Implementing a Nurse-driven Quality Improvement System for Incontinence-associated Dermatitis Prevention in a General Surgery Ward

OBJECTIVE: This quality improvement (QI) project evaluated the effectiveness of a structured, nurse-driven incontinence-associated dermatitis (IAD) prevention system in reducing IAD incidence and severity and improving nursing staff knowledge and caregiver adherence in a general surgery ward. METHODS: A pre-post QI project was conducted in the general surgery ward of a tertiary hospital. The intervention included systematic identification of high-risk patients, standardized preventive nursing protocols, nurse training, and caregiver education. Outcomes assessed before and after implementation included IAD incidence and severity among high-risk patients, nursing staff knowledge, caregiver compliance with preventive measures, and incontinence-related pressure injuries. RESULTS: At baseline, 110 patients were assessed, including 11 high-risk patients, of whom 3 developed IAD (27.3%). After implementation, 122 patients were assessed, including 16 high-risk patients, with 1 case of IAD (6.3%), an absolute reduction of 21.0%. Grade 2 IAD decreased from 9.1% to 0%. Nursing staff knowledge increased from 66.7% to 94.1%, and caregiver compliance improved from 46.7% to 87.5%. No incontinence-related pressure injuries occurred during the intervention period (baseline incidence: 1.34%). All outcomes met or exceeded predefined QI targets. CONCLUSIONS: A structured, nurse-driven QI system implemented in a general surgery ward was associated with reduced IAD incidence and severity and improved nursing practice and caregiver adherence, supporting the value of risk-based, standardized prevention strategies in general surgery settings.