Effect of a Standardized Moisture-Care Protocol Using Skin Barrier Spray on Prevention of Pressure Injuries in the Perineal-Sacral Area Among Incontinent Inpatients: A 3-month Pilot Study.

This pilot study will evaluate whether a standardized proactive moisture-care protocol using a silicone-based skin barrier spray can reduce early-stage pressure injuries in the perineal-sacral area among older incontinent inpatients in an acute medical ward.

Incontinent inpatients are at increased risk of skin damage in the perineal and sacral regions because repeated exposure to urine, feces, moisture, friction, and irritants may compromise skin integrity. Moisture-associated skin damage and incontinence-associated dermatitis can increase skin vulnerability to pressure and shear forces, contributing to the development of early-stage pressure injuries. In the current ward practice, barrier products are commonly applied after early skin redness or irritation is observed. This study introduces a proactive preventive approach in which a barrier spray is applied routinely before visible skin damage develops.

The study will use a prospective, quasi-experimental, sequential design. A total of 70 participants will be recruited, with approximately 35 participants in the usual-care control phase and 35 participants in the intervention phase. Participants will be recruited from an acute medical ward during two consecutive study phases over a 12-week period. During weeks 1-6, participants will receive usual care. During weeks 7-12, participants will receive the standardized proactive moisture-care protocol. Allocation will be based on the participant's admission period rather than randomization. This time-based design is intended to allow the ward to implement one care approach at a time and reduce cross-contamination between usual care and the intervention.

All enrolled participants will receive standard nursing care for pressure injury prevention, including routine skin assessment, incontinence care, repositioning as clinically indicated, use of pressure-redistribution measures where appropriate, and other usual preventive practices according to ward procedures. A standardized cleansing approach will be used for incontinence episodes in both study groups to reduce variation in routine hygiene care.

In the usual-care phase, skin barrier products will be applied according to current clinical practice, typically in response to observed skin redness, irritation, or other signs of early skin compromise. Product selection and frequency of use will follow usual nursing assessment and clinical judgment.

In the intervention phase, participants will receive proactive application of a silicone-based skin barrier spray to intact at-risk perineal-sacral skin during routine morning incontinence care. The intervention is intended to provide a protective barrier before visible skin breakdown occurs. Nursing staff will be trained on the study procedures, application method, documentation requirements, and skin assessment expectations before implementation of the intervention phase.

Participants will be followed for up to 14 days, until hospital discharge or transfer out of the ward, or until the first occurrence of skin breakdown in the perineal-sacral area, whichever occurs first. Baseline data will include demographic and clinical characteristics relevant to pressure injury risk, such as age, sex, mobility status, incontinence type, baseline skin condition, and Braden Scale score. Daily monitoring will include assessment of perineal-sacral skin condition and documentation of any new pressure injury or incontinence-associated dermatitis. Suspected new skin breakdown will be reviewed by trained members of the research team to support consistent classification.

The primary evaluation will focus on the occurrence of new Stage 1-2 pressure injuries in the perineal-sacral area during the observation period. Additional feasibility and process measures will include occurrence of incontinence-associated dermatitis, nursing compliance with the proactive protocol, nursing workload related to skin and wound care, and consumable cost comparison between the usual-care and intervention phases.

The study intervention involves a hospital-approved barrier product used as part of routine nursing skin care and is considered minimal risk. Participants will continue to receive all clinically necessary care. Skin condition will be monitored regularly, and any suspected adverse skin reaction will lead to discontinuation of the barrier spray and appropriate clinical review. All study data will be coded and handled in accordance with institutional privacy and data protection requirements.

Findings from this pilot study will be used to assess feasibility, preliminary clinical effect, staff compliance, workload implications, and resource use associated with implementing a standardized proactive moisture-care protocol. The results will inform whether a larger-scale study or broader implementation of proactive moisture-care practice is warranted.