The development, validation and implementation of an international tool for incontinence-associated dermatitis [IAD) classification : the Ghent Global IAD Categorisation tool (GLOBIAD)

Aims: The aim of the study was to develop the Ghent Global IAD Categorisation tool (GLOBIAD) and to examine the inter- and intra-rater reliability of categorizing incontinence-associated dermatitis according to GLOBIAD. Methods: 25 experts in the field of IAD from 14 countries and 5 continents were invited to evaluate the purpose and structure of the existing IAD Severity Categorisation tool, published in 2015, for content validity using a multiple-round Delphi procedure. Next, the reliability assessment will consist of two phases: the inter­ rater and intra-rater reliability assessment. In the first phase, an international convenience sample of nurses and nursing students (>15 countries) will be asked to complete an online survey (using Limesurvey®) including some demographic questions and the categorisation of 34 photographs (based on an anticipated kappa O of 0.8, a desired expected kappa L of 0.7) supplemented by a random selection of 6 photographs (15%) of the same set. Phase 2 will consist of a test-retest procedure with a 1-week interval to evaluate the intra-rater reliability of GLOBIAD using the same 34 photographs, in a different random order to redu(e potential bias. No feedba(k: will be provided between the test and retest procedure. The nurses and nursing students will be invited via mail. Results: Based on the comments of 22 experts (Ameri(a, Australia, Europe and South Afri(a] who participated in the 3 round Delphi procedure, changes to the purpose, structure and (ategories were made. The twofold purpose of GLOBIAD is (1) to create an internationally agreed description of IAD, and (2) to standardize the documentation within clini(al practi(e and for research purposes. The structure of the tool comprises two categories and two subcategories related to infection, each category consists of critical and additional criteria. The critical (riteria are (1) persistent redness without signs of skin loss and (2) skin loss. The presen(e of maceration, vesicles and bullae and pain are some additional criteria. Ea(h category is subdivided into IAD lesions with and without signs of infection (e.g. white scaling of the skin) and is visualised with clear images. Conclusions: The validation of GLOBIAD by an international expert panel is a first major step towards a better systematic assessment of IAD in clinical practice. In the future, the GLOBIAD will be disseminated via wound organisations and embedded in electronic health records. The reliability assessment is currently ongoing, results will be presented at the symposium