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An Economic Evaluation of Four Skin Damage Prevention Regimens in Nursing Home Residents With Incontinence: Economics of Skin Damage Prevention

Bliss, Donna Z.; Zehrer, Cindy; Savik, Kay; Smith, Graham; Hedblom, Edwin

Journal of Wound, Ostomy and Continence Nursing: March-April 2007 - Volume 34 - Issue 2 - p 143–152
doi: 10.1097/01.WON.0000264825.03485.40
Special Focus: Moisture-Associated Skin Damage: WOUND CARE

Purpose To determine the cost and efficacy of 4 different regimens of incontinence-associated dermatitis (IAD) prevention in nursing home residents.

Methods A multi-site open-label quasi-experimental study was conducted in 16 nursing homes stratified by location in 1 of 4 regions of the United States and randomly selected. In 3 of the 4 regimens, a moisture barrier ointment or cream of different compositions was applied after each episode of incontinence, and in 1 regimen, a polymer-based barrier film was applied 3 times per week. All regimens used a pH-balanced moisturizing cleanser. Time and motion measures were documented for the amount of skin care products used; the number, type, and time of caregivers performing IAD prevention care; and the number and type of supplies used. Rates of incontinence in each nursing home were determined during a 3-day surveillance period.

Results A total of 1,918 nursing home residents were screened, and 51% (n = 981) qualified for prospective surveillance of incontinence dermatitis; the majority were female (80.1%) and elderly (96% ≥ 65 years old). A total of 78.6% (771/981) of the participants were incontinent of both urine and feces. Compared to the 3 regimens in which a barrier was applied after each episode of incontinence, the use of a regimen in which a barrier film was applied 3 times weekly had significantly lower costs for the barrier product, labor associated with barrier application, and total cost, which included products, labor, and supplies. There were also savings in total product (cleanser and barrier) and total labor costs.

Conclusions The use of a defined skin care regimen that includes a cleanser and a moisture barrier is associated with a low rate of IAD in nursing home residents who are incontinent. Use of a polymer skin barrier film 3 times weekly is effective for preventing incontinence-associated skin breakdown and can provide significant cost savings.

Donna Z. Bliss, PhD, RN, FAAN, Professor and Interim Assistant Dean for Research, University of Minnesota School of Nursing, Minneapolis.

Cindy Zehrer, MS, RN, Certified Clinical Research Associate, 3M Health Care Medical Division, St. Paul, MN.

Kay Savik, MS, Biostatistician, University of Minnesota School of Nursing, Minneapolis.

Graham Smith, BS, Statistician, 3M Health Care, Medical Division, Minneapolis, MN.

Edwin Hedblom, PharmD, Technical Manager of the Clinical Research & Discovery Center, 3M Health Care Medical Division, St. Paul, MN.

Corresponding author: Donna Z. Bliss, PhD, RN, FAAN, School of Nursing, University of Minnesota, 5–160 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455 (e-mail:

Copyright © 2007 by the Wound, Ostomy and Continence Nurses Society