Perineal care washcloth with dimethicone 3% vs. water and soap to prevent and treat incontinence-associated dermatitis: an RCT

Objective: To compare the effectiveness of a perineal care washcloth (dimethicone 3%) versus the standard-of-care (water and soap) to prevent and treat incontinence-associated dermatitis (IAD). 

Design: Cluster-randomized controlled trial.

Setting: Random sample of 11 wards (6 experimental;5 control) in Belgium.

Sample: The sample included nursing home residents at risk for IAD (defined as incontinent for urine/feces and/or having discoloration of the perineal skin, caused by urine/feces and not caused by pressure/shear, and/or having edematous skin).

Intervention: Residents in the experimental group were treated according to a peer-reviewed protocol, including the use of a perineal care washcloth (dimethicone 3%). Participants in the control group received standard perineal skin care (washing with water and soap).  A multi-faceted tailored strategy, including interactive education, reminders, monitoring, and feedback was used to implement the experimental protocol. The implementation period was 120 days. Data were collected between February and June 2010.

Measurements: IAD prevalence and severity were assessed using the IAD Skin Condition Assessment Tool (Kennedy & Lutz 1996). The surface (cm²), redness, and depth of the perineal lesion were assessed daily by the nurses.

Analyses: Repeated measures analysis of variance. The Time*Group effect was considered to evaluate the intervention effect.

Results: In total, 464 nursing home residents were included and 32.9% (n=141) were at risk to develop IAD (exp.=73, contr.=68). Baseline IAD prevalence was comparable in both groups (exp.:22.3% vs. contr.:22.8%, p=0.76). Baseline IAD severity was 6.9/10 in both groups. A significant intervention effect on IAD prevalence was found (Day 120: exp.:8.1% vs. contr.:27.1%,F=3.1,p=0.003). A trend towards a significant effect on IAD severity could be determined (Day 120: exp.:3.8/10 vs. contr.:6.9/10,F=0.8,p=0.06).

Conclusion: The use of a soft washcloth, including a 3-in-1 perineal skin cleanser, moisturizer and protectant (3% dimethicone formula) may be more effective than the use of water and soap to prevent and treat IAD.