Preventing Incontinence-Associated Dermatitis (IAD)

Incontinence is a leading risk factor for skin breakdown, known as Incontinence-Associated Dermatitis (IAD).1 IAD is defined as “an inflammation of the skin that occurs when urine or stool comes into contact with perineal or perigenital skin.”2

Not only does IAD cause skin irritation and discomfort, but it also is a major risk factor for pressure ulcers.1 IAD is often grouped with pressure ulcers, but they are not one and the same—IAD works from the outside in, while pressure ulcers work from the inside out. Since they are different conditions, they should be treated differently.

Applying a barrier after incontinence episodes has been proven effective versus using soap and water in a randomized control trial. A 4-month study of 464 nursing home residents using a barrier cream cloth saw a reduction in the prevalence of IAD from 22% to 8%, while residents using soap and water saw IAD prevalence increase from 23% to 27%. The study also found a decrease in IAD severity in residents using the barrier cream cloth, while no improvement was seen with soap and water.3

Using the basin to clean patients after an incontinence episode puts them at risk for nosocomial infection. Basin sampling has proven that the basin is a reservoir for bacteria, including S. aureus and the multi-drug resistant organisms (MDROs) methicillin-resistant S. aureus (MRSA) and vancomycin-resistant enterococci (VRE).4,5

This education section will help you bolster your IAD prevention program with evidence-based incontinence care. The IAD Assessment will help your facility track outcomes from your incontinence care protocol.

These unique tools will help you assess current clinical practice, educate staff, customize and implement evidence-based protocols, complete a performance improvement plan, and track progress, from pressure ulcer rates, to staff compliance, to costs.

REFERENCES: 1. Maklebust J, Magnan MA, Adv Wound Care. Nov 1994;7(6):25,27-8,31-4 passim. 2. Gray M, et al., J Wound Ostomy Continence Nurse. 2007 Jan-Feb;34(1):45-54. 3. Beekman D, et al., A 3-in-1 perineal care washcloth impregnated with dimethicone 3% versus water and pH neutral soap to prevent and treat incontinence-associated dermatitis. Journal of Woun, Ostomy and Continence Nursing, Nov/Dec 2011; 38(6). 4. Marchaim D, et al., Hospital bath basins are frequently contaminated with multi-drug resistant human pathogens. Poster presented at SHEA 21st Annual Scientific Meeting, April 2011. 5. Johnson D, Lineweaver, Maze L, Patients’ bath basins as potential sources of infection: a multicenter sampling study, AJCC, Vol 18, No 1, Jan 2009.

Incontinence-Associated Dermatitis, Characteristics and Relationship to Pressure Injury – A Multisite Epidemiologic Analysis
Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAAN, FAANP; and Karen K. Giuliano, PhD, RN, FAAN
J Wound Ostomy Continence Nurs. 2018 Jan; 45(1): 63–67.
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A 3-in-1 Perineal Care Washcloth Impregnated With Dimethicone 3% Versus Water and pH Neutral Soap to Prevent and Treat Incontinence-Associated Dermatitis
Beeckman D
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Incontinence-Associated Dermatitis: Consensus Statements, Evidence-Based Guidelines for Prevention and Treatment, and Current Challenges
Doughty D
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Location, Location, Location: Incontinence care supplies at the bedside
Schmitz T
Nursing Management
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A review of perineal skin care protocols and skin barrier product use
Nix D
Ostomy/Wound Management. Dec 2004;50(12):59-67.
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Clean, Moisturise and Protect! A Standardized Approach to Preventing Incontinence Associated Dermatitis
Pukiova I
Presented at EMWA 2015; London, UK; 13-15 May, 2015
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All In One: A Quality Improvement Initiative Aimed to Prevent Incontinence Associated Dermatitis
Wright C, Bennett A, RN
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Effectiveness of a Clinically Proven 3-in-1 Perineal Care Washcloth in the Prevention of IAD on a Geriatric Unit
Heinemann K
Presented at the 18th EPUAP Annual Meeting, 16 – 18 September 2015; Ghent, Belgium
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Comparison of Skin Barrier Effectiveness for Products Containing Dimethicone
West D, PhD, FCCP, CIP
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Implementing Nurse-Driven Interventions to Improve Incontinence Associated Dermatitis and Hospital-Acquired Pressure Ulcers
Hall K
The Clinical Symposium on Advances in Skin & Wound Care; September 9-12, 2011
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Consistency the key for treating severe perineal dermatitis due to incontinence
Sturgeon Community Hospital and Health Centre
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Cost-effective, quality care for the patient with incontinence
Dieter L
Research poster abstract presented at WOCN Society Annual Conference, Minneapolis, MN, Jun 2006.
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IHI “Prevent Pressure Ulcers” How-to Guide1,2
4.Manage Moisture: Keep the Patient Dry and Moisturize Skin
Cleanse skin at time of soiling and at routine intervals with “gentle use of a mild cleansing agent that minimizes irritation and dryness of the skin.”
“Minimize exposure of the skin to moisture due to incontinence, perspiration, or wound drainage.”
“Use topical agents that act as moisture barriers and moisturize the skin.”
“Provide supplies at the bedside of each at-risk patient who is incontinent. This provides the staff with the supplies they need to immediately clean, dry, and protect the patient’s skin after each episode of incontinence.”
“Provide premoistened, disposable barrier wipes to help cleanse, moisturize, deodorize, and protect patients from perineal dermatitis due to incontinence.”

Download “Prevent Pressure Ulcers” How-to Guide
Download “Prevent Pressure Ulcers” Annotated Bibliography
View campaign materials for pressure ulcer prevention (and all 12 campaign interventions)
View campaign highlights