Discontinuing absorbent pants in children with bedwetting: a randomized controlled trial.

The objective of this study is to examine the effect of discontinuing wearing protective garments (absorbent pyjama pants - APP) in children with severe childhood nocturnal enuresis (NE). The study employs a multicenter, parallel, randomized controlled trial. Following a 4-week run-in period, participants were randomly allocated in a 2:1 group allocation to discontinue or continue using APP. The research was conducted across seven European pediatric incontinence centers. The study included treatment-naïve children aged 4-8 years with severe (7/7 wet nights per week) mono-symptomatic NE, who had used nighttime protection for at least 6 months prior to the study. The study consisted of a 4-week run-in period (± 7 days), where all children slept wearing APP (DryNites®). At week 4 (± 7 days), if meeting randomization criteria (7/7 wet nights during the last week of run-in), participants were randomized to continue to sleep in APP or to discontinue their use for a further 4 weeks, with the option of another 4 weeks in the extension period. The primary outcome was the difference between groups of wet nights during the last week of intervention. Quality of life (QoL) and sleep were secondary endpoints. In total, 105 children (43 girls and 62 boys, mean age 5.6 years [SD 1.13]) were randomized (no-pants group n = 70, pants group n = 35). Fifteen children (21%) in the no-pants group discontinued early due to stress related to the intervention. Children in the no-pants group experienced fewer wet nights compared to the pants group during the last week (difference 2.3 nights, 95% CI 1.54-3.08; p < 0.0001). In the no-pants group, 20% responded to the intervention, of whom 13% had a full response. Clinical improvement was detected within 2 weeks. Sleep and QoL were reported as negatively affected by APP discontinuation in the extension period but not in the core period.    Conclusion: A ~ 10% complete resolution rate was associated with discontinuing APP. While statistically significant, the clinical relevance is debatable, and the intervention should be tried only if the family is motivated. Response was detectable within 2 weeks. Discontinuing APP for 4-8 weeks was reported to negatively affect QoL and sleep quality. No severe side effects were seen.Trial registration: Clinicaltrials.gov Identifier: NCT04620356; date registered: September 23, 2020. Registered under the name: "Effect of Use of DryNites Absorbent Pyjama Pants on the Rate of Spontaneous Resolution of Paediatric Nocturnal Enuresis (NE)."

Guidance for the provision of absorbent products for adult incontinence.

The Association for Continence Professionals first published their guidance for the provision of absorbent products for adult incontinence in 2017. This consensus document is targeted towards commissioning leads, NHS Trust Boards, Bladder and Bowel leads, among others, and has been updated over the years to ensure that all adults who suffer with continence issues undergo a comprehensive assessment and have access to an equitable service. This article provides an overview of the latest guidelines which were published in February 2023.

Reusable and Disposable Incontinence Underpads: Environmental Footprints as a Route for Decision Making to Decarbonize Health Care.

BACKGROUND: Objectives of quality principles in the clinical setting present nursing with opportunities for quality patient care but at lower environmental footprint. This affects patients, hospital personnel, and community because choices reduce climate change and thus support an innovative nursing role. PURPOSE: This article aims to support nursing knowledge to include environment in decisions regarding patient care and reusable versus disposable incontinence underpads (IUPs). METHODS: A life cycle analysis was conducted, including soiling, reusable cycles before removal, supply chains, laundry use, and end-of-life environmental impact. RESULTS: The selection of reusable IUPs versus disposables reduced total natural resource energy consumption by 71%, greenhouse gas emissions by 61%, blue water consumption by 57%, and solid waste by 97%. CONCLUSIONS: The nursing community can use this information in its health care organizations regarding IUP to advocate for decisions to select reusable IUPs that benefit our environment (air, water, and land).

Integrating Sensor Technology in Disposable Body-Worn Absorbent Products: A Qualitative Study to Define User Profile, (Technical) Criteria, Conditions, and Potential Benefits.

