Incidence of moisture-associated skin damage in an intensive care unit

To determine the incidence of moisture-associated skin damage (MASD) in the nappy area, identify predisposing factors and know the preventive measures and nursing records.

Descriptive longitudinal study (June 2014-April 2015) in a general ICU. Patients whose stay >48hours and without skin lesions were included. The skin was assessed daily until the appearance of MASD, discharge or a maximum of 14 days. Demographics, stay, MASD type, incontinence, number and consistency of stools, obesity, Braden scale and prevention were recorded.

145 patients (66.2% male) were studied, median age was 69 (P₂₅=56.5, P₇₅=76) and median length of stay was five days (P₂₅=3, P₇₅=11.25), 29.9% were obese. Incontinence-associated dermatitis (IAD) was detected in 26.2% and intertriginous dermatitis (ITD) in 15.9%. MASD was recorded in 23.8%. The variables causing IAD to develop were faecal incontinence, number of stools, liquid stools, and stay. Those for ITD were obesity and score on the Braden scale. Multivariate analysis selected faecal incontinence (OR=5.4, CI95%: 1.1-26) and the number of stools (OR=1.1, CI95%:1.0-1.2) as independent variables for developing IAD and obesity (OR=2.8, CI95%:1.0-8.2) and Braden (OR=0.8, CI95%:0.7-1.0) for developing ITD. Prevention to 23.8% of obese and 42.9% of incontinent was performed.

There is a high incidence in MASD. Faecal incontinence and higher number of stools are the risk factors for developing IAD. Obesity and a lower score on the Braden scale may affect susceptibility to ITD. Recording of MASD and its prevention in patients at risk is insufficient.