The Braden score is a reliable predictor of a patient's potential for developing pressure ulcers. Moisture is one of six indicators considered when calculating a Braden Score. Efforts to reduce the effects of moisture and enzymatic activity on skin from incontinent diarrhea have employed various types of non-standardized and non-approved approaches. A recently developed bowel management tube has produced promising outcomes in managing fecal incontinence and associated perineal skin damage. While this fecal diversion tube is useful in managing patients with diarrhea, it can also be used to modify formed stool in patients who have wounds that are likely to become contaminated with incontinent feces, or who are too hemodynamically unstable to turn for lengthy or frequent incontinence care. The Surgical Intensive Care Unit (SICU) at Vanderbilt University Medical Center has been able to decrease the prevalence of perineal skin damage by combining use of the bowel management tube with an educational program on pressure ulcer prevention and treatment. These are accompanied by weekly clinical rounding of the Clinical Nurse Specialist/ Educator and the Certified Wound Care Nurse. An initial survey done prior to the implementation of these measures showed a 43% prevalence rate for Stage II or greater pressure ulcers. Subsequent surveys have shown a decrease in the prevalence and incidence of these findings. Although it is not clear as to whether the decrease in perineal skin damage can be attributed to the use of the bowel management tube, the educational efforts, the rounding, or some combination of those, the data suggests that the combined elements have significant impact on the nursing care of critically ill patients with regard to maintaining skin integrity.