PURPOSE: The purpose of this study was to define the user profile, (technical) criteria, conditions, and potential benefits of the integration of sensor technology in disposable body-worn incontinence materials. DESIGN: Qualitative study using a framework method. SUBJECT AND SETTING: The sample included residents with incontinence, nurses, and decision-makers in a selection of Flemish nursing homes (Belgium). METHODS: Semistructured interviews were performed between June and August 2020. The interviews with nurses included open-ended questions focusing on the user profile, (technical) criteria, conditions, and potential benefits of the integration of sensor technology in disposable body-worn incontinence materials. The interviews with decision-makers were supplemented with questions about purchase cost and other economic criteria (such as reimbursement). Interviews with residents included questions about wearing comfort. Interviews were tape-recorded and transcribed verbatim. Data were analyzed using a framework method. RESULTS: The user profile was defined as (1) residents with cognitive impairment and (2) residents who are bedridden or are severely limited in mobility. The following (technical) criteria emerged from the analyses: a small, thin, and oval/circular sensor, an adaptable or in front attachment of the sensor on the absorbent product, a real-time indication of the absorbent product's saturation, leakage detection, liquid stool detection, the automatic recording of incontinence-related data, a durable sensor easy to disinfect, and receiving notifications on a wearable device. Conditions included a stable connection between the wearable device and the sensor, accurate measurements, user-friendly system, comprehensible training, affordability, and data protection. Potential benefits included workload reduction, increased comfort for residents and staff, more person-centered care, increased quality of care, less skin damage and economic (eg, less costs due to less excessive absorbent product changes), and/or environmental (e.g. less waste) gains. CONCLUSION: Study findings identified the user profile, (technical) criteria, conditions, and potential benefits of the integration of sensor technology in disposable body-worn incontinence materials. Respondents reported problems with changing routines and skepticism about the sensor's accuracy. Based on findings from this study, we recommend involving representatives of all relevant stakeholders in the design of sensor technology to ensure users' needs and increase the use of sensor technology. Comprehensive education is recommended to inform nurses, residents, and their family members on the importance and benefits of the technology and to aid overcoming barriers to use (skepticism, resistance to new technologies, and changing care routines). Study findings also indicate that the sensor technology cannot replace the existing voiding programs; rather it should be an addition to routine continence care.

Alarm interventions for nocturnal enuresis in children.

BACKGROUND: Enuresis (bedwetting) affects up to 20% of five-year-olds and can have considerable social, emotional and psychological effects. Treatments include alarms (activated by urination), behavioural interventions and drugs. OBJECTIVES: To assess the effects of enuresis alarms for treating enuresis in children. SEARCH METHODS: We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP, and handsearching of journals and conference proceedings (searched 25 June 2018), and reference lists of relevant articles. SELECTION CRITERIA: We included randomised or quasi-randomised trials of enuresis alarms or alarms combined with another intervention for treating nocturnal enuresis in children between 5 and 16 years old. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed risk of bias and extracted data. MAIN RESULTS: We included 74 trials (5983 children). At treatment completion, alarms may reduce the number of wet nights a week compared to control or no treatment (mean difference (MD) -2.68, 95% confidence interval (CI) -4.59 to -0.78; 4 trials, 127 children; low-quality evidence). Low-quality evidence suggests more children may achieve complete response (14 consecutive dry nights) with alarms compared to control or no treatment (RR 7.23, 95% CI 1.40 to 37.33; 18 trials, 827 children) and that more children may remain dry post-treatment (RR 9.67, 95% CI 4.74 to 19.76; 10 trials, 366 children; low-quality evidence). At treatment completion, we are uncertain whether there is any difference between alarms and placebo drugs in the number of wet nights a week (MD -0.96, 95% CI -2.32 to 0.41; 1 trial, 47 children; very low-quality evidence). Alarms may result in more children achieving complete response than with placebo drugs (RR 1.59, 95% CI 1.16 to 2.17; 2 trials, 181 children; low-quality evidence). No trials comparing alarms to placebo reported the number of children remaining dry post-treatment. Compared with control alarms, code-word alarms probably slightly increase the number of children achieving complete response at treatment completion (RR 1.11, 95% CI 0.97 to 1.27; 1 trial, 353 children; moderate-quality evidence) but there is probably little to no difference in the number of children remaining dry post-treatment (RR 0.91, 95% CI 0.79 to 1.05; moderate-quality evidence). Very low-quality evidence means we are uncertain if there are any differences in effectiveness between the other different types of alarm. At treatment completion, alarms may reduce the number of wet nights a week compared with behavioural interventions (waking, bladder training, dry-bed training, and star chart plus rewards) (MD -0.81, 95% CI -2.01 to 0.38; low-quality evidence) and may increase the number of children achieving complete response (RR 1.77, 95% CI 0.98 to 3.19; low-quality evidence) and may slightly increase the number of children remaining dry post-treatment (RR 1.39, 95% CI 0.81 to 2.41; low-quality evidence). The evidence relating to alarms compared with desmopressin in the number of wet nights a week (MD -0.64, 95% CI -1.77 to 0.49; 4 trials, 285 children) and the number of children achieving complete response at treatment completion (RR 1.12, 95% CI 0.93 to 1.36; 12 trials, 1168 children) is low-quality, spanning possible harms and possible benefits. Alarms probably slightly increase the number of children remaining dry post-treatment compared with desmopressin (RR 1.30, 95% CI 0.92 to 1.84; 5 trials, 565 children; moderate-quality evidence). At treatment completion, we are uncertain if there is any difference between alarms and tricyclics in the number of wet nights a week, the number of children achieving complete response or the number of children remaining dry post-treatment, because the quality of evidence is very low. Due to very low-quality evidence we are uncertain about any differences in effectiveness between alarms and cognitive behavioural therapy, psychotherapy, hypnotherapy and restricted diet. Alarm plus desmopressin may reduce the number of wet nights a week compared with desmopressin monotherapy (MD -0.88, 95% CI -0.38 to -1.38; 2 trials, 156 children; low-quality evidence). Alarm plus desmopressin may increase the number of children achieving complete response (RR 1.32, 95% CI 1.08 to 1.62; 5 trials, 359 children; low-quality evidence) and the number of children remaining dry post-treatment (RR 2.33, 95% CI 1.26 to 4.29; 2 trials, 161 children; low-quality evidence) compared with desmopressin alone. Alarm plus dry-bed training may increase the number of children achieving a complete response compared to dry-bed training alone (RR 3.79, 95% CI 1.85 to 7.77; 1 trial, 80 children; low-quality evidence). It is unclear if there is any difference in the number of children remaining dry post-treatment because of the wide confidence interval (RR 0.56, 95% CI 0.15 to 2.12; low-quality evidence). Due to very low-quality evidence, we are uncertain about any differences in effectiveness between alarm plus bladder training versus bladder training alone. Of the 74 included trials, 17 reported one or more adverse events, nine reported no adverse events and 48 did not mention adverse events. Adverse events attributed to alarms included failure to wake the child, ringing without urination, waking others, causing discomfort, frightening the child and being too difficult to use. Adverse events of comparator interventions included nose bleeds, headaches and abdominal pain. There is probably a slight increase in adverse events between code-word alarm and standard alarm (RR 1.34, 95% CI 0.75 to 2.38; moderate-quality evidence), although we are uncertain because of the wide confidence interval. Alarms probably reduce the number of children experiencing adverse events compared with desmopressin (RR 0.38, 95% CI 0.20 to 0.71; 5 trials, 565 children; moderate-quality evidence). Very low-quality evidence means we cannot be certain whether the adverse event rate for alarms is lower than for other treatments. AUTHORS' CONCLUSIONS: Alarm therapy may be more effective than no treatment in reducing enuresis in children. We are uncertain if alarm therapy is more effective than desmopressin but there is probably a lower risk of adverse events with alarms than with desmopressin. Despite the large number of trials included in this review, further adequately-powered trials with robust randomisation are still needed to determine the full effect of alarm therapy.

