Evidence-based Study Of Different Skin Protectants In The Prevention And Treatment Of Incontinence Associated Dermatitis

Objective:This study explored the best evidence for the prevention and treatment of incontinence-associated dermatitis（IAD）with different skin protectants.The aim of this study were:（1）to analyze the recommendations of the clinical practice guidelines（CPGs）and expert consensus on the prevention and treatment of IAD with skin protectants.（2）to compare and rank the efficacy of skin protectants to prevent and treat IAD.（3）to provide a reference for optimizing evidence-based practice（EBP）of skin protectants by investigating the status of the use of skin protectants in clinical practice,as well as EBP readiness and EBP influencing factors.Methods:（1）Evaluation and content analysis of CPGs and expert consensus: major databases and guideline websites were searched.CPGs and expert consensus on IAD were included.Five independent reviewers assessed the methodological quality of guidelines and consensus statements using the AGREE II and AGREE-REX instruments.（2）NMA of different skin protectants for the prevention and treatment of IAD:major databases and clinical trial registration platforms were searched,while randomized controlled trials（RCTs）of skin protectant prevention and treatment were included.The cure rate,cure time,IAD incidence and IAD occurrence time were selected as outcome indicators.Optimal preventive and therapeutic skin protectants were obtained based on Bayesian NMA and ranking with R software.（3）The current status of the use of skin protectants in the prevention and treatment of IAD in clinical nursing,as well as the developing evidence based practice questionnaire（DEBPQ）and the clinical readiness to evidence-based nursing assessment（CREBNA）survey: A questionnaire survey was used to investigative nurses from 12 hospitals in Gansu Province,Shaanxi Province,and Sichuan Province in the high incidence of IAD departments.Descriptive analysis,univariate analysis,and multiple linear regression methods were used to analyze factors influencing CREBNA score.Results:（1）Evaluation and content analysis of CPGs and expert consensus: five expert consensuses and two CPGs were included.A total of 14 recommendations on prevention and treatment of IAD with skin protectants were extracted.The recommendations were in the same direction,and the use of skin protectants were recommended for prevention and treatment of IAD,but no skin protectant was recommended for prevention and treatment of IAD.（2）NMA of different skin protectants for prevention and treatment of IAD: 34 RCTs of skin protectants in the treatment of IAD were included,and 24 RCTs of skin protectants for the prevention of IAD were included,involving 17 skin protectants alone and in combination.All RCTs were at risk of bias.34 RCTs reported the cure rate of skin protectants in the treatment of IAD,the NMA results showed that the skin protectants with the greatest potential to be the best intervention were alginate hydrocolloid dressings.23 RCTs were included,reporting the healing time of skin protectants for IAD.The results showed that alginate hydrocolloid dressings were best.Incidence was the primary outcome measure for the prevention of IAD by skin protectants,and 24 RCTs were included.Silicone dressings were best.（3）Status of the use of skin protectants in the prevention and treatment of IAD in clinical nursing and DEBPQ and CREBNA surveys: 507 questionnaires were finally included,with rate of 96.57%.At present,in clinical nursing work,when preventing IAD,the most used skin protectant is stoma powder combined with skin protective film,and the most source of evidence is department requirements.In the treatment of IAD,the most used skin protectant is stoma powder combined with skin protective film,and the source of most evidence is the training of ostomy specialists.The average scores of the four dimensions of the DEBPQ questionnaire were（3.40±0.99）points,（3.03±0.97）points,（3.13±0.89）points,and（2.34±1.02）points.The total score of CREBNA was（114.76±18,58）points,accounting for 73.54% of the total score.The results of multiple linear stepwise regression analysis showed that the evidence subscale of nursing staff who knew the process of evidence-based nursing practice very well,chief nurses,and it was necessary to carry out evidencebased nursing practice had higher scores.Conclusion:（1）The use of skin protectants were recommended for the prevention and treatment of IAD,but CPGs and expert consensus did not recommend specific types of skin protectants.（2）Based on the incidence of IAD as an outcome indicator,silicone dressings are the best skin protection for IAD prevention compared with other skin protectants included.Alginate hydrocolloid dressings are the best skin protectant for the treatment of IAD.（3）There is a gap between the use of skin protectants for the prevention and treatment of IAD and the best evidence,the main influencing factor of EBP is the lack of EBP skills,the preparation of EBP of nursing staff needs to be improved.