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. Residents' age and sex did not differ among regimens. In regimen A, a barrier film was applied 3 times weekly and in regimens B, C, and D, one of three ointment barriers of different compositions were applied after each incontinence episode. Total cost of ID prevention was determined using prospective time and motion measures of staff time and number, amount of products used, and number of supplies. Staff assessed resident skin damage for 6 weeks to determine efficacy of the regimens.

Results: The median number of incontinent episodes/day differed among regimens (A=6.3, B=6.3, C=7.0, D=6.7; p=.005). Different numbers of staff provided ID prevention care (range = 1 to 4; p<.001). Due to these differences, the analysis was standardized using total costs per episode of incontinence provided by 1-2 caregivers. The median total cost of regimen A($0.89) was significantly less than B($1.74), C($1.31), and D($1.28) p<.001. Incidence of ID did not differ among regimens (A=3.5%, B=2.1%, C=4.1%, D=4.0%, p=.55). Nearly half (48%) of those developing ID were incontinent of both urine and stool.

Conclusions: A regimen for preventing ID that uses a polymer skin barrier film three times weekly resulted in a lower total cost per episode of incontinence and was as effective as regimens in which a skin barrier ointment was applied after each episode of incontinence.