After 5 years of continuous refinement, Dignity Continence Solutions now creates permanent behavior change that supports natural sleep patterns and improves outcomes, according to the company.

Clinicians know that incontinence-related moisture often results in skin irritation and breakdown.1,2 To combat these negative effects, caregivers routinely check and change absorbent products up to nine times a day. However, this practice compromises the resident’s dignity, independence, and, most of all, their natural sleep patterns. Dignity Continence Solutions (DCS) by Hartmann USA Inc offers a new care protocol that restores a good night’s sleep and protects resident dignity and comfort. Utilizing more absorbent products and fewer of them reduces the amount of disruptive and embarrassing product changes, without compromising skin health or the rate of urinary tract infections (UTIs), the company says. Additionally, a comprehensive training program promotes the necessary behavior change among staff, through the use of one-on-one consultancy, specialized tools, and products. A clinical outcomes study was conducted and independently verified to demonstrate the benefits of this protocol.

Study Design

This outcomes study was based on Minimum Data Set (MDS) 2.0 data for a total of 268 residents from July 2009 through July 2010. The residents included in the study lived in 16 long-term care communities from the Presbyterian Manors of Mid America Group. Independent researcher Christie Teigland analyzed the MDS data to determine the physical and mental health-related outcomes of residents following the DCS care protocol.

Mental Health Outcomes

Several improvements in depression indicators provided exciting and unexpected results. Although depression indicators in the nursing home population typically increase, the indicators during the intervention period showed a decrease. The percentage of residents with repetitive complaints declined by 33.0% in the intervention period, compared to the control period that increased by 9.4%. Teigland says in a release, “The intervention has significantly reduced these types of complaints in residents treated under the new protocol.” Compared to the control period, 62.9% fewer residents in the intervention period possessed the depression indicator of unpleasant mood in the morning. This finding is directly related to the residents’ ability to sleep soundly through the night and to choose their own waking time.

Researchers also identified a reduction in the number of repetitive questions and the instances of crying/tearfulness. While this reduction was not statistically significant, it does represent an encouraging trend.

Physical Health Outcomes

Despite reducing product changes by half, neither the rate of UTIs nor the rate of pressure ulcers increased during the intervention period. In her report of the study outcomes, Teigland says, “A primary [concern] expressed by the nursing staffs was that the new incontinence protocol may result in an increase in UTIs, which is a quality issue for residents. This did not prove to be true based on the data.”

While the rate of pressure ulcers and UTIs remained unchanged, the rate of falls decreased by 28.4% in the intervention period. Teigland says that “falls represent a serious quality of life issue, leading to functional and cognitive decline and depression, and result in significantly higher healthcare costs.” In describing the link between better sleep and fewer falls, Teigland stated that getting more sleep is “likely to contribute to fewer falls—ie, not getting up and trying to move around on their own at night and [being] more alert during the daytime hours.”

This clinical outcomes study provides evidence that supports a person-centered approach to adult incontinence care. With DCS, clinicians can offer an incontinence care protocol that protects residents’ sleep and dignity, and considers the resident’s individual needs and wishes without compromising skin health.


1 Gray M. Incontinence-related skin damage: essential knowledge. Ostomy Wound Management. 2007;53:28-32
2 Beeckmean D, Schoonhoven L, Verhaeghe S, Heyneman A, Defloor T. Prevention and treatment of incontinence-associated dermatitis: literature review. J Adv Nurs. 2009;65:1141-1154