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Course Name

Clinical Improvement Project II CAPSTONE

Graduation Year

2026

Faculty Advisor

Dr. Sarah Lee

Abstract

Globally, skin injury related to diaper dermatitis remains a pervasive yet preventable threat to neonatal patients (Jaieyoba and Visscher, 2025). In fact, the Jani et.al. 2022 study found that diaper dermatitis is the most frequently reported skin injury in premature infant patients across NICU units globally at 39%, with NICU patients in North America having a significantly higher rate of diaper dermatitis of 62%, juxtaposed to European NICU patients at 31% (Jani et.al., 2022). However, numerous studies found that implementation of a standardized skin assessment tool was a key factor in reducing rates and/or severity of perineal skin injury (Ahmadizadeh et.al., 2025; Buckley et.al., 2016; Broom et.al., 2019; Grosvenor et.al., 2016; Jani et.al., 2022; Visscher et.al., 2023). This is paramount for neonatal health, since for neonatal patients, diaper dermatitis carries particular clinical significance, increasing the risk to these medically fragile patients of opportunistic pathogens, elevated pain and the disruption of sleep essential for positive neurological outcomes and overall healing (Jaieyoba and Visscher, 2025; Paciello et al., 2025). Given the preventable nature of diaper dermatitis and its potential for serious clinical consequences in this vulnerable population, this project aims to establish a validated, evidence-based standardized skin assessment tool for use in the NICU at San Joaquin General Hospital (SJGH).

Because the full project is a long-term initiative, it will be completed in phases by successive cohorts. Phase 1, the focus of this paper and the responsibility of the current cohort, is staff education: preparing SJGH NICU nurses to understand and accurately score the Visscher Skin Integrity Scale (VSIS), and measuring changes in their knowledge, scoring accuracy, confidence, and attitudes. Later cohorts will carry out piloting of the scale in practice, unit-wide implementation, outcome evaluation (diaper dermatitis incidence, time to identification, and adherence), and integration into the electronic health record (EHR). The full-project goals are described throughout this paper as context, but the aims, measures, and analysis presented here address Phase 1 only.

Keywords

Dermatitis, NICU, Visscher, Neonates

Building a Common Language for Diaper Dermatitis Assessment: A Nurse Education Quality Improvement Project Using the Visscher Skin Integrity (VSIS) Scale in a Safety-Net NICU

Included in

Nursing Commons

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