Decrease in Prevalence and Incidence of Incontinence Associated Dermatitis (IAD) through Empowerment of Non-Licensed Personnel

            Incontinence Associated Dermatitis (IAD), defined by Junkin and Selekof (2008), is “an inflammation of the skin, [resulting from] chronic or repeated exposure to urine or fecal matter and manifested as redness with or without blistering and skin erosion.”  Practice innovation for the incontinent patient is necessary because of IAD prevalence throughout hospitals today. IAD leads to increased hospital length-of-stay, infections, pain, and increased cost of care. There is, too, an association and increased risk of Facility Acquired Pressure Ulcers in patients with IAD (Nix and Haugen, 2010, p. 492).

            A CWOCN lead study, conducted over four months with an objective of reducing IAD prevalence, focused on empowering non-licensed personnel—Certified Nurse Aides (CNAs)—to identify patients with, or at risk of developing, IAD. Empowerment began with education, encompassing:  types and causes of IAD; and, proper usage of skin care products. CNAs were authorized to start an individualized skin care program based upon their initial determination of patient needs, but under an RN’s supervision. Products were made immediately available on the studied units, and the CNAs selected them based upon a pre-determined, specific algorithm—developed by the CWOCNs— that included: a pH-balanced cleanser; a choice of barrier creams (with or without anti-fungal treatment); and a skin moisturizer.

            The outcome of the study showed that treatment by the CNAs decreased the incidence—or improved the severity—of IAD on their units, directly resulting from enhanced education and immediately available products. Prior to the study, acquiring skin care products through the nurse could take up to twenty-four hours. By empowering the CNA and using a standardized skin care program, the time interval decreased, with the patient receiving appropriate treatment within two hours of admission.