Effect of insulation with bubble wrap and an absorbent pad on heat loss in anaesthetised cats.

Aims: To evaluate the efficacy of insulating the limbs and thorax of cats with a combination of bubble wrap and an absorbent, plastic-lined pad in reducing heat loss during ovariohysterectomy. Methods: A preliminary study was performed to compare heat loss of 1 L bags of Hartmann's solution heated to 38°C which were either wrapped in two layers of bubble wrap and an absorbent pad (n = 6) or were unwrapped (n = 6). Bags were allowed to cool in a temperature-controlled room and the temperature of the bags was measured every 10 minutes for 60 minutes. The clinical study, included 16 intact female cats undergoing ovariohysterectomy. The cats were premedicated with I/M morphine and either medetomidine or dexmedetomidine, and anaesthesia was induced with I/V propofol and maintained with isoflurane in 100% oxygen. Cats were randomly assigned to either the treatment group (n = 8) whose limbs and thorax wrapped with two layers of bubble wrap and an absorbent pad immediately after induction, or the control group (n = 8) which were unwrapped. Body temperature (measured with an oesophageal temperature probe), heart rate, respiratory rate, mean arterial pressure and partial pressure of end-tidal CO2 were recorded immediately after induction (T start), before surgery started (T surgery), and at the end of isoflurane administration (T end). The times from T end to extubation, from T end to when the cat could maintain sternal recumbency and from T end to when the cat was able to stand, were also recorded. Results: In the preliminary study of heat loss by fluid bags, the mean temperature at 60 minutes was higher in wrapped bags (35.4 (SD 0.2)°C) compared to unwrapped bags (33.0 (SD 0.3)°C; p < 0.01). For cats undergoing ovariohysterectomy, mean body temperature of wrapped cats was higher than that of unwrapped cats both at T surgery (36.0 (SE 0.3) vs. 34.5 (SE 0.3)°C; p = 0.001) and at T end (37.2 (SE 0.5) vs. 36.0 (SE 0.5)°C; p = 0.01). Wrapped cats regained the ability to stand more rapidly that unwrapped cats (26.4 (SE 5.8) vs. 47.0 (SE 5.8) minutes p = 0.01). Conclusions: Wrapping the limbs and thorax of cats undergoing ovariohysterectomy in a combination of bubble wrap and absorbent pads reduced heat loss, which in turn improved recovery time from general anaesthesia. Clinical relevance: This inexpensive and practical method may reduce perioperative hypothermia, in cats undergoing abdominal surgery.

The Effect of Absorbent Pad Design on Skin Wetness, Skin/Pad Microclimate, and Skin Barrier Function: A Quasi-experimental Open Cohort Study.

