From the Deputy Editor
We are very pleased to share the results of a highly novel experiment conducted by Phipps, Call and Gray to help us better understand the relationships between barrier functions of the skin and length of time the skin is exposed to urine. It was surprising to me to learn how quickly (within 15 minutes) the skin mantle changes after contact with synthetic urine. This study underscores the need to practice hypervigilance in promptly initiating interventions to prevent incontinence associated dermatitis (IAD). And speaking of IAD, check out a quality improvement study of an evidence-based, bundled intervention for patients in the surgical intensive care unit with urinary and fecal incontinence conducted by Brandon Gates, Joy Vess, Mary Arnold Long, and Emily Johnson published in this issue of the Journal. The authors share their algorithm model that was shown to substantially reduce the incidence of IAD from 29% to 5%. The work of Susan Kayser and colleagues published here reminds us that IAD from all causes (urine, fecal, and both) remains a concern in acute care settings. They analyzed data from the International Pressure Prevalence™ Survey for prevalence and risk factor and found many similarities to pressure injuries. For example, they noted the predominant risk factors for IAD were diminished mobility, longer length of stay, and additional linen layers under the patient.
For a more in-depth understanding of risk factors and causes of hospital hospital-acquired pressure injuries, I guide your attention to an excellent continuing education (CE) piece by Joyce Black on root cause analysis methodology and commentary by editor-in-chief Mikel Gray. We also offer another CE opportunity on onychomycosis co-authored by Tara Beuscher and myself in our new Foot and Nail Care section. Finally, we are pleased to publish important best practice recommendations for the management of enterocutaneous fistula and enteroatmospheric fistula development, both of which are complex and challenging conditions, highlighting the need for care delivery that includes emotional and psychological support. Jillian Brooke, Amanda El-Ghaname, Karen Napier and Lauren Sommery and colleagues from the voluntary network of Nurses Specialized in Wound, Ostomy and Continence Canada, formerly Canadian Association for Enterostomal Therapy (CAET) updated the 2009 recommendations and provide information on resources, algorithms, and other tools, and optimized a user-friendly electronic format to improve access.
In closing, it was great to see you in Nashville at WOCNext!! There were lots of exciting presentations and posters and new products to discover. I enjoyed talking with you about your ideas for submissions to the Journal. We invite you to reach out to Mikel and myself or your Section Editors to explore the multitude of opportunities to share your challenges in practice, views from here and quality improvement and research projects. We would be proud to publish your work!
Teresa Kelechi, PhD, RN
Gates BP, Vess J, Arnold Long M, Johnson E. Deceasing Incontinence-Associated Dermatitis in the Surgical Intensive Care Unit: A Quality Improvement Study. 2019; 46(4): 327-331.