J Wound Ostomy Continence Nurs. 2022 Sep-Oct;49(5):405-415.doi: 10.1097/WON.0000000000000905.

Kimberly Koloms ^1 2 3 4, Jill Cox ^1 2 3 4, Catherine A VanGilder ^1 2 3 4, Laura E Edsberg ^1 2 3 4

Author information

¹Kimberly Koloms, MS, Hillrom Inc, now a Baxter company, Deerfield, Illinois.

²Jill Cox PhD, RN, APN-c, CWOCN, FAAN, Clinical Professor, Rutgers University School of Nursing, Newark, New Jersey/WOC Advanced Practice Nurse Englewood Health, Englewood, New Jersey.

³Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee.

⁴Laura E Edsberg, PhD, Professor Natural Sciences, Center for Wound Healing Research, Natural & Health Sciences Research Center, Daemen University, Amherst, New York.

Abstract

Purpose: The purpose of this study was to identify and describe the prevalence of incontinence (urinary and/or fecal) and incontinence management practices among patients in US adult acute care settings, with and without hospital-acquired pressure injuries (HAPIs), using the data from the 2018/2019 International Pressure Ulcer Prevalence™ (IPUP) survey.

Design: Observational, cohort study with cross-sectional data collection and retrospective data analysis.

Subjects and setting: The sample comprised 296,014 patients hospitalized in 1801 acute care facilities in the United States that participated in 2018 and/or 2019 IPUP survey. Of these, 192,852 (65%) patients had information recorded in the survey on incontinence status and were included in the analytical sample.

Methods: Data from the 2018/2019 IPUP database were analyzed to evaluate the prevalence of incontinence (urinary [UI], fecal [FI], and dual [DI]), and the use of incontinence and moisture management strategies. Incontinence prevalence was analyzed between 3 groups of patients: (1) those without pressure injuries; (2) patients with stage 1 and 2 HAPIs; and (3) those with severe HAPIs (stage 3, 4, unstageable, deep tissue pressure injury). Analysis of the subgroups within acute care was also undertaken and included medical-surgical, critical care, and step-down units.

Results: Incontinent patients were older (mean age 69-74 years depending on type of incontinence as compared to 62 years for continent patients) and had lower Braden Scale scores (range, 14.7-16.7, compared to 19.4 for continent patients). Half of the patients were female, 49.6% male, and 0.4% were unknown. Incontinence was identified in 32% of patients. Among patients with incontinence, 33% had UI, 12% had FI, and 55% had DI. Hospital-acquired pressure injuries were present in 27.4% of continent patients and 72.6% of incontinent patients, with DI having the highest rate of HAPIs. Analysis revealed a higher proportion of incontinent patients with unstageable HAPIs than continent patients (14.9% vs 9.6%, P = .00), as well as a higher proportion of incontinent patients with deep tissue HAPIs as compared to continent patients (27.0% vs 22.1%, P = .00). Significantly more incontinent patients regardless of HAPI status were using a bowel or bladder management system (P = .00).

Conclusion: Results of this study support the importance of incontinence as a risk factor in HAPI development. The prevalence of all types of incontinence was 31.7% for the entire sample. Almost three-fourths (72.6%) of patients with HAPI had UF, FI, or DI. A standardized definition of both UI and FI is needed, given that over 70% of all critical care unit patients with a urinary catheter for incontinence management were still classified as urinary incontinent.