A comprehensive incontinence management program, guidelines and algorithm for clinical decision making include: (a) protection, (b) treatment with active ingredients, and (c) containment devices for persistent fecal incontinence. An estimated 33% of all hospitalized adults suffer from fecal incontinence. ¹ Incontinent patients are at 22% higher risk for pressure ulcer development and when immobile the risk increases to 30%. ² Fecal incontinence reduces skin tolerance, macerates tissue, increases tissue permeability, reduces tolerance for friction, exposes skin to bacteria, digestive enzymes, increase pain and compromises the skin's protective acid-mantle.^{1, 3} Cleaning with alkaline soaps, coarse washcloths and prolonged exposure to digestive enzymes are related to development of perineal dermatitis (PD).^4,5 PD presents clinically as painful erythemia with or without vesication, induration, denuding, crusting and scaling in the perineal and perianal regions.^{3, 1}Incontinence management programs that address only cleaning and single product protection are insufficient to address PD in the presence of persistent incontinence.^{1, 2,6,11}

A review of WOCN Clinical Practice Guidelines, AHRQ Clinical Practice Guidelines, Ovid, Info-Quest, Pro-quest and Medline databases from 2000-2005 was completed to support EBP and best clinical practice. Key search words included, incontinence, fecal incontinence, perineal dermatitis. Outcome and comparison data was collected by retrospective and post implementation review of CCU medical records. Product selection criteria included: (a) cost effectiveness, (b) ease of use, (c) patient comfort, (d) positive clinical outcomes, (e) compliance and (f) clinical validation of manufactures product claims. Products selected included disposable wipes with 3 % dimethicone, a barrier/treatment product with active ingredients (tripsin-bassam-peru-caster-oil ointment in a safflower oil base) and fecal containment systems (internal and external).^7,8,5,9.10 Key program elements include: (a) consistent protection of intact skin, (b) active treatment of compromised skin, (d) non-traumatic cleansing, (c) containment of intractable fecal incontinence, and (d) guidelines and algorithms that facilitate use.^{1,2,4,5,6,7,8,9,10,11}