Implementation of Skin Care Formulary in View of Reduction of Patient Developing Pressure Injury Related to Incontinence-Associated Dermatitis in Surgical Intensive Care Unit-Rashid Hospital

Abstract

Introduction:  Incontinence-associated dermatitis (IAD), resulting from diarrhea and/or fecal incontinence, and perspiration and enzymatic wound drainage is a common problem in intensive care unit. Skin care formulary was used to treat patient with Moisture associated skin damage. The formulary served as a guide on skin care management products that were recommended to use at Rashid Hospital. The formulary was used as an educational tool, to promote evidence-based, safe and cost-effective recommendations of skin care products for Moisture damage. The formulary included a brief description of all the wound care materials approved by the Dubai Academic Health Corporation (DAHC)

Aims:  The project aimed to reduce the number pressure injury incident in surgical Intensive Care unit by improving staff knowledge about incontinence associated dermatitis and implementing skin care management products as per skin care formulary to prevent and treat IAD. 

Methods: A survey was conducted on staff’s knowledge on prevention of moisture associated skin damage – incontinence associated dermatitis. Team was formulated. Skin care formulary education was provided to each team member by wound care management department. All surgical intensive care unit staff was educated on Incontinence Associated Dermatitis, and implementation of skin care formulary to prevent and treat it. 

Products mentioned in the skin care formulary was made available in the unit. Audit was conducted to closely monitor the nurse’s practice in using these products by direct observation method for a period of 6 months. Nurses were communicated about patients who were high risk of developing IAD.  Post education survey was conducted to evaluate Nurse’s knowledge and practice in implementation of the skin care formulary to prevent and treat IAD. 

Result:  Before the implementation of the project, survey conducted revealed that 79.27% of nurses had full knowledge on prevention of IAD and about skin care formulary. After that the team conducted extensive education in the unit, post audit survey showed marked improvement with 100% staff nurses completely aware about skin care formulary and prevention of IAD. 

In the year 2020 and 2021, pressure injury related to MASD- IAD was 7 and 9 respectively. After the implementation of the project in the year 2022, pressure injury incident related to MASD- IAD significantly dropped to 3.  In the year 2023, to maintain sustainability of the project it was adopted as a Best practice Initiative in the unit. During this phase re-education was done for all Nurses reinforcing the significance of implementing Moli care foam and Zinc oxide cream to prevent IAD. As a result, pressure injury related to IAD further dropped to 2 in the year 2023.   Moli care foam Spray and zinc oxide cream played a vital role in prevention of skin breakdown of patient who are having diarrhea and/ or fecal incontinence.

Conclusion:  The project created an awareness about incontinence-associated dermatitis in the SICU. Staff knowledge improved by 20.73%. and subsequently, an aggregate reduction of pressure injury related to incontinence-associated dermatitis of about 9% was noted in the year 2022-2023 as compared to the year 2020-2021. A direct correlation was observed between staff knowledge and reduction of pressure injury related to IAD.  Moli care foam spray and zinc oxide cream played a vital role in the prevention of skin breakdown of patients who are having diarrhea and/ or fecal incontinence.