Continence Coach: Absorbent Product Selection for Contemporary Continence Management

  Absorbent briefs cannot be held as the cause for pressure ulcers, even at their earliest stage. An aide, LPN, or RN with even the most basic understanding of incontinence diagnostics should be able to recognize the symptoms and severity of incontinence, toileting needs and limitations, and absorbent product requirements. As such, absorbent products should not be generically distributed like allotments of bed linens and towels — rather, absorbent product use should be customized to each person’s unique requirements. Above all, myths about “open to air” advantages and reusables must be discarded as outmoded. Because of the high turnover rate of nursing staff in long-term care facilities, guidelines for product selection (such as those that follow) should be kept simple, contemporary, and reinforced with frequent visual and verbal communications.

  Screening. Continence status should be assessed when a resident moves in or returns from a hospital stay; any change in status must be documented. Although the Minimum Data Set (MDS) can serve as an admission baseline, it is the staff’s ongoing responsibility to continue to gather data about the resident. Screening includes both physical functionality and incontinence severity, as well as the degree of assistance needed with toileting. This serves to anticipate the extent of staff involvement and helps when selecting the most appropriate type of absorbent product.

  Physical functionality. Today’s product designs vary not only by absorbency, but also relative to resident position during changes (supine, sitting, or standing), all affecting choice and costs. If the resident can ambulate, even with assistance for safety, absorbents should not be substituted for the independence and dignity of self-toileting. Always keep in mind that independent toileting raises the importance of fall prevention measures.

  Incontinence severity. Frequency of incontinent episodes, the amount of urine lost in an episode, nocturnal episodes, and whether incontinence includes fecal matter along with urine all have a bearing on product selection. For example, persons with some control over their bladder during the day and occasional fecal incontinence may benefit from absorbent briefs or protective wear. More severe or complex situations may require a product offering versatile fit, superabsorbency for nighttime to prevent interruption of sleep, and liners. In the latter cases, the most prudent choice is a product designed to capture stool. Products are not gender-neutral — for example, a man should not be fitted with a female pad as a liner because its design does not comfortably accommodate the male anatomy and leakage and discomfort will result. Instead, a male guard should always be used as a liner. As a clinician, you should demand products that demonstrate the ability to quickly wick or draw urine away from the body. Don’t be misled into thinking that waterproof backings or tight, elastic leg- and waistbands are substitutes for the benefits of absorbency rate and wicking action. Ask to have comparative choices demonstrated.

  Product sizing and fit. Bigger is not always better. Fit is essential. Look for products with reclosable fasteners that will adhere to any part of the disposable garment for optimal fit regardless of creams or powders that may be used. Vendors providing such products can help instruct staff about how to angle fasteners for closure. A higher-priced but superior-performing product may yield fewer changes, resulting in lower cost than using a less expensive, inferior product that requires more frequent changes, particularly when the cost of labor and patient discomfort are considered. Breathability helps with comfort and skin integrity — trapped body heat can contribute to skin inflammation, irritation, and bacterial growth. If the absorbent brief is selected appropriately for absorption rate and frequency of episodes, sized properly, and correctly fitted, extra, wasteful underpads that bunch up beneath the resident should be unnecessary. Overuse of underpads is outmoded thinking.

  Disposing of myths. Historically, based on the concept that the skin needed to “breathe,” nurses were advised not to place disposable briefs on residents around the clock. Today’s nonwoven technology and product versatility free clinicians from this archaic thinking. When residents are lying in urine or feces even on a disposable underpad, they are more readily subject to skin breakdown, not to mention they are wet, cold, and embarrassed. Soiled, damp bed linens need to be changed. Sleep is interrupted. Linen, labor, and utility costs escalate. Disposables with high-performance features allow clinicians to dispense with outdated beliefs.

  The other antiquated myth is that reusables and natural fibers are better than disposables for the skin. They aren’t. They cost more to use and facilitate skin irritation, breakdown, and higher labor and utility costs. Once again, the technology of layering superabsorbent polymers with fluff and other high performance materials to facilitate wicking action and providing breathable fabrics for ventilation have advanced continence care into a new era.

  Vendor value. You can rely on your vendors for inservicing, ongoing training, and product selection. These knowledgeable resources are equipped to help you improve the dignity and quality of care for all of your residents with minimal costs for the highest value.

The National Association For Continence is a national, private, non-profit organization dedicated to improving the quality of life of people with incontinence. The NAFC’s purpose is to be the leading source for public education and advocacy about the causes, prevention, diagnosis, treatments, and management alternatives for incontinence.

This article was not subject to the Ostomy Wound Management peer-review process.