PURPOSE: The main aims of this study were to describe the effects of incontinence pad composition on skin wetness, the skin/pad microclimate, and skin barrier function. We also evaluated the potential utility of our methods for future clinical investigation of absorbent pad design. DESIGN: Single-blind, quasi-experimental, open cohort design. SUBJECTS AND SETTING: Twenty healthy older volunteers (mean age = 72.8 years, SD = 5.8 years; 8 male and 12 female) tested 2 absorbent pad types, with acquisition layers of different compositions (A and B) applied to different sites on the volar aspect of the forearms. One type A pad served as control (A dry) versus 3 pad samples wetted with 3 volumes of saline (A 15 mL, A 35 mL, and B 15 mL). The study was conducted within the clinical laboratory of a university nursing research group in the United Kingdom. METHODS: Skin barrier function was assessed by measuring transepidermal water loss (TEWL), stratum corneum (SC) hydration by corneometry, and skin surface pH using a standard skin pH electrode. Skin water loading (excess water penetration into the skin) was quantified by measuring TEWL and creating a desorption curve of the water vapor flux density. Calculating the area under the curve of the desorption curve to give skin surface water loss reflected excess water penetration into the skin. In a subgroup of the sample, the temperature and relative humidity (microclimate) at the interface between the skin and test pads were measured using a wafer-thin sensor placed between the skin and pad sample. Proinflammatory cytokine release from the SC was assessed using a noninvasive lipophilic film. The main outcome measures in this study were the differences in biophysical measurements of skin barrier function (TEWL, corneometer, and pH) before and after the application of the different pads. RESULTS: Mean ± SD baseline TEWL across all test sites was 10.4 ± 4.4 g/h/m. This increased to 10.6 ± 3.8 g/h/m at the control site, 15.3 ± 6.3 g/h/m for the A 15-mL pad, 15.3 ± 3.9 g/h/m for the A 35-mL pad, and 15.6 ± 3.2 g/h/m for the B 15-mL pad. The mean baseline skin surface pH was 5.9 ± 0.04; cutaneous pH increased to a mean of 6.1 ± 0.06 following all pad applications (P = .16). Mean SC hydration remained unchanged at the control site (A dry). In contrast, SC hydration increased following the application of all wetted pads. Target cytokines were detected in all samples we analyzed. The IL-1RA/IL-1α ratio increased following pad application, except for the wettest pad. CONCLUSION: Study findings suggest that absorbent pad design and composition, particularly the acquisition layer, affect performance and may influence skin health. Based on our experience with this study, we believe the methods we used provide a simple and objective means to evaluate product performance that could be used to guide the future development of products and applied to clinical settings.

Results of the British Association of Urological Surgeons female stress urinary incontinence procedures outcomes audit 2014-2017.

OBJECTIVES: To analyse the results of the stress urinary incontinence (SUI) audit conducted by the British Association of Urological Surgeons (BAUS), and to present UK urologists' contemporary management of SUI. PATIENTS AND METHODS: The BAUS audit tool is an online resource, to which all UK urologists performing procedures for SUI are invited to submit data. The data entries for procedures performed during 2014-2016 were collated and analysed. RESULTS: Over the 3-year period analysed, 2917 procedures were reported by 109 surgeons, with a median of 20 procedures reported per surgeon. A total of 2 366 procedures (81.1%) were recorded as a primary surgery, with 548 procedures (18.8%) performed for recurrent SUI. Within the time period analysed, changes were noted in the frequency of all procedures performed, with a trend towards a reduction in the use of synthetic mid-urethral tapes, and a commensurate increase in the use of urethral bulking agents and autologous fascial slings. A total of 107 (3.9% of patients) peri-operative complications were recorded, with no association identified with patient age, BMI or surgeon volume. Follow-up data were available on 1832 patients (62.8%) at a median of 100 days postoperatively. Reduced pad use was reported in 1311 of patients (84.5%) with follow-up data available and 86.3% reported a pad use of one or less per day. In all, 375 patients (85%) reported being satisfied or very satisfied with the outcome of their procedure at follow-up, although data entry for this domain was poor. De novo overactive bladder (OAB) symptoms were reported by 15.2% of patients (263/1727), and this was the most commonly reported postoperative complication. For those reporting pre-existing OAB prior to their SUI surgery, 28.7% (307/1069) of patients reported they got better after their procedure, whilst 61.9% (662/1069) of patients reported no change and 9.4% of patients (100/1 069) got worse. CONCLUSIONS: This review identified that, despite urological surgeons undertaking a relatively low volume of procedures per year, SUI surgery by UK urologists is associated with excellent short-term surgeon- and patient-reported outcomes and low numbers of low grade complications. Complications do not appear to be associated with surgeon volume, nor do they appear higher in those undergoing mesh surgery. Shortfalls in data collection have been identified, and a longer follow-up period is required to comment adequately on long-term complications, such as chronic pain and tape extrusion/erosion rates.

