Addressing Continence Care in Nursing Communities
Ways to ease and enhance nursing protocols
by Dr. Ara Sayabalian

An estimated 25 million people in the United States are affected by continence challenges. This will increase over time due to age, pelvic, bladder and prostate health and chronic conditions.

Health care providers can help prevent adverse outcomes of incontinence with good product choices and nursing protocols. It is important for nursing professionals to know how to address the continence care challenges and possible negative outcomes.

In my work, I have had the unique opportunity to interact with people who have experienced continence challenges on all spectrums, as well as the opportunity to study and learn the science behind clinical outcomes and product manufacturing and marketing.

Many women who have experienced continence challenges have anonymously asked me questions from fear of embarrassment and loss of dignity. Many of these women are also customers of home medical equipment (HME) providers or patients of home health care (HHC).

According to the National Association for Continence, one in four American women over the age of 18 experiences episodes of bladder leakage. Stress urinary incontinence, caused by weakened pelvic muscles, is the most prevalent form of incontinence among women; it affects an estimated 15 million adult women in the United States.

Preventing urinary incontinence is difficult. There can be several causes of urinary incontinence in women 18 and older. The most common are childbirth, obesity, menopause and injury. Once women have experienced a bladder leakage episode, chances are likely they may experience it again. The severity of symptoms however, can be controlled.

Symptoms of urinary incontinence can significantly improve through pelvic floor exercises (also known as Kegel exercises), controlled fluid consumption and using the restroom more often to keep the bladder empty.

Prioritizing UTI Prevention

Urinary tract infections are a common result of incontinence. The most common health care associated infection is a catheter-associated UTI. Prevention of catheter-related UTIs has become a priority in the United States since UTIs can ultimately lead to bladder infections and skin irritations such as life-threatening pressure ulcers. The ultimate outcome leads to hospitalizations and even death.

With home health care on the rise, the uncontrolled home environment and the complexity of illnesses inhibiting self-control such as, Alzheimer’s, dementia and other chronic conditions, there is an increased risk of infections.

According to the CDC, the second highest infection rate in home health care patients involved catheter use. As a result, new Conditions of Participations (CoPs) for HHCs will be in effect in 2018.

Safe and effective hygiene protocol can help prevent skin irritations and infections. This involves frequent skin cleansing and air-drying, moisture barrier creams to help prevent friction, anti-fungal creams and powders, moisture-wicking pads and underwear, and frequent changes can help prevent unnecessary infections.

The Safety Factor

Urge incontinence, chronic conditions, environmental factors (poor lighting, low chairs and other environmental hazards, for example) can increase the risk of falls and ultimately lead to hip fractures and hospitalization for incontinence patients.

To reduce the risk of falls, prompted voiding, easily removable underwear, good lighting, clear and clutter-free pathways to the bathroom can help.

Care 101

Good incontinence care product choices would ease and enhance nursing protocol, as well as address the patient’s comfort (through better absorbency and odor control) and dignity.

The incontinence care market is saturated with information, but some products stand out above others, primarily due to the quality of materials used and the technologically advanced construction process.

Generally, better absorbency results in better odor control. The most important components for odor control are the quantity and quality of super absorbent polymers (SAP) inside the product. These little beads not only absorb, but they also encapsulate liquid, containing the odor.

Features, such as standing leg cuffs, bladder control pads with a strike zone for maximum absorbency, and nonwoven material to wick away liquid, help prevent leaks. How quickly the product absorbs liquid also matters.

With modern machinery, pads can be produced to be super-thin and super-absorbent. Additionally, some manufacturers produce a booster pad—also known as a boost-up or a pass-through pad—and this product significantly increases the absorbency of any pull-up or disposable diaper.

Placing a booster pad in a pull-up increases absorption and helps improve the sleeping patterns of patients, preventing falls and improving the mental health of the patient. These products are designed for ease of use for the nursing provider as well the comfort and well-being of the incontinent patient. Some manufacturers offer inexpensive or even free samples and sample kits.

Health Information Exchange

Open dialogue between the health care provider and the patient can lead to optimal nursing protocols—with better product choices and placement, resulting in better outcomes for the patient and gaining the patient’s trust and business.

People often turn to their HME and home health care contacts for guidance and answers on products to relieve symptoms. Many women with continence challenges are embarrassed to discuss their symptoms. However, unanswered questions can lead to fear, lower self-confidence and incorrect product usage, which in turn can lead to leaks, odor and discomfort. Then the situation may go from bad to worse in the form of urinary tract infections, bladder infections and skin irritations.

Good nursing protocols can help prevent negative outcomes, as well as help promote patient dignity, self-control, independence, an active lifestyle and ultimately a better quality of life.