Wound, Ostomy and Continence Nurses Society™

Body Worn Absorbent Product Guide

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Acknowledgement

Thank you to the dedicated developers of the Body Worn Absorbent Products Guide:

JoAnn Ermer-Seltun, MS, RN, FNP-BC, CWOCN, CFCN
WEB WOC Nursing Education Program, Minneapolis, Minnesota; and
MercyOne North Iowa Continence Clinic, Mason City, Iowa

Mikel Gray, PhD, RN, PNP, FNP, CUNP, CCCN, FAANP, FAAN
Department of Urology, University of Virginia, Charlottesville, Virginia

Dea Kent, DNP, RN, NP-C, CWOCN, QCP
Community Health Network, Indianapolis, Indiana

Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, FAAN
Cone Health, Greensboro, North Carolina

The WOCN Society does not endorse any specific brands or products.

INTRODUCTION

Despite recent advances in multiple areas of continence management including pharmacotherapy, surgery, physiotherapy, and neuromodulation, evidence suggests that use of incontinence products remains the most prevalent strategy among adults with urinary or fecal incontinence. To address this gap, the WOCN Society developed an evidence- and consensus-based algorithm for selection, use, and evaluation of body worn absorbent products for the management of individuals with urinary and/or fecal incontinence. This algorithm will help to fill the gap in resources available for first-line and WOC specialty practice nurses guiding optimal use of these products.

To learn more about the algorithm’s development, we invite you to read the accompanying article, “Assessment, Selection, Use, and Evaluation of Body Worn Absorbent Products for Adults With Incontinence: A WOCN Society Consensus Conference”, published in Journal of Wound, Ostomy and Continence Nursing: May/June 2018 - Volume 45 - Issue 3 - p 243–264.

  • Assessment, Selection, Use & Evaluation

Use

Perigenital Skin Health
  • Use a structured skin care regimen based on principles of cleanse, protect, restore to maintain optimal skin health.
    • Select a skin cleanser with a pH close to the acid mantle of healthy skin (pH balanced), cleanse using a soft cloth and gentle technique, consider use of a no-rinse skin cleanser.
    • Apply an ointment, cream or polymer-based skin protectant as indicated.
    • Consider application of emollient-based leave-on product to restore moisture barrier function of the skin.
  • When using an ointment or cream-based skin protectant consider frequency and quantity of product application and its potential to clog and impair absorbent capacity.
  • Avoid application of corn starch or talc, and shaving, which have not been found to reduce odor or optimize skin health.
  • The use of unbreathable plastic outer layer or rubber pants to protect outer clothing or mattress is not recommended.

Evaluation

Categories for evaluating products

  • Containment: Leakage from beneath or around the product.
  • Odor: Patient's perception of odor; and others' ability to perceive odor when in immediate vicinity of user (less than 5 feet from user); versus 5 feet or greater of user.
  • Perigenital skin health:
    • Presence and severity of IAD
    • Presence and severity of intertriginous dermatitis
    • Pressure injury
    • Chaffing and friction injury especially at waist and elasticated leg bands
  • Ask user and caregivers about satisfaction with product: containment, odor, wet comfort, noise, discretion when worn under clothing, fit, cost

Indications for Referral

  • Inability to fit a body worn absorbent product (BMI, atypical body habitus)
  • Failure of two products after 7-day trial (repeated containment failure)
  • Development of perigenital skin damage that does not respond to structured skin care program within 7 days or rapid deterioration of perigenital skin
  • Preexisting perigenital wound or vascular access device

Indications for Referral

  • Failure of two products after 7-day trial (repeated containment failure)
  • Development of perigenital skin damage that does not respond to structured skin care program within 7 days or rapid deterioration of perigenital skin
  • Preexisting perigenital wound or vascular access device
  • Inability to fit a body worn absorbent product (BMI, atypical body habitus)

Incontinence present?

  • Yes
  • No

Additional Assessments

Body habitus

Obtain waist or hip circumference. If unable to measure, use BMI. BMI is not optimal, but can be used as a rough measure.

Perigenital skin health

Evaluate for intact skin, moisture associated skin damage, friction, pressure injury, cutaneous infection.