The impact of the absorbent products distribution system on family caregivers of older people with incontinence in Italy: perception of the support received.

BACKGROUND: Urinary incontinence is a chronic, age-related disorder, likely to increase in the future due to global population ageing. In Italy, as in most countries, older people with incontinence are often cared for by family caregivers, whose burden might be worsened by the perception of receiving an inadequate support, due to the lack of customized services. The aim of this study was to evaluate the impact of the absorbent products distribution method on family caregivers' perception of the support received. METHODS: The study compared the distribution of pads to homes and in pharmacy via a survey reaching 101 family caregivers of older people with incontinence living in two geographical areas of the Marche Region (Central Italy) with different distribution systems. The association between "Quality of perceived support" (the outcome variable) and two types of absorbent products delivery methods (i.e. pharmacy and home distribution) was analysed by means of a general linear model. RESULTS: Findings show that family caregivers receiving pads at home (HODs) perceived a higher support than those gaining them at the pharmacy (PHADs) (respectively 68.1% vs 35%). The association between perceived support level and distribution system remained even after correction for confounding factors. 70.2% of PHADs reported "Poor well-being", versus only 53.7% of HODs. The latter are more satisfied with the type of products distribution and thus less inclined to experiment different systems for the supply of products for the urinary continence (e.g. by voucher). The results are virtually reversed among PHADs and the difference is statistically significant (p <  0.001). CONCLUSIONS: When family caregivers feel supported by a more customized service delivery system, their perception of the care-related burden is mitigated. Thus, it is important to consider the needs of both family caregivers and cared for older people, and not only of the latter for designing a more suitable distribution of absorbent products. The best solution could be leaving end-users the freedom to choose how they want to get products (e.g. voucher or personal budget). This requires a reorganization of the current pads delivery systems adopted by the Marche and by other Italian Regional Health Systems.

Where Do Women With Urinary Incontinence Find Information About Absorbent Products and How Useful Do They Find It?

PURPOSE: This study aimed to determine from what sources women with urinary and dual urinary and fecal incontinence sought and received information about incontinence and absorbent products. We also evaluated source utility. DESIGN: Descriptive, embedded, mixed-methods study with qualitative interviews nested into a survey design in a modified explanatory sequence. SUBJECTS AND SETTING: The target population was community-dwelling women in Canada who used containment products to manage urinary incontinence. Three hundred fifteen women completed the online survey, and 9 participated in interviews. METHOD: Quantitative data were collected using an online survey that was advertised in multiple locations, including continence and urogynecology clinics, non-for-profit health Web sites, and social media. Descriptive statistics were used for analysis. Using initial quantitative data results, a semistructured interview guide was designed to gain further insight. Local survey participants were invited to interviews at the end of the survey. Interview transcripts were coded using content analysis. The codes were then collapsed into categories and finally themes. RESULTS: The most common sources of information (n = 284/315) were retail outlets (43%) and television/radio (42%). The greatest percentages of "useful" or "very useful" resources were healthcare professionals (83%). Content analysis identified 5 themes: (1) using existing knowledge, (2) seeking knowledge, (3) finding the right pad, (4) being safe and secure, and (5) perceptions of healthcare professionals' roles. Product choice was made through trial and error; women drew information from a variety of sources, including product labels. Perceptions of helpfulness of experiences with healthcare professionals varied. CONCLUSION: Although women used multiple sources when selecting containment products, they did not receive information in a manner that suited their needs, resulting in a trial-and-error approach to product selection. Healthcare professionals should actively give information on containment products during their assessment of continence in patient encounters.

Time of Onset to Changes in Skin Condition During Exposure to Synthetic Urine: A Prospective Study.

