Study On Incontinence-Associated Dermatitis And Its Correlation With Pressure Ulcer In Critically Ill Patients With Fecal Incontinence

Objective1.Discuss the impact on patients of risk factors for incontinence-associated dermatitis(IAD)in intensive care units.2.To investigate the correlation between IAD,pressure ulcers and the ability to predict the occurrence of pressure ulcers.MethodsThis study used convenience sampling to select patients with fecal incontinence from the four ICUs of a tertiary general hospital,the general ICU,the NICU,the elderly ICU,and the rehabilitation ICU.The patients'general condition and disease data were collected:1.The patient's sociodemographic and disease data was collected using a self-made questionnaire,including department,age,gender,temperature,consciousness,history of diabetes,history of hypertension,Braden Scores,APACHE II scores,sedative,nutritional modes,albumin levels,ventilation patterns,antibiotic use,length of hospitalization.2.Fecal incontinence assessment,including ratings of perineal skin assessment tools,date of fecal incontinence,frequency of incontinence,and stool traits.3.IAD assessment,including the location of IAD,the time of occurrence,the severity of IAD,and nursing care.4.Assessment of pressure ulcers,including site,staging and severity of pressure ulcers.The?~2 and t test was used to compare the differences in incidence of IAD between patients in different groups.Logistic single factor regression was used to analyze IAD severity and pressure ulcers.ROC curves were used to predict the ability of IADS scores to predict the occurrence of pressure ulcers.ResultsThis study investigated 266 critically ill patients with fecal incontinence.Of these,174 patients developed IAD(65.41%).Thirty-two(18.39%/174)patients with IAD developed pressure ulcers.1.Risk factors of IAD in patients with fecal incontinenceThe statistically significant indicators of univariate analysis were analyzed by two-class unconditional Logistic regression analysis.GCS scores,sedative,PAT score fecal incontinence frequency and stool traits were independent risk factors of IAD(P<0.05).Patients with PAT?7 points increased the risk of IAD 3.437 times(OR=3.437,95%CI:1.612~7.330).The patients with type of 7 stool traits were more likely than patients with normal bowel movements to have IAD(OR=51.046,95%CI:5.404~482.144).2.The correlation between IAD and pressure ulcers and the predictive ability of pressure ulcers in patients with fecal incontinenceThe univariate Logistic regression analysis of the IADS scores and the occurrence of pressure ulcers showed a statistically significant difference(P=0.005,OR=1.119,95%CI:1.035~1.210).Compared the scores of IADS among different pressure ulcers severity groups,and the difference was statistically significant(H=12.682,P=0.013).The scores of IADS and the severity of pressure ulcers were analyzed and there was a correlation between them(r=0.817,R~2=0.657).The 14 sites of IAD and the total scores of 14 sites used ROC curves to analyze the IADS ability to predict the occurrence of pressure ulcers.The results showed that the area under the ROC curve of the IADS was 0.709,which was higher than the area under the separate curve of 14 sites.And when the IADS score=5.5,the Youden index=0.239,when sensitivity=56.3%,specificity=67.6%.Conclusion1.The consciousness,length of hospitalization,PAT score,frequency and stool traits were independent risk factors for IAD in critically ill patients with fecal incontinence.2.The incidence and development of IAD and pressure ulcers are related.The higher the IAD severity rating score is,the more severe the pressure ulcers are.3.Therefore,the care givers should identify high-risk groups and risk factors of IAD as early as possible in nursing work.It is of great significance for the prevention of IAD and pressure ulcers in clinical nursing work.