Dexterity

Ability of user to apply and remove absorbent product, manipulate tabs, place in underclothing.

Cognition

Assess cognition using validated instrument such as Mini-Mental State Examination (MMSE®), as indicated.

Caregiver

  • Availability of caregivers
  • Ability of caregiver to position user, apply and remove absorbent product, manipulate tabs

Preference

  • Consider multiple designs of body worn absorbent products to manage incontinence in users depending upon performance and personal preference.
  • Reusable products may be considered as an alternative for community-dwelling men and women.
  • Consider cost and environmental impact of products.

  • Continue

Assess Severity

  • Light
  • Moderate/Heavy (Urinary, Fecal, or Dual)

Assess incontinence type

  • Urinary
  • Fecal
  • Dual

Gender

  • Male
  • Female

Timing

  • Daytime
  • Nighttime

Ambulatory

  • Ambulatory
  • Non-ambulatory

Toiletable

  • Toiletable
  • Non-toiletable

Result

Use of body worn absorbent products is contraindicated in patients who are continent. Their use may impair continence status.

Result for Light, Fecal, Male/Female

Regardless of gender, disposable products are positioned over anus and between the buttocks.

When selecting products, consider the following:

  • Consider contour, shape and other design elements to maximize effectiveness and comfort.
  • If absorbent products become inadequate for containment or bothersome, consider use of pull ons.
  • Comfort
  • Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
  • Odor control
  • Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
  • Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design and appearance)

Change frequency:

  • Limited evidence indicates that patients and clinicians found wait times greater than 15 minutes after the fecal incontinence episode unacceptable.
  • Change times should be patient centered and not based on routine and caregiver convenience.

Result for Light, Urinary, Male, Daytime

Disposable pads (guards and shields): Consider contour shape and other design elements to maintain effectiveness and comfort.

DO NOT! Disposable menstrual pads are not recommended for use in males.

When selecting products, consider the following:

  • Comfort
  • Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
  • Odor control
  • Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
  • Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Change frequency:

  • Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
  • Change times should be patient centered and not based on routine and caregiver convenience.

Result for Light, Urinary, Female, Daytime

First line recommendation: Disposable incontinence pads (up to 100 mLs per pad)

When selecting products, consider the following:

  • Comfort
  • Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
  • Odor control
  • Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
  • Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Alternative recommendation: Disposable menstrual pads (up to 15 mLs per pad) based on patient preference, acceptability and cost. Not designed for urine containment.

Change frequency:

  • Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
  • Change times should be patient centered and not based on routine and caregiver convenience.

Result for Urinary/Fecal/Dual, Moderate/Heavy, Male, Daytime, Ambulatory

First line recommendation: Disposable pull ons with superabsorbent polymer technology.

Alternative recommendation: Disposable absorbent briefs with superabsorbent polymer technology.

When briefs or pull ons provide inadequate containment, consider addition of absorbent wrap or booster pad. Booster products or absorbent wraps should not be used for staff or caregiver convenience alone.

When selecting products, consider the following:

  • Comfort
  • Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
  • Odor control
  • Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
  • Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Change frequency:

  • Limited evidence indicates that patients and clinicians found wait times greater than 15 minutes after the fecal incontinence episode unacceptable.
  • Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
  • Change times should be patient centered and not based on routine and caregiver convenience.
  • To minimize sleep interruption and maximize containment, booster pads or absorbent wraps may be used as an adjunct to briefs or pull ons.

Result for Urinary/Fecal/Dual, Moderate/Heavy, Female, Daytime, Ambulatory

First line recommendation: Disposable pull ons with superabsorbent polymer technology.

Alternative recommendation: Disposable shape pads with superabsorbent polymer technology worn with close-fitting underwear.

When pull ons provide inadequate containment, consider addition of booster pad. Booster products should not be used for staff or caregiver convenience alone.

When selecting products, consider the following:

  • Comfort
  • Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
  • Odor control
  • Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
  • Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Change frequency:

  • Limited evidence indicates that patients and clinicians found wait times greater than 15 minutes after the fecal incontinence episode unacceptable.
  • Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
  • Change times should be patient centered and not based on routine and caregiver convenience.
  • To minimize sleep interruption and maximize containment, booster pads may be used as an adjunct to pull ons.

