Reducing irritant diaper dermatitis among sick neonates in a tertiary care unit: A quality improvement initiative

Background Irritant diaper dermatitis is a morbidity which is often overlooked from a preventive point of view in neonatal intensive care units (NICU), when other more pressing priorities take precedence. Prolonged hospitalisation, immaturity of the skin barrier, frequent exposure to urine and stool contribute to aetiology. It causes much distress to the infant and parents, increases risk of infection and adds to nursing care load. Objectives This quality improvement (QI) initiative was designed to reduce the incidence of irritant diaper dermatitis among neonates admitted to the NICU by at least 50% within six months and to achieve near-zero incidence within one year through implementation of standardised, evidence-based skin care practices. Methods A QI project using Plan−Do−Study−Act (PDSA) methodology was conducted over a 12-month period (May 2024−April 2025). Baseline surveillance was followed by sequential implementation of targeted interventions focusing on staff training, standardised diaper care protocols, skin protective strategies and parental engagement. The primary outcome measure was monthly incidence of diaper dermatitis. Results Baseline incidence ranged from 18-21.6%. Following successive PDSA cycles, incidence reduced to 3−4 cases per month after the first two cycles and further declined to 0−1 in later cycles with sustained improvement for 3 months post-intervention. Implementation of the preventive care bundle resulted in over 95% reduction in diaper dermatitis with rates declining from ∼20% at commencement of the project to near-zero levels with sustained effects for over 6 months thereafter. Limitations Cost effectiveness analysis and impact on length of hospital stay were not formally done. Conclusion Simple, low-cost interventions implemented through a structured QI framework significantly reduced irritant diaper dermatitis in the NICU. Standardisation of diaper care practices and sustained staff and parent engagement were key drivers of success.