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  1. Conley, Patricia MSN, RN, PCCN
  2. McKinsey, David MD
  3. Ross, Olwyn RN, CWS
  4. Ramsey, Anthony PhD, FNP-C
  5. Feeback, Jennifer CCRP


Background: Incontinence-associated dermatitis (IAD) is a potentially serious skin injury that can lead to pressure ulcers (PUs). Multiple studies have indicated the need for evidence to find the most effective skin care protocol to reduce the incidence and severity of IAD in critically ill patients.


Objective: To compare the incidence and severity of IAD in two groups on a progressive care unit (PCU) using a defined skin care protocol: cleaning with a gentle cleanser and moisturizer, then applying a skin protectant/barrier. The control group received the skin care protocol every 12 hours and the interventional group received the protocol every 6 hours; both groups also received it as needed.


Methods: A 9-month randomized prospective study was conducted on 99 patients (N = 55 in the intervention group and N = 44 in the control group) who were incontinent of urine, stool, or both, or had a fecal diversion device or urinary catheter for more than 2 days.


Results: The dermatitis score in the intervention group on discharge was significantly less (7.1%; P <= 0.001) in the moderate IAD group than in the control group (10.9%). The dermatitis score means and P values of each group were compared using a paired t test.


Conclusion: The researchers studied a defined skin care protocol using a cleanser with aloe vera and a cleansing lotion, followed by application of either a moisture barrier with silicone or skin protectant with zinc oxide and menthol, undertaken at two different frequencies. Data revealed the incidence of moderate IAD was decreased in the experimental group (receiving the skin protocol every 6 hours and p.r.n.).