RN, Drammen Hospital, Vestre Viken HF, Drammen, Norway.

Zena Moore, PhD, MSc, Royal College of Surgeons in Ireland, Dublin, Ireland.

Eva Marie Vestby, RN, Ringerike Hospital, Vestre Viken HF, Hønefoss, Norway.

Dimitri Beeckman, PhD, RN, University Centre for Nursing and Midwifery, Ghent University, Belgium, and School of Health Sciences, Nursing and Midwifery, University of Surrey, Guildford, UK, and School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland; Visiting Professor, School of Health Sciences, Örebro University, Sweden.

Correspondence: Edda Johansen, ProfDoc, RN, University of South-Eastern Norway, Grønland 58, 3045 Drammen, Norway (

The authors declare no conflict of interest.

© 2018 by the Wound, Ostomy and Continence Nurses Society.