Incidence and Risk Factors of Incontinence-Associated Dermatitis among Hospitalized Patients in a Tertiary Care Hospital in India

Abstract

Introduction: Incontinence-associated dermatitis (IAD) is a common condition among hospitalized patients with incontinence, causing skin inflammation, erosion, and increasing the risk of pressure injuries. This study aims to estimate the incidence and identify risk factors of IAD in a tertiary care hospital in Western India.

Material and Methods: A prospective study was conducted from February 17, 2023, to February 20, 2024, in a tertiary care hospital in
Western India. Among 3729 admitted patients, 700 developed urinary, stool, or combined incontinence after admission and were prospectively observed to estimate the incidence of IAD. In a case–control analysis, 234 IAD cases and 234 age and gender-matched controls (hospitaladmitted patients without incontinence) were compared for socio-demographic characteristics, presence of co-morbidities, and medications being consumed to identify risk factors for IAD.

Results: The incidence of IAD among incontinent inpatients was 33.43/100 person-days, with an overall hospital-wide incidence of 5.28%. Univariate analysis showed that type of incontinence, length of hospital stay (odds ratio [OR] = 2.95, 95% confidence interval (CI) = 1.75– 4.99, P = 0.001), diabetes mellitus (OR=2.08, 95% CI = 1.39–3.08; P = 0.001), use of antibiotics (OR = 11.44, 95% CI = 2.65–49.38; P =
0.001), laxatives (OR = 29.24, 95% CI = 17.71–48.2, P = 0.001), immunosuppressants (OR = 8.81, 95% CI = 3.67–21.12, P = 0.001), and
corticosteroids (OR = 57.47, 95% CI = 30.37–108.76, P = 0.001) were significantly associated with IAD. Multivariate analysis identified the
type of incontinence, comorbidities, and aforementioned medication use as independent risk factors for IAD.

Conclusion: Hospitalized patients with incontinence, especially those with a moderate to high Braden score, moderate to severe Katz Index of activities of daily living (ADL) dependency, prolonged hospitalization, diabetes, and multiple comorbidities and patients prescribed with antibiotics, laxatives, immunosuppressants, and corticosteroids had a higher risk of IAD. Targeted preventive strategies – including improved skin care protocols and careful management of identified risk factors – may significantly reduce the incidence and severity of IAD in hospitalized patients.