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Beginning at the Bottom: Evidence-Based Care of Diaper Dermatitis

Heimall, Lauren M. MSN, RNC-NIC, PCNS-BC; Storey, Beth MSN, RN, CPON; Stellar, Judith J. MSN, CRNP, PNP-BC, CWOCN; Davis, Katherine Finn PhD, RN, CPNP

MCN, The American Journal of Maternal/Child Nursing: January/February 2012 - Volume 37 - Issue 1 - p 10–16
doi: 10.1097/NMC.0b013e31823850ea

Diaper dermatitis (DD), an acute inflammatory reaction of skin in the perineal area, is an extremely common pediatric condition. Nurses' practice of preventing and treating DD is inconsistent and often not evidence-based. In addition, a 2008 Skin Injury Prevalence Study at our hospital revealed that 24% of inpatients had DD. The authors developed a project to determine a consistent and evidence-based approach to DD prevention and treatment including the availability of products. A complete literature review was conducted in addition to benchmarking with other pediatric hospitals, consultation with topic experts, and evaluation of current nursing practice prior to revising the existing perineal skin care nursing standard. The evidence supports frequent diaper changes, use of super absorbent diapers, and protection of perineal skin with a product containing petrolatum and/or zinc oxide. As supported by the literature, we revised the standard to include improvements in practice as well as product updates for prevention and treatment. Hospital-wide implementation of the revised standard included training “Skin Care Champions” to educate staff and support practice improvements. Ongoing education and monitoring by the Skin Care Champions is necessary to further improve the prevention and treatment of DD for our patients.

Have you witnessed a clinical practice in your institution and said to yourself “Why do we do that?” These nurses did and put together a strong evidence-based practice change. You can use this as a model.

Lauren M. Heimall is a Clinical Nurse Specialist in the Newborn/Infant Intensive Care Unit, The Children's Hospital of Philadelphia, Philadelphia, PA. She can be reached via e-mail at

Beth Storey is a Clinical Nurse Specialist in the Inpatient Oncology/Blood and Marrow Transplant Unit, The Children's Hospital of Philadelphia, Philadelphia, PA.

Judith J. Stellar is a Wound, Ostomy, Continence Advanced Practice Nurse at The Children's Hospital of Philadelphia, Philadelphia, PA.

Katherine Finn Davis is a Nurse Researcher, The Center for Pediatric Nursing Research & Evidence-Based Practice, The Children's Hospital of Philadelphia, Philadelphia, PA.

The authors declare no conflicts of interest.

For 13 additional continuing nursing education articles on evidence-based practice, go to

© 2012 Lippincott Williams & Wilkins, Inc.