Exploration of Current Practice and Context for the Prevention and Treatment of Incontinence Associated Dermatitis for adults living in Care Homes and Community Settings: a qualitative study

This study aimed to explore current practice and context for the prevention and treatment of incontinence associated dermatitis (IAD), identify challenges and solutions, current prevention and treatment strategies, and products used. Using a qualitative cross-sectional approach online focus groups were conducted with stakeholders including experts by experience of IAD (n = 5) and health/care professionals (n = 16). Verbatim transcripts were coded independently by two researchers and analysed using framework analysis. Four themes and two sub-themes were identified: (1) Impact of IAD: "significant" damage could occur in a short space of time; (2) Uncertainty, is it IAD? Correct diagnosis of IAD was challenging, especially in people with black skin. Uncertainty was underpinned by a lack of education and clear guidance on skin inspection. (3) Lack of resources (sub-themes human resources and product resources): Lack of human resources related to the number of staff available, deficiency of knowledgeable and skilled staff, and limited leadership. Lack of availability of pads was a challenge and carers reduced the number of pad changes to "conserve pads"; (4) Variation in practice, both for cleansing skin and applying a leave-on 'barrier' product. Care for adults with incontinence to prevent and/or treat IAD is challenging in the social care sector. Wide variation in practice exists and there is a need for educational interventions in the sector, targeting an international and transient workforce.