Result for Urinary/Fecal/Dual, Moderate/Heavy, Female, Daytime, Nonambulatory, Toiletable

First line recommendation: Disposable pull ons with superabsorbent polymer technology.

Alternative recommendation: Disposable pad with close-fitting underwear.

When selecting products, consider the following:

  • Comfort
  • Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
  • Odor control
  • Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
  • Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Change frequency:

  • Limited evidence indicates that patients and clinicians found wait times greater than 15 minutes after the fecal incontinence episode unacceptable.
  • Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
  • Change times should be patient centered and not based on routine and caregiver convenience.
  • To minimize sleep interruption and maximize containment, booster pads may be used as an adjunct to pull ons.

Result for Urinary/Fecal/Dual, Moderate/Heavy, Female, Daytime/Nighttime, Nonambulatory, Nontoiletable

First line recommendation: Disposable briefs with superabsorbent polymer technology.

Use of absorbent products that are pulled up are not recommended in individuals who are bed-bound and non-toiletable.

When selecting products, consider the following:

  • Comfort
  • Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
  • Odor control
  • Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
  • Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Change frequency:

  • Limited evidence indicates that patients and clinicians found wait times greater than 15 minutes after the fecal incontinence episode unacceptable.
  • Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
  • Change times should be patient centered and not based on routine and caregiver convenience.
  • To minimize sleep interruption and maximize containment, booster pads may be used as an adjunct to briefs.

Result for Urinary/Fecal/Dual, Moderate/Heavy, Male, Daytime/Nighttime, Nonambulatory, Nontoiletable

First line recommendation: Disposable briefs with superabsorbent polymer technology.

Use of absorbent products that are pulled up are not recommended in individuals who are bed-bound and non-toiletable.

When briefs provide inadequate containment, consider addition of absorbent wrap or booster pad. Booster products or absorbent wraps should not be used for staff or caregiver convenience alone.

When selecting products, consider the following:

  • Comfort
  • Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
  • Odor control
  • Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
  • Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Change frequency:

  • Limited evidence indicates that patients and clinicians found wait times greater than 15 minutes after the fecal incontinence episode unacceptable.
  • Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
  • Change times should be patient centered and not based on routine and caregiver convenience.
  • To minimize sleep interruption and maximize containment, booster pads or absorbent wraps may be used as an adjunct to briefs.

Result for Urinary/Fecal/Dual, Moderate/Heavy, Male, Daytime, Nonambulatory, Toiletable

First line recommendation: Disposable briefs with superabsorbent polymer technology.

Alternative recommendation: Close-fitting underwear with integral pads (urinary only) or pull ons (all types).

When briefs or pull ons provide inadequate containment, consider addition of absorbent wrap or booster pad. Booster products or absorbent wraps should not be used for staff or caregiver convenience alone.

Disposable and reusable diapers for infants are not recommended for incontinence containment in men with urinary, fecal, or dual incontinence.

When selecting products, consider the following:

  • Comfort
  • Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
  • Odor control
  • Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
  • Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Change frequency:

  • Limited evidence indicates that patients and clinicians found wait times greater than 15 minutes after the fecal incontinence episode unacceptable.
  • Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
  • Change times should be patient centered and not based on routine and caregiver convenience.
  • To minimize sleep interruption and maximize containment, booster pads or absorbent wraps may be used as an adjunct to briefs or pull ons.

Result for Urinary/Fecal/Dual, Moderate/Heavy, Male, Nighttime, Ambulatory/Nonambulatory

A disposable brief with additional absorbent capacity designed for nighttime use.

When briefs provide inadequate containment, consider addition of absorbent wrap or booster pad. Booster products or absorbent wraps should not be used for staff or caregiver convenience alone.

When selecting products, consider the following:

  • Comfort
  • Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
  • Odor control
  • Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
  • Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Change frequency:

  • Limited evidence indicates that patients and clinicians found wait times greater than 15 minutes after the fecal incontinence episode unacceptable.
  • Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
  • Change times should be patient centered and not based on routine and caregiver convenience.
  • To minimize sleep interruption and maximize containment, booster pads or absorbent wraps may be used as an adjunct to briefs or pull ons.

