Incontinence Management and Pressure Injury Rates in US Acute Care Hospitals: Analysis of Data From the 2018-2019 International Pressure Injury Prevalence™ (IPUP) Survey.
Kimberly Koloms, Jill Cox, Catherine A VanGilder and 1 others
PMID 36108224WHAT IT FOUND
Hospitalized patients with urinary, fecal, or dual incontinence had high rates of hospital-acquired pressure injuries, especially severe injuries.
Nurses should include continence and moisture status in pressure injury risk assessment, not just skin checks.
Key findings
01In the analysed sample, 32% of patients had incontinence: 10.5% urinary, 3.9% fecal, and 17% dual.
02Most patients with hospital-acquired pressure injuries had incontinence: 73% of HAPI patients were incontinent, and among severe HAPI patients 77% were incontinent and half had dual incontinence.
03Incontinent patients used more management strategies than continent patients: fecal systems 6.4% versus 1.2%, indwelling urinary catheters 45% versus 20%, absorbent briefs 49% versus 10.5%, and external urine systems 10.5% versus 0.8%; moisture management was used in 91% to 92% of fecal incontinence patients with HAPIs, 88% to 91% of dual incontinence patients, and 81% to 89% of urinary incontinence patients.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study is cross-sectional and collected at one point, so it cannot show that incontinence caused pressure injuries or that any management strategy prevented them. All data were self-reported by facilities, so errors and response bias are possible. The main analysis used only patients who answered the incontinence question. Definitions of urinary and fecal incontinence may have been misinterpreted, especially for patients with indwelling catheters or fecal management devices. The survey had a 24-hour data collection window, so it is not known whether pressure injuries resulted from inconsistent prevention practices before that period. Moisture management was recorded as present or absent, but the study did not determine how consistently the strategies were implemented.
Declared interests
The supplied text states that the IPUP survey is distributed and administrated by Hillrom, Inc. It gives no further funding or conflict-of-interest declaration.
The easy way to misread this
Do not conclude that indwelling catheters, absorbent briefs, or moisture management prevent pressure injuries. The study is a point prevalence survey and only shows that incontinence and pressure injuries occurred together; it did not test whether these strategies work, and it notes indwelling urinary catheterization is not an appropriate incontinence strategy.