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clinical trial

A quality improvement approach to perineal skin care

16 Feb

New independent clinical study reveals use of WaterWipes reduces incidence and shortens duration of diaper dermatitis in premature babies

A new independent clinical study of 1,070 premature babies revealed that consistent use of WaterWipes alongside other perineal skin care guidelines, reduced diaper dermatitis incidence in premature babies by 17% and severe diaper dermatitis by over a third. The duration of severe diaper dermatitis was also reduced by more than half (57%) – 3.5 days per 100 patient-days.

Reduced overall diaper dermatitis & reduced severe diaper dermatitis

Shortened duration of severe diaper dermatitis

Entitled ‘A Quality Improvement Approach to Perineal Skin Care,’ the robust year-long study is the first clinical study in a neonatal intensive care unit (NICU) to show that WaterWipes are well tolerated by both term and preterm infants, including those less than 30 weeks gestation.

The clinical study, which has been published in Advances in Neonatal Care1, was conducted by the University of Utah Hospital’s NICU in Salt Lake City, US.

Standardizing perineal skin care guidelines

Diaper dermatitis remains prevalent in NICUs2, despite studies documenting an understanding of prevention and treatment among healthcare professionals. Many NICUs lack a standardized approach to perineal skin, which can result in:

  • Underestimations in the prevalence of diaper dermatitis

  • Challenges in monitoring improvements in care

  • Varying use of cleansing methods and products

  • Varying use of skin care emollients

Diaper dermatitis has also been shown to cause emotional and physical distress in premature infants3 and can lead to an increased risk of infection4, it is therefore essential that steps are taken to reduce the incidence of diaper dermatitis across all NICUs. As part of the University of Utah Hospital’s clinical study, a multidisciplinary quality improvement team was formed within the NICU to identify neonatal risk factors for diaper dermatitis – reviewing skin care guidelines and compiling interventions. Following the development of new Perineal Skin Care Guidelines, the team began implementing changes, educating staff, tracking progress and monitoring compliance.

The new guidelines standardized prevention and treatment protocols for the management of diaper dermatitis across the NICU, with a focus on:

  • Early detection with improved skin assessment documentation

  • Consistent use of WaterWipes

  • Prevention with timely barrier emollients application

  • Treatment standardization

“Diaper dermatitis (DD) is a major issue for infants in the NICU; leading to increased medical costs, risk of infection and emotional distress for both babies and parents,” says Misty Williams, NICU Advanced Practice Partner, University of Arkansas for Medical Sciences, Arkansas, US. “The reduced incidence and duration of DD in the NICU at the University of Utah Hospital is a great accomplishment for the team. It provides a best in practice case to inspire other NICUs to review current management of DD, use of baby wipe products and to implement guidelines to help improve perineal skincare outcomes and maintain skin integrity for premature babies’ delicate skin.”

Safety and efficacy of wipes on newborn skin

Diaper dermatitis is one of the most common skin complaints in infants. Healthcare professionals have historically recommended cloth and water or cotton wool and water for cleaning babies’ newborn skin; however, recent studies highlight the safety and efficacy of using baby wipes to help decrease skin irritation5,6 with parents reporting greater convenience over cotton wool and water.3 Primary care physician, Dr Stephanie Ooi has also shared her practical advice for helping parents avoid and manage diaper dermatitis including the practical role wipes can play.

WaterWipes are gentle on the most sensitive skin

WaterWipes have been specifically developed to be purer than cotton wool and water while offering the convenience of a wipe. Containing just two ingredients, 99.9% high purity water and a drop of fruit extract, they provide gentle cleansing for the most delicate newborn skin and even premature babies’ skin.

WaterWipes are manufactured under clean room conditions using a unique purifying technology. The water passes through a seven-step purification process that uses a series of filters to remove impurities, soften and purify the water. This purifying process makes the water significantly purer than cooled boiled water and produces a unique product that effectively cleanses the skin, without the need for several additional cleansing ingredients. The fruit extract acts as a gentle skin conditioner.

WaterWipes are purer than cotton wool and water

Following a review of scientific literature, a team of independent experts at the Skin Health Alliance has validated that WaterWipes are purer than cotton wool and water.

7 stage purification

WaterWipes are recommended by neonatal nurses and other healthcare professionals worldwide and have become the preferred wipe for many Neonatal Intensive Care Units throughout the United States, United Kingdom, Ireland, Portugal, Australia, and New Zealand.

About the study: A Quality Improvement Approach to Perineal Skin Care

The University of Utah’s Hospital NICU is a level III NICU with an average of 35 infant patients per day. A multidisciplinary quality improvement team were tasked with identifying neonatal risk factors for diaper dermatitis – reviewing skin care guidelines and compiling interventions.

Following the development of new Perineal Skin Care Guidelines, the team began implementing changes, educating staff, tracking progress and monitoring compliance.

The purpose of the study was to implement the new Perineal Skin Care Guidelines, while introducing WaterWipes, to decrease the incidence of diaper dermatitis within a 1-year period. The inclusion criteria for the study were all babies who stayed for more than 1 day in the NICU.

The project targeted babies who were admitted to the NICU between July 2017 and March 2019; however, the study was conducted between January 2018 and March 2019 – once the Perineal Skin Care Guidelines had been implemented in January 2018.


1Rogers S, Thomas M, Chan B, et al. A Quality Improvement Approach to Perineal Skin Care: Using Standardized Guidelines and Novel Diaper Wipes to Reduce Diaper Dermatitis in NICU Infants. Adv Neonatal Care 2020. doi:10.1097/anc.0000000000000795 [Epub ahead of print]

2Malik A, Witsberger E, Cottrell L, et al. Perianal dermatitis, its incidence, and patterns of topical therapies in a level IV neonatal intensive care unit. Am J Perinatol. 2018;35(5):486-493

3Stamatas GN, Tierney NK. Diaper dermatitis; etiology, manifestations, preventions, and management. Pediatr Dermatol. 2014;31(1):1-7.

4Pogacar MS, Maver U, Varda NM, et al. Diagnosis and management of diaper dermatitis in infants with emphasis on skin microbiota in the diaper area. Int J Dermatol. 2018;57(3):265-275.

5Visscher M, Odio M, Taylor T, et al. Skin care in the NICU patient: effects of wipes versus cloth and water on stratum corneum integrity. Neonatology 2009, 96:226-234.

6Lavender T, Furber C, Campbell M, et al. Effect on skin hydration of using baby wipes to clean the napkin area of newborn babies: assessor-blinded randomised controlled equivalence trial. BMC Pediatrics 2012. 12:59.

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