Standardizing Peristomal Hygiene: Reducing Variation and Complications in Ostomy Care.

Abstract

Abstract: Peristomal skin complications (PSCs) remain a common, costly, and underrecognized challenge in ostomy care, driven by inconsistent education, variable clinical practices, and the absence of standardized terminology and protocols. These complications affect a substantial proportion of people living with an ostomy and are associated with leakage, pain, psychological distress, reduced health-related quality of life (QoL), and preventable health care utilization. To address this global gap, an international panel of ostomy care experts convened as the Peristomal Hygiene Advancement in Skin Education (PHASE) group to develop a standardized, evidence-informed protocol of care applicable across health care settings. Drawing on global survey data, published evidence, and expert consensus, the group developed the Peristomal Hygiene protocol, a simple 4 step framework: Cleanse, Assess, Secure, and Live! This protocol standardizes essential practices while remaining adaptable for specialist and nonspecialist providers, caregivers, and individuals living with an ostomy. The model emphasizes safe cleansing and adhesive removal, systematic and repeatable assessment using validated tools, individualized product selection and securement based on anatomy and risk, and holistic support for long-term adaptation to life with an ostomy. By embedding proactive prevention into routine care, the Peristomal Hygiene protocol shifts practice from reactive management of complications to preservation of healthy peristomal skin. It aims to improve communication among providers, support consistent clinical decision making, and empower individuals to actively participate in self-care. Importantly, the framework addresses both physical and psychosocial dimensions of living with an ostomy, reinforcing confidence, independence, and sustained QoL. The Peristomal Hygiene protocol offers a practical, globally applicable approach to reducing variation in ostomy care, preventing PSCs and leakage, and improving long-term outcomes for people living with an ostomy.