PURPOSE: The purpose of this study was to evaluate the impact of incontinence on epithelial-moisture barrier function and the subsequent risk for incontinence-associated dermatitis by exposing healthy volunteers to a premium incontinence pad wet with synthetic urine. DESIGN: Prospective, single-group study. PARTICIPANTS AND SETTING: Thirty women 65 years or older participated in the study. Participants had healthy skin of the buttocks, perineal, and perigenital areas and were not incontinent of urine or stool. The study was conducted at a contracted clinical research facility in Southeastern United States. METHODS: Four hundred milliliters of synthetic urine was distributed across the width of a premium incontinence pad with wicking technology containing a superabsorbent polymer core. Participants laid supine for a total of 4 hours, with the wet pad under the buttocks. Skin assessments were conducted at baseline prior to contact with the wet pad, at 15 minutes, 30 minutes, and 1, 2, and 4 hours after exposure to the synthetic urine. Outcome measures were skin moisture content, cutaneous pH, transepidermal water loss (TEWL), mean coefficient of friction values (static and dynamic), and tolerability evaluations (expert clinical grader-assessed erythema and participant-assessed discomfort). RESULTS: Mean moisture content of the skin increased from 46.19 ± 22.1 to 1845.28 ± 542.7 micro-Siemens (µS) after just 15 minutes of exposure and was significantly increased at all time points compared to baseline (P < .001). Cutaneous pH increased from 5.67 ± 0.5 to 6.25 ± 0.1 after 15 minutes; pH was higher at all time points compared to baseline (P < .001). Passive transfer of water through the stratum corneum (TEWL) showed an increase from 9.02 ± 2.2 g/m/h at baseline to 16.83 ± 5.2 g/m/h at 4 hours (P < .001). There was a significant increase from baseline to 4 hours in mean coefficient of static friction (0.32 ± 0.01 vs 0.47 ± 0.03; P < .00001) as well as mean coefficient of dynamic friction (0.29 ± 0.01 vs 0.42 ± 0.02; P < .00001). There was a significant increase in erythema and an increase in participant-assessed discomfort at all time points (P < .005). CONCLUSIONS: Our findings suggest that impairment of the skin's epithelial-moisture barrier function associated with inflammation and development of incontinence-associated dermatitis begins rapidly after an incontinence event, even with the use of a premium pad with wicking technology. Study findings also suggest that prompt attention to incontinence events is needed to prevent moisture-associated skin damage (incontinence-associated dermatitis) even when absorbent pads are used.

A Laboratory Method for Determining Bacterially Formed Odorants and Reducing Odor in Absorbent Incontinence Products.

PURPOSE: The purpose of this study was to design a laboratory test method to mimic the formation of bacterially formed odorants during the use of absorbent urinary incontinence products. Three odor inhibitors with different modes of action were tested and evaluated. METHODS: Bacterially formed odorants in incontinence products were evaluated by adding a synthetic urine inoculated with a mixture of 4 bacterial strains to product samples cut from the incontinence products. The product samples were incubated in sealed flasks. The odorants that formed in the head space were sampled onto adsorbent tubes and analyzed by gas chromatography. The inhibitory effects of low pH, ethylenediaminetetraacetic acid (EDTA), and activated carbon were then measured. RESULTS: This technique enabled production of known odorants 3-methylbutanal, guaiacol, diacetyl, and dimethyl disulfide (DMDS) in concentrations of 50 to 600 ng/L in incontinence products. The method was further evaluated by testing 3 types of odor inhibitors; EDTA significantly reduced formation of all 4 odorants (P < .001). Lowering the pH from 6.0 to 4.9 decreased levels of 3-methylbutanal, DMDS, and guaiacol (P < .001); however, diacetyl levels increased (P < .001). Activated carbon significantly reduced the formation of diacetyl, DMDS, guaiacol, and 3-methylbutanal (P < .001). CONCLUSIONS: The technique we developed can be used to evaluate inhibitors with different modes of action to determine odor control in incontinence products. The odorants formed are produced by bacteria and have been identified as key contributors to the odor of used incontinence products. This work can be a step toward establishing a standard in the field of incontinence and odor control; creation of a standard will help the health care sector compare products to be purchased and benefit patients through the development of better products.

Evaluation of airborne asbestos exposure from routine handling of asbestos-containing wire gauze pads in the research laboratory.

Three independently conducted asbestos exposure evaluations were conducted using wire gauze pads similar to standard practice in the laboratory setting. All testing occurred in a controlled atmosphere inside an enclosed chamber simulating a laboratory setting. Separate teams consisting of a laboratory technician, or technician and assistant simulated common tasks involving wire gauze pads, including heating and direct wire gauze manipulation. Area and personal air samples were collected and evaluated for asbestos consistent with the National Institute of Occupational Safety Health method 7400 and 7402, and the Asbestos Hazard Emergency Response Act (AHERA) method. Bulk gauze pad samples were analyzed by Polarized Light Microscopy and Transmission Electron Microscopy to determine asbestos content. Among air samples, chrysotile asbestos was the only fiber found in the first and third experiments, and tremolite asbestos for the second experiment. None of the air samples contained asbestos in concentrations above the current permissible regulatory levels promulgated by OSHA. These findings indicate that the level of asbestos exposure when working with wire gauze pads in the laboratory setting is much lower than levels associated with asbestosis or asbestos-related lung cancer and mesothelioma.

An observational study of a superabsorbent polymer dressing evaluated by clinicians and patients.

