降低重症病房腹瀉病人失禁性皮膚炎發生率

Reducing the Incidence of Incontinence Associated Dermatitis in Intensive Care Unit Diarrhea Patients

背景：失禁性皮膚炎發生常見於重症病房腹瀉病人，病人需承受疼痛、發紅、腫脹等不適，處理不當甚至可能引發續發性感染，2013年10月至12月調查重症病房腹瀉病人失禁性皮膚炎平均發生率為34.72%，顯示此問題之嚴重性。經分析顯示四個主要原因為：（1）人員層面：護理人員照護方式不正確、未具備足夠失禁性皮膚炎預防及照護知識、清潔方式不正確；（2）設備層面：未提供隔離防護產品、尿布材質不透氣；（3）政策層面：缺乏失禁性皮膚炎照護標準、未定期稽核；（4）病人層面：皮膚水腫、失禁、使用藥物。目的：重症病房腹瀉病人失禁性皮膚炎發生率從34.72%下降至22%以下。解決方案：搜尋Cochrane、PubMed、CINAHI及Nursing Reference Center資料庫，年限2000年至2014年，搜尋到52篇文獻，刪除不相關文章，共4篇實證文獻，證據等級為level 2及level 3，依據文獻建議設計措施包括：設計高危險群標示、舉辦6場在職教育課程、錄影教學課程、製作失禁性皮膚炎預防及照護標準與流程圖及製定稽核制度。結果：2014年4月至10月失禁性皮膚炎平均發生率從34.72%下降至19.8%。結論：透過實證措施，確實達到預防重症病房腹瀉病人失禁性皮膚炎之成效，期望透過建立急重症病房腹瀉病人皮膚完善照護標準，期增進重症照護品質。

Background & Problems: Incontinence associated dermatitis (IAD) is a common skin disorder in critical patients who suffer from fecal incontinence. Symptoms of IAD include pain, redness, swelling, and, in some cases, secondary infections. IAD is thus a major problem faced in critical nursing care. The incidence of incontinence associated dermatitis averaged 34.72% at the intensive care unit in our hospital from October to December 2013. The factors that we identified as associated with IAD included: (1) Nurses: incorrect nursing care and insufficient IAD-related knowledge among nurses; (2) Devices: lack of skin barrier products and the use of diapers with poor air ventilation; (3) Regulations: lack of IAD care standards and lack of auditing oversight; (4) Patient problems: skin edema, incontinence, and medication use. Purpose: To decrease the incidence of IAD from 34.72% to 22%. Methods: The authors searched the Cochrane, PubMed, CINAHI, and Nursing Reference Center databases for relevant articles that were published from 2000 to 2014. Fifty studies were identified and four evidence-based references were selected for follow-up assessment. Levels of evidence were at levels 2 and 3. We designed an intervention that: (1) set a high-risk notice to increase awareness; (2) held six in-service training programs; (3) developed nursing standards and designed e-learning education lessons that specifically targeted reducing the incidence of IAD; (4) established a regular audit system. Result: The incidence of IAD decreased from 34.72% pretest to 19.8% posttest (posttest period: April-October 2014). Conclusion: This project effectively reduced the incidence of IAD in high-risk patients in our intensive care unit. The authors established evidence-based interventions that significantly improved patient outcomes.