Examining ‘Open-Air’ Incontinence Management
February 26, 2025
By Josef Halcomb
In my line of work, I primarily visit hospitals, outpatient centers and nursing homes. One thing I have learned is that they all operate uniquely.
For example, one area I have seen these care communities differ is with their treatment protocols. I have seen several different methods of incontinence management used, including:
• Disposable absorbent garments
• Urinary catheters
• Urethral insertion appliances
• Fecal collection systems
• Urinary suction devices
I have a particular interest in the contrast between those using an “open-air” technique and body-worn products.
“Open-air” is a practice in which incontinent patients are not given a disposable brief or pull-on underwear product to wear (sometimes called “diapering”) to contain their urine or fecal matter. Instead, the open-air preference is to lie on a bed pad, unclothed, to manage incontinence episodes.
Before I go on, I want to make one thing clear: Whether a facility chooses to use open-air or incontinence garments, there is someone extremely intelligent who made that decision based on years of clinical experience and expertise; someone who has earned an array of credentials next to their name and has a flock of certificates hanging on their office wall.
I’m not here to say that anyone is wrong, one way or the other. I have seen situations where open-air techniques produced great results.
However, when I have the opportunity to meet with folks at open-air communities, I do ask them to consider the successful outcomes I have seen in other care communities using disposable garments, for several reasons, including:
- Enhanced dignity – Open-air can lead to exposure of private body parts, which can be embarrassing (especially when family and friends come to visit). From this standpoint, body-worn garments can significantly improve the patient’s quality of life.
- Effective infection control – Briefs and pull-ons can capture and contain urine, feces and other potentially infectious body fluids more effectively than an underpad alone, substantially lowering the risk of splash-and-spray episodes. Additionally, some product brands like Tranquility® feature leg cuffs (we call them Kufguards®) that act like “bumpers” to contain gushing liquid, holding it in place for a few vital seconds so it can be absorbed into the product’s core. Underpads don’t offer these “guardrails,” potentially leading to fluids dripping onto beds and floors.
- Maximum fluid absorption – It’s true that underpads these days can absorb a massive amount of liquid – in fact, Tranquility Air-Plus™ Extra-Strength Breathable Underpads hold over a quart of fluid. However, that large capacity is only maximized if the liquid is spread out over the entire surface of the pad, which is unlikely given the product’s standard usage. On the other hand, a superabsorbent disposable garment is designed to maximize wicking of fluid and absorption into the core, locking in moisture and leaving skin dry and safe. Layering a booster pad into the garment can add even more capacity for longer wear time.
Finally, while “letting the skin breathe” with open-air methods certainly has clinical advantages, disposable products with breathable sides or 100% breathable materials can mimic this benefit. Tranquility recently upgraded its OverNight™ underwear to 100% breathable, with a microporous outer layer that allows warm, moist, harmful vapor to escape while permitting fresh, cooler air to circulate, creating an ideal climate for skin health protection.
I understand that protocols can be hard to break. For some facilities, cost is king and underpads are the “lowest cost, technically acceptable” solution.
And sometimes new and old just don’t mix. For instance, did you know that the once tried-and-trusted protection method of using large amounts of skin barrier cream can clog the pours of modern, breathable incontinence garments, halting absorption and causing fluid to leak out? I have, unfortunately, seen this happen in open-air facilities, and it only reinforced their aversion to briefs and pull-ons.
Regardless of a community’s protocols, I will continue to share my side of the incontinence management story, satisfied and confident with the knowledge that we’re all striving to provide the best outcomes for patients and residents.
For more information or questions about this article, please contact Steve or complete this form.
Steve Sczesny
Steve, a National Account Executive Regional Sales Manager for Principle Business Enterprises, parent company of Tranquility Incontinence Products, is passionate about incontinence care. He has spent the last 16 years building relationships with personal caregivers and healthcare professionals, educating them on products that significantly improve medical outcomes and uplift, enlighten and enrich the lives of the family members, clients and patients they serve.
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