OBJECTIVE: This open, non-comparative, multi-centre investigation examines the use of a new superabsorbent polymer (SAP) wound dressing used for exudate management (in medium-to-high exuding wounds) in a patient population with a variety of wound types. The primary objective of this study was to evaluate the fluid management capabilities of the dressing. METHOD: Both acute and chronic wounds with moderate-to-high exudate production levels were assessed (over a period of two weeks) as requiring exudate management, with a SAP dressing, Zetuvit Plus (designated Resposorb Super in Europe), as part of their normal treatment regimen. Clinicians recorded a subjective assessment of exudate management and its impact on periwound skin conditions. In addition, wound bed preparation, healing trajectory and pain level reduction were monitored to give an insight into the clinical implications of using this dressing. Data was also collected from clinicians and patients on clinical performance of the dressing. RESULTS: The SAP dressing achieved ratings of 'very good'/'good' (83% and 13%, respectively) in relation to its wound exudate handling properties. The dressing supported improved wound healing, reduced damage to and enhanced the status of the periwound skin. Pain levels were reduced and, as a consequence, patient reported outcomes were improved. Patients commented that the exudate handling capabilities of the dressing, its conformability and comfort allowed them to resume a semblance of normality in their life. All participating clinicians indicated that they would continue to use the SAP dressing. A sub-population cost analysis has highlighted that, when compared to alternative (historical) exudate management treatments, the SAP dressing was less expensive. The cost reduction arises from data that shows product use and frequency of dressing change (that impacts on nurse time) are both reduced. For the 10 patients evaluated, total costs were £2,491 and £1,312 before and during use, respectively; a saving of £1,179.00 (47%). CONCLUSION: The SAP dressing was well tolerated and shown to be effective in the management of moderate-to-high exudate. Consequently, the dressing supported improved healing, and reduced damage to periwound skin, leading to lower pain levels. Overall, both the patients and clinicians rated the SAP highly.

Handling properties of a superabsorbent dressing in the management of patients with moderate-to-very high exuding wounds.

OBJECTIVE: Exudate control is an important aspect of wound management in both acute and chronic wounds. Exudate can be an indicator of the wound bed condition, specifically inflammation and infection. This study aimed to evaluate the performance, in terms of usability, handling properties, exudate management, user satisfaction and patient comfort, in daily clinical practice, of a superabsorbent dressing, Vliwasorb Pro (Lohmann & Rauscher), suitable for the management of moderate-to-very high exudate levels. METHOD: The user test was conducted between September 2016 and July 2017, with clinicians from different specialisms in 55 centres across Germany. Both the dressing and user test were supplied by the sponsor. The superabsorbent dressing was used for at least three dressing changes, with frequency dependent on the patient and wound condition. RESULTS: A total of 55 clinicians recruited 171 patients with various wound types. The clinicians rated dressing application as 'easy' for 163 (95.3%) of the patients. The dressing was rated as easy to remove (168 (98.3%) and, according to clinicians, did not soil patients' clothing in 165 (97.1%) of cases. The dressing demonstrated a 'good absorbent capacity', as noted by clinicians in 167 (98.2%) of cases. Clinicians also commented that the dressing reduced foul odour, maceration and improved periwound skin condition. CONCLUSION: The evaluated dressing was easy to use, comfortable and reliable for patients with moderate-to-very high exuding wounds. In view of these results, superabsorbent dressings seem to be interesting for both clinicians and patients. Clinical studies are required to confirm these results.

The Impact of Microclimate on Skin Health With Absorbent Incontinence Product Use: An Integrative Review.

This integrative review considers the role of skin occlusion and microclimate in incontinence-associated dermatitis (IAD), with a particular focus on disposable, body-worn, absorbent incontinence products. Although the mechanisms are not fully understood, the primary causes of IAD are well-established: occluded skin, in prolonged contact with urine and/or feces and exposed to abrasive forces, is more likely to be affected, and each of these factors can be influenced by wearing absorbent incontinence products. Studies comparing the effect of various absorbent products on skin health have been hindered by the many differences between compared products, making it difficult to clearly attribute any differences in performance to particular materials or design features. Nevertheless, the large and significant differences that have sometimes been found invite further work. Breathable back sheets can significantly reduce the temperature of occluded skin and the humidity of the adjacent air, and several treatments for nonwoven top sheet materials (used next to the skin) have been shown to impart antimicrobial properties in the laboratory, but an impact on IAD incidence or severity has yet to be demonstrated directly. Recent work to introduce sensing technology into absorbent incontinence products to reduce the exposure of skin to urine and feces, by encouraging prompt product changing, seems likely to yield measurable benefits in terms of reducing incidents of IAD as the technology develops. Published work to date suggests that there is considerable potential for products to be engineered to play a significant role in the reduction of IAD among users.

Assessment, Selection, Use, and Evaluation of Body-Worn Absorbent Products for Adults With Incontinence: A WOCN Society Consensus Conference.

The Wound, Ostomy and Continence Nurses (WOCN) Society charged a task force with creating recommendations for assessment, selection, use, and evaluation of body-worn absorbent products. The 3-member task force, assisted by a moderator with knowledge of this area of care, completed a scoping literature review to identify recommendations supported by adequate research to qualify as evidence-based, and area of care where evidence needed to guide care was missing. Based on findings of this scoping review, the Society then convened a panel of experts to develop consensus statements guiding assessment, use, and evaluation of the effect of body-worn absorbent products for adults with urinary and/or fecal incontinence. These consensus-based statements underwent a second round of content validation using a modified Delphi technique using a different panel of clinicians with expertise in this area of care. This article reports on the scoping review and subsequent evidence-based statements, along with generation and validation of consensus-based statements that will be used to create an algorithm to aid clinical decision making.

