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The effectiveness of support surface microclimate management on prevention of incontinence-associated dermatitis

Ariyakul, Chonnikan (2023) The effectiveness of support surface microclimate management on prevention of incontinence-associated dermatitis. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Background: Incontinence-associated dermatitis (IAD) is a costly problem in acute care. Clinicians often experience difficulties distinguishing IAD from pressure injuries (PI) and other moisture-related skin conditions. Support surfaces are designed to distribute pressure and control moisture to prevent and treat PI; however, their performance characteristics vary widely. Evidence suggests support surfaces prevent PI; however, no studies have investigated their performance relative to preventing and treating IAD.

Purpose: This research investigated the prevention and treatment effectiveness of support surfaces with microclimate management with airflow features (LAL) and their performance characteristics on IAD development and severity. The aims were also to identify clinical factors and support surface performance characteristics that predict the severity of IAD among patients in acute care settings with moisture risk.

Methods: A secondary analysis was performed on a subset of data from an RCT on the effectiveness of support surfaces with microclimate management in preventing pressure injuries (n=451), limited to participants enrolled without IAD for prevention provision. Three hundred eighty-one patients were randomized into either LAL (n=276) or non-LAL (n=105). One hundred seventy-four patients who developed IAD for treatment provision were randomized into either LAL (n=128) or non-LAL (n=46). In addition, clinical risk factors identification included 174 patients in the analysis. Demographic data, clinical characteristics, baseline Perineal Assessment Tool (PAT) scores, number of days on the support surface, and support surface performance characteristics were considered parameters. IAD incidence was the primary outcome for prevention provision, and the Incontinence-Associated Dermatitis Severity (IADS) scale score was the primary outcome for treatment and IAD severity.

Results: In this study, IAD incidence was 27%, and prevention effectiveness was similar between LAL and non-LAL groups (2 (.904), p = .342). In addition, support surface immersion correlated with IAD severity score (B= .024, S.E.= .0057, p<.001). The generalized linear model suggested that sex (p= .008), BMI (p= .021), baseline PAT score (p= .004), and immersion of support surface (p = <.001) were significantly associated with increased IAD severity. Males, lower BMI, higher baseline PAT score, and higher immersion of support surface correlated with higher IAD severity scores in acute care patients with moisture risk.

Conclusion: The results from this study suggest support surface immersion characteristics should be considered when treating IAD in addition to factors already known to be significant (i.e., Perineal Assessment Tool (PAT) score, sex, and BMI).


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Thesis AdvisorBrienza, David
Committee MemberKarg,
Committee MemberTerhorst,
Committee MemberGray,
Committee MemberZamarripa,
Date: 6 June 2023
Date Type: Publication
Defense Date: 28 February 2023
Approval Date: 6 June 2023
Submission Date: 14 April 2023
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 113
Institution: University of Pittsburgh
Schools and Programs: School of Health and Rehabilitation Sciences > Rehabilitation Science and Technology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: IAD, moisture-associated skin damage, Low air loss
Date Deposited: 06 Jun 2023 13:54
Last Modified: 06 Jun 2023 13:54


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