Purpose: Develop consistent care of the incontinent patient that is cost-effective and provides quality outcomes.

Objective: Streamline incontinence care by standardizing practice and measure the effect on patient outcomes and care costs.

Methods: A process improvement, clinical product trial was conducted in 3 adult medical/surgical units where patients were randomly assigned to each treatment group based on the last digit of their medical record number. The three incontinence cleanup processes were compared: the current practice of cleansing spray/towel/skin protectant (A), a disposable washcloth impregnated with dimethicone skin protectant in a lotion (B) and a disposable bathing washcloth without skin protectant C). For each incontinent episode, the type of incontinence, cleanup process and skin assessment were recorded.

Statistics: With a 2% improvement and approximated standard deviations, an n of 44 per group was determined as adequate to test the equivalence hypothesis at 95% confidence.

Results: Group C treatment was discontinued at 4 weeks when an analysis revealed a larger proportion (29%) of skin problems per the number of incontinent episodes. Proportion of skin problems between the A and B groups were similar at 10% and 8% respectively. Cost analysis revealed an average cost per patient per stay of $6.13 for the A group and $5.40 for the B group.

Conclusion: This research showed that a simple all-in-one cleansing and protectant washcloth could achieve similar skin outcomes to a multi-step cleansing and protectant process. With equivalent skin outcomes and favorable costs the B process was adopted as the new standard for evidence-based incontinence clean-up care. Additionally, a comparison was made between 2003 and 2004 regarding patient referrals for incontinence issues. There were 72 consults in 2003 before the B process was initiated and 10 in 2004 when the B process was implemented!