A Comparison of Cost and Efficacy of Three Incontinence Skin Barrier Products

  • Wed, 9/3/08 - 10:25am
  • 0 Comments
  • 5643 reads
Author(s): 
Cindy L. Zehrer, BSN, MSN; James B. Lutz, MS; Edwin C. Hedblom, PharmD; and Li Ding

A n estimated 15% to 30% of non-institutionalized older Americans (>age 65), and approximately 50% of institutionalized older adults are incontinent.1 Incontinence is more than just an inconvenience to residents and caregivers. Maintaining healthy, intact perineal skin in the incontinent nursing home resident is a time- and resource-intensive challenge. Residents who are incontinent are at risk for developing incontinence dermatitis (ID) and may be predisposed to developing pressure ulcers.2,3 In addition, ID is significantly correlated with pain4; thus, frequent occurrence of ID may diminish quality of life among nursing home residents.

Products used to prevent ID vary greatly in formulation and technology. The oldest and still most commonly used formulations contain petrolatum. When used properly, petrolatum ointments are seemingly inexpensive and have time-proven efficacy.5,6 However, because they easily wash off the skin and readily transfer to clothing, linens, and briefs,5 proper use dictates reapplication after every incontinent episode. Frequent application may add product and labor costs, burden the already overworked caregiver, and possibly increase caregiver burnout and protocol noncompliance.

A relatively new incontinence skin care technology involves polymer-based barrier films. Evidence of the effects of barrier films in ID treatment or prevention protocols is sparse. However, in one study,6 a non-alcohol barrier film was shown to be more effective at treating ID than an alcohol-based barrier film. The investigators evaluated patients in this study for ID five times over a 2-week study period. The investigators recorded area and severity of the ID at each visit on a case report form. Of the 18 subjects, 14 (77.8%) with existing ID improved after treatment with the non-alcohol barrier film, compared to 4 of 16 subjects (25%) who improved after treatment with the alcohol-based barrier film. In another study7 involving 164 residents with incontinence in six nursing homes in the UK, perineal skin condition was maintained or improved after a new incontinence skin care protocol involving a no-rinse cleanser, a durable barrier cream, and a non-alcohol barrier film was implemented. As part of this new protocol, the no-rinse cleanser was used on all residents with incontinence, the durable barrier cream was used on residents with incontinence and intact skin or mild ID, and the non-alcohol barrier film was used on residents with incontinence and moderate to severe ID and/or broken skin. After the new skin care protocol was implemented, a significant reduction in the presence of ID (P = 0.021) and a significant reduction in the presence of grade 1 pressure ulcers (P = 0.042) occurred. The authors also reported a high compliance rate (99%) with the new protocol.

The objective of this prospective, multi-site study was to compare the costs of using a non-alcohol barrier film to the costs of using two commonly used petrolatum ointments in an ID prevention protocol.

References: 

1. McCormick KA, Diokno A, Colling J, et al. Clinical Practice Guideline Number 3: Urinary Incontinence in Adults. Rockford, Md.: U.S. Department of Health and Human Services, Public Health Service. Agency for Health Care Policy and Research, Publication No. NCHS 86-121. March 1992: 4.
2. Bergstrom N, Braden BJ, Laguzza A, et al. The Braden Scale for Predicting Pressure Sore Risk. Nursing Research. 1987;36(4):205–210.
3. Mayrovitz HN, Sims N. Biophysical effects of water and synthetic urine on skin. Adv Skin Wound Care. 2001;14(6):302–308.
4. Lewis-Byers K, Thayer D, Kahl A. An evaluation of two incontinence skin care protocols in a long-term care setting. Ostomy Wound Manage. 2002;48(12):44–51.
5. Skin Protectant Drug Products for Over-the- Counter Human Use; Proposed Rule Making for Diaper Rash Drug Products. 21 CFR Part 347. Federal Register June 20, 1990. Available at: http://www.fda.gov/cder/otcmonographs/Skin_Protectant/skin_protectant_di.... Accessed November 19, 2004.
6. Newman K, Wallace D, Wallace J. Moisture control and incontinence management. In: Krasner D, Rodeheaver G, Sibbald R, editors. Chronic Wound Care: A Clinical Source Book for Healthcare Professionals, Third Edition. Wayne, Pa.: HMP Communications; 2001.
7. Bale S, Tebble N, Jones V, Price P. The benefits of implementing a new skin care protocol in nursing homes. J Tissue Viability. 2004;14(2):44–50.
8. 3M Price Pages for Distributors, Medical, Surgical and Skin Health Products. Effective March 1, 2003. Data on file at 3M Health Care.
9. ConvaTec, A Bristol-Myers Squibb Company — Distributor Prices Effective April 1, 2003. Data on file at 3M Health Care.
10. Smith & Nephew, Inc. Wound Management Division — 2003 Master Price Book, Effective January 1, 2003. Data on file at 3M Health Care.
11. U.S. Department of Labor, Bureau of Labor Statistics, Occupational Employment Statistics, 2001 National Occupational Employment and Wage Estimates, 31-1012 Nursing Aides, Orderlies, and Attendants. Available at: http://www.bls.gov/oes/2001/oes311012.htm. Accessed January 22, 2004.
12. Federal Reserve Bank Minneapolis. What Is A Dollar Worth? Available at: http://minneapolisfed.org/research/data/us/calc/. Accessed January 22, 2004.
13. U.S. Department of Labor, Bureau of Labor Statistics, Most Requested Statistics, Private industry, All workers, Total benefits - CCU230000100000D. Available at: http://data.bls.gov/cgi-bin/surveymost?cc. Accessed January 22, 2004.
14. Good Clinical Practice, 21 C.F.R. Parts 11, 40, 54, 56, 312, 314. Available at: http://www.fda.gov/oc/gcp/regulations.html. Accessed October 8, 2004.
15. Standards for Privacy of Individually Identifiable Health Information; Final Rule, 45 C.F.R. Parts 160, and 164. Federal Register August 14, 2002. Available at: http://www.hhs.gov/ocr/hipaa/privrulepd.pdf. Accessed October 8, 2004.
16. Data 4.0/Data Professional Healthcare User’s Manual. Williamstown, Mass.: TreeAge Software, Inc.;2001.

image description image description 




  


  
Post new comment


  



 
 



  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
  • Use  to create page breaks.
More information about formatting options




Image CAPTCHA

 
 
 
Enter the characters shown in the image.