Result for Urinary/Fecal/Dual, Moderate/Heavy, Female, Nighttime, Ambulatory

First line recommendation: Disposable pull ons with superabsorbent polymer technology designed for nighttime use.

Alternative recommendation: Close-fitting underwear with integral pads (urinary only), designed for nighttime use.

When selecting products, consider the following:

  • Comfort
  • Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
  • Odor control
  • Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
  • Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Change frequency:

  • Limited evidence indicates that patients and clinicians found wait times greater than 15 minutes after the fecal incontinence episode unacceptable.
  • Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
  • Change times should be patient centered and not based on routine and caregiver convenience.
  • To minimize sleep interruption and maximize containment, booster pads may be used as an adjunct to pull ons.

Result for Urinary/Fecal/Dual, Moderate/Heavy, Female, Nighttime, Nonambulatory

First line recommendation: Disposable briefs with additional absorbent capacity designed for nighttime use.

When briefs provide inadequate containment, consider addition of disposable booster pad. Disposable booster pads should not be used for staff or caregiver convenience alone.

When selecting products, consider the following:

  • Comfort
  • Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
  • Odor control
  • Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
  • Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Change frequency:

  • Limited evidence indicates that patients and clinicians found wait times greater than 15 minutes after the fecal incontinence episode unacceptable.
  • Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
  • Change times should be patient centered and not based on routine and caregiver convenience.
  • To minimize sleep interruption and maximize containment, booster pads may be used as an adjunct to briefs.

Result for Urinary/Fecal/Dual, Light, Male

Recommendations for light fecal male incontinence: Use disposable products positioned over the anus and between the buttocks.

Recommendations for light urinary male incontinence: Use disposable pads (guards and shields); consider contour shape and other design elements to maintain effectiveness and comfort.

DO NOT! Disposable menstrual pads are not recommended for use in males.

When selecting products, consider the following:

  • Comfort
  • Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
  • Odor control
  • Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
  • Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Change frequency:

  • Limited evidence indicates that patients and clinicians found wait times greater than 15 minutes after the fecal incontinence episode unacceptable.
  • Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
  • Change times should be patient centered and not based on routine and caregiver convenience.
  • To minimize sleep interruption and maximize containment, booster pads or absorbent wraps may be used as an adjunct to briefs or pull ons.

Result for Urinary/Fecal/Dual, Light, Female

Recommendations for light fecal female incontinence: Use disposable products positioned over the anus and between the buttocks.

First line recommendations for light urinary female incontinence: Disposable incontinence pads (up to 100 mLs per pad)

When selecting products, consider the following:

  • Comfort
  • Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
  • Odor control
  • Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
  • Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Alternative recommendation for light urinary female incontinence: Disposable menstrual pads (up to 15 mLs per pad) based on patient preference, acceptability and cost. Not designed for urine containment.

Change frequency:

  • Limited evidence indicates that patients and clinicians found wait times greater than 15 minutes after the fecal incontinence episode unacceptable.
  • Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
  • Change times should be patient centered and not based on routine and caregiver convenience.
  • To minimize sleep interruption and maximize containment, booster pads may be used as an adjunct to briefs or pull ons.

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Glossary

Absorptive capacity:
The maximum capacity of fluid an absorbent product can hold; this value is determined in the laboratory using a standardized technique.

Booster pad:
A disposable, absorbent, flow-through pad inserted into the primary body worn absorbent product (BWAP) such as a pull on or a brief to enhance absorbent capacity. It can be removed once it is wet without the need to replace the primary BWAP.

Breathability:
Airflow within an absorbent product that allows release of heat, perspiration, and gas in the pelvic girdle region.

Brief:
A body worn absorbent garment that is shaped similar to a diaper and has tabs that seal and reseal with adhesive, Velcro or hooks.

Disposable absorbent pull ons (or pull ons):
A body worn absorbent garment that generally has an elasticated waist and hip area, or that has an elastic strap for security, designed to be similarly applied and removed similar to underwear.

Elastication:
The ability of elastics that are woven together to maintain fit snugly around the waist or thigh despite repeated movement.

