Purpose: Prevention of incontinence dermatitis (ID) is a major nursing concern in nursing homes (NHs) given the high rates of incontinence in residents. Little is known about the cost of ID prevention. This study examined the cost and efficacy of four ID prevention regimens in NH residents. The costs of the skin care products (cleanser and barrier) used in the regimens are reported.

Methods: Residents (n=1,918) in 16 U.S. NHs, randomly selected, were screened for eligibility; 981 residents qualified and were enrolled. All were incontinent and started free of perineal skin damage. Age and sex of residents did not differ among the regimens. In regimen A, a barrier film was applied 3 times weekly (A) and in regimens B, C, and D, one of three ointment barriers of different compositions were applied after each incontinence episode. Prospective time and motion measures of the amounts of skin cleanser and barrier used were conducted to analyze the product costs. Staff assessed resident skin damage for 6 weeks to determine efficacy of the regimens.

Results: Overall occurrence of ID was 3.4% and not different among regimens (p=.55). The median number of incontinent episodes/day differed (A=6.2, B=6.3, C=7.0, D=6.7) p=.005. Due to these differences, the analysis standardized the product costs per 100 episodes of incontinence.

The median total product cost (cleanser + barrier) in regimen A($14.36) was less than B($29.21), C($44.67), and D($27.04); p<.0001. Median barrier cost in regimen A($3.98) was less than B($22.17), C($24.57), and D($20.67) p<.0001.

Conclusion: Use of a skin barrier film applied 3 times weekly was as effective in preventing ID and has a significantly lower total product cost and barrier cost than regimens in which a barrier must be applied after each incontinence episode.