Karen has worked in the medical device industry for over 25 years in the areas of product management and medical information/publications for several companies, including Philips Respironics (Westminster, CO), OSNovative Systems (Santa Clara, CA) and Solventum (Eagan, MN). In her current position as a medical writer, Karen assists health care professionals worldwide in preparing manuscripts regarding wound care outcomes and techniques for publication in various medical journals. Karen earned a Bachelor of Science degree from University of Colorado.
Beach_Current-Dialogues-in-Wound-Management_2026_Article-5
Incontinence-associated dermatitis (IAD) is an inflammation of the skin that occurs from contact with urine and/or feces. Its severity varies, ranging from erythema—with or without loss of skin integrity—to infection. Lack of prevention and effective management often leads to deeper tissue damage.1 Since the 2015 publication of a pivotal document addressing IAD prevention,2 significant progress has been made toward implementing best practice principles.3 Despite these achievements, misdiagnosis of IAD and pressure ulcers/injuries remains a significant problem.4
Responding to a growing body of evidence and insights from healthcare professionals (HCPs) worldwide, members of an international expert panel have recently published a 2026 update to synthesize the latest evidence regarding IAD, and translate it into practical, clinically relevant guidance to support frontline clinicians, inform quality improvement initiatives and research, and improve patient outcomes.
The 2026 update5 is significantly more extensive than the 2015 consensus document.2 Notably, the update presents 40 implementation-ready Best Practice Statements in contrast to the narrative guidance of the earlier version. Key advancements detailed in the 2026 update, compared to the original 2015 document, are shown below.
Key Revisions to the 2026 Consensus Document Update Compared to the Original 2015 Publication
A strong focus on IAD prevention as a measurable, system-level practice of accountability
An emphasis on proactive rather than reactive organization-wide approaches to IAD prevention
A recognition of IAD as a preventable harm, quality indicator and system-level safety issue, as opposed to strictly a clinical measure
The importance of integrating pressure injury prevention into IAD prevention initiatives
More comprehensive guidance on product selection, addressing durability, breathability, wash off resistance and cost effectiveness
Clearer directives for organizational accountability and standardized implementation
An expanded understanding of IAD risk factors beyond continence-related factors-now encompassing medication-related, physiology-related, cognition-related, and care-related factors
Enhanced guidance on documentation, reassessment intervals, escalation procedures, and the use of standardized tools (Ghent Global IAD Tool [GLOBIAD] for classification, GLOBIAD-M for monitoring progression, and Minimum Data Set [MDS]-IAD for structured data capture)
Increased attention on patient experience, dignity, pain management and equity
Improved alignment of IAD prevention strategies with current healthcare priorities, including cost-effectiveness, sustainability, antimicrobial stewardship and the emerging role of digital and AI-enabled decision support systems
A summary of the recently published 2026 Best Practice Update5 follows.
Understanding IAD
IAD is a type of moisture-associated skin damage (MASD) caused by prolonged contact with urine and/or feces, affecting perineal and adjacent areas.6 It is essential to differentiate between IAD and moisture-associated skin damage, with IAD established as a specific subtype within the broader MASD framework.
The 2026 IAD Moving Prevention Forward consensus document outlines best practice statements to standardize terminology, simplify classification systems, improve recognition and management of IAD, and address this condition that can develop even in individuals who are continent.
fields for skin assessment, diagnostic reasoning, IAD classification and the progression of IAD-related lesions.
IAD Reporting
Accurate and consistent documentation of clinical assessments and interventions is fundamental to continuity of care and to establish epidemiological indicators of care burden and effectiveness. Healthcare organizations should adopt standardized data collection approaches, including clinical photographs, to reduce documentation burden and minimize variability in the reporting of IAD.
IAD Management
Two key interventions essential for effective IAD management are: 1) managing exposure to urine and feces, and 2) implementing a structured skin care regimen. The skin care regimen to be performed daily or after each incontinence episode should prioritize gentle cleansing and proper drying, skin protection, and restoration when appropriate. Recommended are no-rinse, non-ionic or amphoteric skin cleansers with surfactants.
