ICU失禁相关性皮炎防控指引的制订及临床应用

Development and application of the clinical guideline for prevention and treatment of incontinence-associated dermatitis in ICU

目的通过建立ICU失禁相关性皮炎防控指引（简称防控指引），指导护理人员加强对危重患者失禁相关性皮炎（Incontinence-Associated Dermatitis，IAD）的预防控制，以提升护理质量。方法通过检索文献．访谈ICU医护人员及查阅IAD病例资料等方法，分析并归纳IAD预防控制安全管理中的常见问题。依据美国伤口造口失禁护士协会公布的2012年循证指南、我院皮肤安全管理制度及ICU实践需求制订防控指引。2013年1～12月，通过开展循证培训,建立防控流程，加强医护沟通，进行质量控制等推行防控指引。对比应用指引前后IAD的发生率及严重度发展情况。结果实施防控指引后，IAD的发生率低于实施前，差异有统计学意义（P〈0．01）。IAD轻度、中度、重度及并发真菌性皮疹的病例数低于实施前，差异有统计学意义（P〈0．05）。结论防控指引对危重患者IAD的预防控制有较好的临床指导作用。

Objective To formulate a clinical guideline for prevention and treatment of incontinence-associated dermatitis（IAD） in ICU. Methods The common problems in IAD prevention and treatment were analyzed by using the methods of literature review,interviewing medical staff and analysis of IAD cases. Then,the clinical guideline was formulated based on evidence-based guidelines of Wound,Ostomy,Continence Nurses Society （WOCNS）,the safety management regulations of skin care in the hospital and clinical demands in ICU. A series of measures were implemented to apply the clinical guideline in critically ill patients from January to December 2013,such as conducting evidence-based training,formulating workflows,strengthening communication between doctors and nurses and carrying out quality control. The incidence and severity of IAD were compared before and after implementation of the guideline. Results After implementation of the guideline,the incidence and severity of IAD significantly decreased （P〈0.01 or P〈0.05） in critically ill patients. Conclusion The clinical guideline is feasible and effective for nursing staff to prevent and treat IAD in critically ill patients.