Reduce Healthcare-Acquired Infections

December 7, 2020

By Nathan Sheffer

Incontinence Care Practices and The Impact on HAI

By: Judy Borcherdt, RN, BSN, CWCMS and Linsee Nungester, LPN
Average time to read: 6 minutes

According to the CDC, there are approximately 1.7 million Healthcare-Acquired Infections (HAI) per year.

Have you considered how your incontinence care practices impact the health of your patients and care providers?

Healthcare-Acquired Infections Background

HAI is a common medical acronym that is used interchangeably for Healthcare-Acquired Infections and Healthcare-Associated Infections. These infections, also referred to as nosocomial infections, are acquired while receiving care for a medical condition. To be considered a HAI, the infection must not be present before that individual is under hospital care.

Infection prevention (IP) is recognized as the preventing or stopping the spread of infections in healthcare settings. The focus of HIA is typically on eliminating infections that result from medical procedures and devices. While IP primarily focuses on the spread of infections between healthcare patients (infections such as the seasonal flu or COVID-19), these infections remain under the umbrella of HAI. This article will focus on how improved incontinence care can reduce infections from medical procedures and devices and improve facility HAI outcomes.

For more information on how incontinence care can help reduce the spread of infections like COVID-19 and the seasonal flu, check out our article Infection Prevention and Incontinence Care During COVID-19 and Beyond.

Incontinence Care Practices and The Impact on HAI

Of the 1.7 million HAI each year, the most common type of infection is urinary tract infections (UTIs), with roughly 32% (over half a million) of all HAI. While UTIs can have many causes, they often occur within healthcare settings as the result of catheterization for continence management. Incontinence care practices have an impact on HAI as incontinence is generally managed in one of the following three ways:

• Catheterization
• Open-Air Practice
• Absorbent Products

Let’s consider how each of these practices can impact HAI and affect patient care, experience, and quality of life.

Catheters for Managing Urinary Incontinence

Catheter use is more commonly seen as a practice for incontinence management and medical procedures in acute care settings. In recent years, healthcare settings have illuminated some of the issues associated with catheter use, specifically high risk of urinary tract infections, difficulty urinating, patient pain, and challenges with sexual function.

This increased attention is also the result of CMS (Center for Medicare & Medicaid Services) eliminating reimbursements for costs associated with healthcare-acquired CAUTI. According to the Agency for Healthcare Research and Quality (AHRQ), CAUTI results in additional costs of around $1,300 to $1,600 per patient and between $340 and $450 million in total costs across the U.S.

It is important to acknowledge that catheterization may be an easier incontinence/continence management tool for some patients, such as patients who may be immobile or difficult to change.  However, the risk of CAUTI and the required ongoing maintenance of the catheter often outweighs the assumed simplicity and convenience of catheter use. It is important for healthcare professionals to first consider what is best for the patient, while following specific facility guidelines, in order to give a holistic consideration for what is best for managing patient outcomes. Improving catheter protocols and eliminating unnecessary catheterization are significant ways to reduce the risk of HAI.

The CDC has explicit recommendations for when catheter use is appropriate and guidelines for preventing CAUTI.

Open-Air Incontinence Management

An alternative incontinence management practice in some healthcare and acute care facilities is the use of “open-air” to manage urinary and/or fecal incontinence. “Open-air” is a practice characterized by the absence of a body worn absorbent product, leaving incontinence patients skin exposed with some type of underpad to catch and contain urine and feces.

While “letting the skin breath” may have certain clinical benefits, it is a questionable practice during this time of heightened IP and HAI concerns. First, the “open-air” practice poses a significant concern for affecting the patient’s dignity and quality of life. Open-air may be a preferred option by the healthcare facility or professional but is generally not the preference for the patient receiving care, or their family.

Another concern with the practice of “open-air” for incontinence management, is the risk for transmission of infectious pathogens due to decreased containment of bodily excrement. Containing urine and feces in a body worn absorbent product, such as pull-ons or tape-tab style briefs, is key preventing splash/spray episodes as well as minimizing Moisture-Associated Skin Damage (MASD), like Incontinence-Associated Dermatitis (IAD), which increases the risk for wounds and pressure injuries. Containment of bodily fluids must be a component of incontinence management.

Additionally, contrary to the “open-air” practice, skin health can be maintained and even improved with the right superabsorbent incontinence product. An absorbent brief or pull-on style product that is designed to lock away body fluids and neutralize the pH of urine has been shown to promote an appropriate microclimate for skin health.

Absorbent Products

The third common incontinence care practice in healthcare facilities is the use of absorbent products. Absorbent products are used in many acute care, hospital, and long-term care settings as incontinence management solutions, designed to contain feces and absorb urine.