Guard:
An inserted absorbent product that covers the penis and scrotum that can be used with close-fitting underwear to absorb urine in the front of the garment. Sometimes referred to as a leaf or shield.

Insert:
An absorbent product, often shaped and contoured to fit into underwear in the crotch panel, to absorb urine. Often referred to as a pad, booster pad or guard.

Leaf:
See guard.

Liners:
An absorbent pad with an adhesive strip that will allow it to be placed in regular underwear. Often referred to as feminine hygiene pad, or pantyliner.

Liquid acquisition rate:
The speed at which urine is wicked away from the skin by an absorbent material.

Nonambulatory:
The inability to move independently from bed or chair or be able to transfer or reposition without maximum assistance of another.

Pad:
An inserted absorbent product with or without an adhesive strip, often shaped and contoured to fit into the crotch panel of underwear to absorb urine. Often referred to as a bladder control pad, guard, or shield.

Pouch
An absorbent pocket that fits over the penis and often can hold 1-2 oz of urine. It can be used with other products.

Retention capacity
The maximum volume of fluid an absorbent product can hold without leaking.

Rewet
A measure of an absorbent material’s ability to absorb urine with multiple incontinent episodes.

Shield
See guard.

Superabsorbent polymer technology:
Material able to absorb and retain extremely large amounts of liquid relative to its mass (sap’s can absorb up to 300 times its weight).

Toiletable
The ability of an individual to transfer to a toilet or commode with or without assistance for voiding or defecation purposes.

Wet comfort:
Sensation of skin wetness, product bulkiness, lumpiness or heaviness creating increased awareness and concern.

Wrap:
An absorbent, layered pad that fits around the penis and wicks away urine. It is similar to a pouch and can be used in conjunction with other products.

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Resources

Professional Societies:

The WOCN Society does not endorse any specific brands or products.

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References

Black J, Gray M, Bliss DZ, Kennedy-Evans KL, Logan, S, Baharestani MM, Colwell JC, Goldberg M, Ratliff CR. MASD Part 2: Incontinence-Associated Dermatitis and Intertriginous Dermatitis: A Consensus. Journal of Wound, Ostomy & Continence Nursing 2011; 38(4):359-370.

Gray M, Black JM, Baharestani MM, Bliss DZ, Colwell JC, Goldberg M, Kennedy-Evans K, Logan S, Ratliff CR. Moisture-Associated Skin Damage: Overview and Pathophysiology. Journal of Wound, Ostomy and Continence Nursing. 2011; 38(3):233-241.

Wound, Ostomy and Continence Nurses Society Guideline Development Task Force. WOCN Society Clinical Guideline: Management of the Adult Patient With a Fecal or Urinary Ostomy: An Executive Summary. Journal of Wound, Ostomy and Continence Nursing 2018; 45(1):50-58.

Beeckman D, Campbell J, Campbell K, Chimenato D, Coyer F, Domansky R, Gray M et al Proceedings of the Global IAD Expert Panel. Incontinence associated dermatitis: moving prevention forward. https://multimedia.3m.com/mws/media/1048834O/incontinence-associated-dermatitis-best-practice-principles.pdf.

Beeckman D, Van den Bussche K, Alves P, Arnold Long MC, Beele H, Ciprandi G et al. Towards an international language for incontinence-associated dermatitis (IAD): design and evaluation of psychometric properties of the Ghent Global IAD Categorization Tool (GLOBIAD) in 30 countries. British Journal of Dermatology 2018; 178(6): 1331-40.

Bliss DZ, Hurlow J, Cefalu J, Mahlum L, Borchert K, Savik K. Refinement of an Instrument for Assessing Incontinent-Associated Dermatitis and Its Severity for Use With Darker-Toned Skin. Journal of Wound, Ostomy and Continence Nursing 2014; 41(4):365-370.

Doughty D, Junkin J, Kurz P, Selekof J; Gray M, Fader M, Bliss DZ, Beeckman D, Logan S. Incontinence-Associated Dermatitis: Consensus Statements, Evidence-Based Guidelines for Prevention and Treatment, and Current Challenges. Journal of Wound, Ostomy and Continence Nursing 2012; 39(3):303-315.