Rationale and Design of a Novel Method to Assess the Usability of Body-Worn Absorbent Incontinence Care Products by Caregivers.

PURPOSE: The purpose of this study was to develop and test a new method to measure the usability of absorbent incontinence care products from the caregivers' perspective and to investigate if the method can be used to differentiate between product types in a product change. DESIGN: Process evaluation and validation study. SUBJECTS AND SETTING: Product developers and end users participated in designing the new method. Thereafter, professional caregivers acted as testers of the new method, ranking usability when performing absorbent product changes on patients in a simulated nursing home care environment, assisted by third-party research institute moderators. METHODS: Design and evaluation of a new method designed to assess the usability of body-worn absorbent incontinence care products for lay caregivers were completed. The evaluation included formative and summative evaluations of effectiveness (product fit), efficiency (time and physical workload), and satisfaction. A person-centered approach aimed at including all subjects and settings to generate a single usability score for decision making and product benchmarking. Experienced caregivers changed 4 types of products: (1) disposable body-worn pads with mesh briefs (2-piece system); (2) disposable all-in-one briefs; (3) disposable, T-shaped, and belted brief; and (4) disposable pull-up pants on simulated patients in standing or lying position. Each product change was performed by 1 unassisted experienced caregiver. The probability of success as a score for each product type was calculated across the 4 metrics and reported with 95% confidence intervals (CIs). Descriptive and inferential statistics were developed assuming a binary statistical model, using the weighted scores from each of the factors. An overall usability score was calculated. RESULTS: The method we developed discriminated between usability of different product types. The overall score for the disposable pull-up product (90%; CI: 83%-97%) was better (P < .05) than for the disposable T-shaped brief (83%; CI: 77%-89%), the disposable brief (53%; CI: 45%-61%), and the disposable body-worn pad with mesh pant (61%; CI: 56%-66%) in standing patients. For lying patients, the overall score for the disposable T-shaped brief product (81%; CI: 73%-89% was better (P < .05) than the disposable brief (65%; CI: 45%-61%) and the disposable body-worn pads with mesh brief (62%; CI: 55%-69%). Reliability was evaluated quantitatively in terms of measurement uncertainties in the results. CONCLUSION: The method we described demonstrated differentiation of usability based on product type indicating concurrent validity. Further testing in diverse real-world care environments is needed to evaluate and confirm the validity and to assess reliability of this method in the research setting.

Urinary Management With an External Female Collection Device.

BACKGROUND: Strategies to decrease use of female indwelling urinary catheters and catheter-associated urinary tract infections are challenging due to the limited availability of proper fitting external collection devices. Female urinary incontinence predisposes the skin to potential pain, itching, burning, infection, or pressure injuries. CASE STUDIES: This article discusses 3 patients' trajectory of care with use of an external female urinary collection device. All of these females were incontinent of urine after the indwelling urinary catheter was removed and managed with an external female urinary collection device. CONCLUSIONS: The use of an external female urinary collection device is a feasible alternative to an indwelling urinary catheter as well as managing urinary incontinence.

Use of a postoperative pad test to identify continence status in women after obstetric vesicovaginal fistula repair: a prospective cohort study.

OBJECTIVE: Determine whether a 1-hour pad test at discharge can identify continence status within 120 days of obstetric vesicovaginal fistula (VVF) repair. DESIGN: Prospective cohort study. SETTING: Fistula Care Centre in Lilongwe, Malawi. POPULATION: Women with VVF who underwent repair between January 2012 and December 2014. METHODS: Data on demographics, obstetric history, physical exam findings, operative management, postoperative findings, and follow up evaluations were collected on women with VVF repair. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and a receiver operating curve (ROC) were calculated to assess the utility of using a discharge pad test at three thresholds to identify women likely to be continent at follow up. RESULTS: After VVF repair, 346 women had a 1-hour pad test performed at the time of hospital discharge and completed follow up within 120 days of repair. Of these, 79.8% (n = 276) were completely continent, whereas 20.2% (n = 70) had some degree of incontinence. The sensitivity and specificity of a negative 1-hour pad test at predicting continence is 68.1% and 82.9%, respectively. With this prevalence, a negative pad test at a 1.5-g threshold demonstrates a high predictive value (PPV = 94.0%, 95% CI 90.0-96.9) in detecting women with continence after repair. CONCLUSIONS: At the 1.5-g threshold, a negative pad test at discharge identifies 94% of women who will remain continent after VVF repair. Adding the pad test to fistula care can identify women who are likely to remain continent and may not need further therapies in settings where resources are limited and follow up after repair is difficult. TWEETABLE ABSTRACT: A negative pad test after repair is associated with continued continence at follow up.