After cleansing, durable and breathable skin barrier products that resist wash-off and allow for ongoing skin inspection are preferred. Film-forming barrier products, such as formulations with cyanoacrylate tetrapolymer, can help maintain skin integrity by reducing moisture exposure, minimizing irritation from urine and feces, and supporting early identification of skin changes needing clinical intervention.22
Complications and Pain Management
The best practice update5 notes that managing severe IAD involves skin damage that may present as weeping erosions and/or areas of partial skin denudement. In these cases, application of dressings that support moist wound healing may be appropriate to protect exposed tissue, manage exudate and promote epithelial repair.
Pain associated with IAD remains under-recognized and undertreated,23 despite its potential to worsen skin damage through scratching and increased infection risk. Timely and appropriate pain management is therefore an essential component of comprehensive IAD care.
IAD Guidelines and Education
The consensus document5 stresses the need for updated guidelines and educational programs for HCPs, patients, and caregivers to improve recognition and management of IAD. Emphasis is placed on developing rigorous educational interventions supported by validated assessment tools. Messaging that should be emphasized in all HCP and patient education programs is summarized.
Artificial Intelligence (AI) Tools in IAD Management
The update5 acknowledges that artificial intelligence (AI) presents a promising avenue to address challenges in IAD management, from diagnosis to treatment planning.24, 25 However, it advises that clinical judgment remains paramount when utilizing AI technologies, and that AI should never replace the clinical judgement of healthcare professionals in skin care.
Conclusions
The 2026 update5 consolidates and advances evidence-based practices for IAD, aimed at improving patient outcomes through standardized care models. Recent advances in IAD research have substantially strengthened the evidence base and contributed to a more comprehensive, person-centered understanding of IAD.
Despite progress, challenges remain in achieving diagnostic accuracy and comprehensive education. Many HCPs remain insufficiently informed about the comparative effectiveness and safety of IAD-related products, including cleansers, skin barrier protectants and absorbent continence systems. A global effort is needed to transition from outdated practices to evidence-based recommendations to ensure effective prevention and management of IAD.
This summary encapsulates the main themes and best practices proposed in the original manuscript, highlighting the critical need for improved awareness and management of IAD in clinical settings. The original manuscript can be accessed at: https://woundsinternational.com/best-practice-statements/incontinence-associated-dermatitis-moving-prevention-forward-2/
References
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- Beeckman D. Best Practice Principles: Incontinence-associated dermatitis: moving prevention forward. Wounds Int. 2015:1-21.
- Banharak S, Panpanit L, Subindee S, Narongsanoi P, Sanun-Aur P, Kulwong W, et al. Prevention and Care for Incontinence-Associated Dermatitis Among Older Adults: A Systematic Review. J Multidiscip Healthc. 2021;14:2983-3004.
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- Beeckman D, Barakat-Johnson M, Ahtiala M, Bernaerts K, Conway B, Dunk AM, et al. Incontinence-Associated Dermatitis: Moving prevention forward. Best Practice Update 2026. Wounds Int. 2026.
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- Kayser SA, Koloms K, Murray A, Khawar W, Gray M. Incontinence and Incontinence-Associated Dermatitis in Acute Care: A Retrospective Analysis of Total Cost of Care and Patient Outcomes From the Premier Healthcare Database. J Wound Ostomy Continence Nurs. 2021;48(6):545-52.
- Elli C, Novella A, Nobili A, Ianes A, Pasina L. Factors Associated with a High-Risk Profile for Developing Pressure Injuries in Long-Term Residents of Nursing Homes. Med Princ Pract. 2022;31(5):433-8.
- Gray M, Giuliano KK. Incontinence-Associated Dermatitis, Characteristics and Relationship to Pressure Injury: A Multisite Epidemiologic Analysis. J Wound Ostomy Continence Nurs. 2018;45(1):63-7.
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