Hospital-acquired incontinence-associated dermatitis drops to 0 with small quality improvement intervention

Incontinence-associated dermatitis (IAD) is defined as an inflammation of the skin that occurs when urine or stool comes into contact with perineal or perigenital skin.¹ One prevalence survey reported incontinence in 19.7% of patients, and 42.5% of these patients had some type of skin injury present at the time of the survey, with IAD and pressure ulcers the most prevalent skin injuries.² Many factors can influence the development of IAD, including age, health, nutritional status, skin perfusion, hydration, and pH.³  Given the propensity toward IAD with incontinence, prompt and adequate clean-up protocols with application of a barrier are helpful in preventing hospital-acquired IAD.³ The Institute for Healthcare Improvement How-To-Guide for Preventing Pressure Ulcers includes a section under “manage moisture” which recommends staff be provided with “pre-moistened, disposable barrier wipes to help cleanse, moisturize, deodorize, and protect patients from perineal dermatitis due to incontinence”.⁴
Methods
The Skin Care Council identified incontinence-associated skin injury as a problem on the patient care units (PCUs). An evidence-based review of the literature revealed suggested methods for measuring skin injury, and implementing quality improvement measures for addressing the problem. A baseline skin injury incidence survey was conducted, and after finding a level of skin injury related to IAD, a pilot quality improvement intervention was initiated on 3 PCUs whereby a standardized, defined skin care regimen was developed with use of an all-in-one cloth with 3% impregnated dimethicone after each episode of incontinence. Licensed and non-licensed caregiver education was initiated, and the protocol was implemented. After a 2 month time period, the skin injury incidence survey was re-conducted.
Results
The baseline incidence of IAD-related skin injury was 6.5%, and after 2 months of consistent use of the skin care regimen and incontinence clean-up protocol, the follow up incidence survey revealed 0 cases of IAD-related skin injury.