Product Considerations

Are the products easy to apply and reapply for staff and patients? Can the product be reapplied securely and easily after an incontinence check is done and the person was found to be dry, or will it not re-fasten and your team member has to get a new brief or find some tape? Do the products you use for containment have a way to check for wetness without removing the product--for those patients who can’t tell us if they are wet or are not? Most organizations rely on disposable products for incontinence management. Some individuals being cared for at home may opt for washable, reusable products due to cost and/or environmental concerns. Just like with advanced wound care dressings, the purchase price of the incontinent absorbent product is only one part of the story. While something might be less costly, you may use more of them since it’s not doing as good a job with absorption--and so more staff time is spent changing products. Or maybe the urine just sits on the skin, causing moisture-associated skin damage (MASD) requiring topical skin treatments, more documentation, explanations to the family and discomfort for the patient. Evaluate products from manufacturers who can provide you with some product in-servicing and instruction for appropriate use, as well as some education on incontinence and skin care. A new product feature of some incontinence products is skin care cream built right into the brief. Some products also include an odor-eliminating ingredient.

 

Size Matters When Considering Absorbent Products

  Measure across front of body from hip bone to hip bone over the abdomen, or thigh to thigh if this is larger

  Double this measurement and add two inches

  Match this final measurement with manufacturer’s size chart

One size does not fit all. A product that is too small can cause mechanical injury to the skin in addition to making the patient psychologically feel bad. Too big and the product doesn’t contain the incontinency and there is leakage. The too large product can slide down while the patient is ambulating setting the stage for a fall. The formula on this slide from Sweeney can assist us in selecting the right size for our patients.

 

NAFC Performance Standards for 2012

These recommendations from the National Association for Continence were released on July 10, 2012  and represent standards for disposable adult absorbent products. The guidelines were developed to “protect skin and dignity, and to guard against waste, foolish spending and fraudulent practices.”

Let’s look at how National Association for Continence (the NAFC) defines these terms:

Rewet: ability to withstand multiple incontinent episodes. Rate of acquisition: speed at which urine is drawn away from the skin.

Retention capacity: measure of product’s capacity to hold fluid without leaking.

Sizing options: selection of youth and adult sizes to optimize fit and reduce waste.

Safety: none of the components in the product should be listed by the Federal Regulatory Agency as “unsafe”.

Presence of closure system: allows for multiple unfastening and refastening.

Breathable zones: acceptable minimum air flow in side “wings” sufficient to release body heat and perspiration.

Ability to contain feces-product: delivers gentle snug fit using leg and waistband elastic.

This slide shows skin that has been exposed to moisture due to incontinence. There is maceration evident (look toward the top of buttocks--white water-logged skin and denudement [epidermis missing] of the skin). Since the dermis, which contains nerve endings, is exposed, this skin condition is quite painful. It is much easier to prevent this skin damage than it is to treat it.

What steps should be taken to prevent this skin damage?

 Rick Fields-Gardner