title: An economic evaluation of four skin damage prevention regimens in nursing home residents with incontinence: economics of skin damage prevention.
abstract: OBJECTIVE
  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% > or = 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.
authors.affiliation: School of Nursing, University of Minnesota, Minneapolis, MN 55455, USA. bliss@umn.edu
authors.forename: Donna Z
authors.initials: DZ
authors.lastname: Bliss
authors.forename: Cindy
authors.initials: C
authors.lastname: Zehrer
authors.forename: Kay
authors.initials: K
authors.lastname: Savik
authors.forename: Graham
authors.initials: G
authors.lastname: Smith
authors.forename: Edwin
authors.initials: E
authors.lastname: Hedblom
mesh_terms: D000368:Aged; D001458:Bandages / Q000191:economics*; D015400:Clinical Nursing Research; D003362:Cost-Benefit Analysis; D003872:Dermatitis / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D003879:Dermatologic Agents / Q000191:economics; D004129:Dimethylpolysiloxanes / Q000191:economics; D005242:Fecal Incontinence / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D015401:Nursing Administration Research; D009735:Nursing Homes; D010577:Petrolatum / Q000191:economics; D011446:Prospective Studies; D017592:Skin Care / Q000191:economics* / Q000379:methods; D013996:Time and Motion Studies; D016896:Treatment Outcome; D014481:United States; D014549:Urinary Incontinence / Q000150:complications*; D016526:Workload; D014945:Wound Healing; D015034:Zinc Oxide / Q000191:economics
chemical_list: D003879:Dermatologic Agents; D004129:Dimethylpolysiloxanes; D010577:Petrolatum; C501844:dimethicone; D015034:Zinc Oxide