Urinary incontinence products.

As a service to readers, NURSING HOMES initiated this year our "Ask The Vendors" department. It offers the views of top executives and managers of major nursing home product vendors on questions of interest to their potential customers. The questions relate to product categories, rather than specific products, with the aim of helping administrators become enlightened purchasers, particularly in these days of growing technological capabilities vs. tightening resources.

For this issue, NURSING HOMES asked manufacturers of incontinence control products:

"Which features are essential to a good incontinence control 'diaper,' and which are preferable?"

"When it comes to disposables, what are the environmental concerns, and what can be done about them?"

"What would you define as 'optimal use' of a diaper?"

Vendor executives' telephone responses follow:

Clyde A. Shew, Director of Marketing, Professional Medical Products:

"The essentials of any such product are good skin care and good containment. Absorbency is, of course, an essential, too, and many of the leading products do an acceptable job, but the first two items are worth special attention.

"As for preferable features, I would include a wetness indicator, refastenable tapes, waterproof backing, and an odor neutralizer. The basic value, though, all comes back to skin care.

"Environmentally, there are trade-offs between disposables and reusables. There are the costs of disposal and of landfills vs. costs in staff time in laundering, water consumption, energy for drying, etc. There are studies and beliefs supporting both sides, but basically there is no free lunch. What outweighs the trade-offs, in my opinion, is the significant patient care benefits offered by today's disposables. With today's superabsorbent technology, you are better able to keep the skin dry, and the design allows for much more discreet underclothing for residents who are ambulatory and wear their own clothes.

"We define 'optimal use' in a couple of ways. We recommend a 24-hour system for the ambulatory -- briefs by day and superabsorbent pads by night, allowing more air to reach the skin during the night. It is also recommended to keep people from having to use these products if at all possible. This is the way that we've been educated by nurses, and this is the way we've educated our sales staff."

David Lehman, Director of Vendor Relations, Red Line (distributors): "From talks with our sales staff, we would offer these observations:

"Essential features would include, above all, a product that helps maintain dry skin. The product should be leak-proof and also have refastenable tape tabs. Preferable features would include a wetness indicator, be color coded for ready size identification, have gathered legs, a polymer product for superabsorbency, product support in the form of inservice training and retraining as staffs change, and continuing education on skin care.

"Environmentally, there are several considerations in terms of reducing landfill needs. One might be, if possible, to use incineration as a means of disposal. Another consideration already being addressed by several manufacturers is reduction of packaging material. Many manufacturers are compressing the product during manufacturing, thereby reducing bulk by as much as 40%, which reduces the size of the carton the product is packed in, thus creating less waste. Another consideration would be to use cloth briefs, but you must consider the home's ability to collect and wash soiled briefs, the need for increased water and electricity use, disposal of waste water and, in some cases, water availability.

"The optimal use of any such product is to assist and enhance a bowel and bladder training program. Disposable briefs are not a permanent substitute for such a program, unless the resident's condition is such that this simply cannot be avoided."

Elaine Matthews, Spokesperson, Procter & Gamble Co.: "The essentials are products that help keep skin dry to help maintain healthy skin, and are discreet to assure comfort and enhance each resident's dignity. It is preferable that the products come in different sizes that are color coded to enhance performance and comfort, and have wetness indicators and refastenable tapes. It is also preferable to have extra leakage protection and, for active residents, the ability to wear unobtrustively under clothes.

"Environmentally, it is worth noting that disposables are less than 0.25% of the solid waste stream, and there is no evidence that disposal of these products in landfills is a hazard to public health. Lower bulk weight makes large economy sizes more practical and less expensive, while saving energy and costs. Additionally, where we use plastic, it can be recycled and is five times less costly to produce than paper packaging.

"Optimal use always involves a training program. Also, it is always important to preserve the resident's dignity through the selection of incontinence products that help keep skin dry, to meet individual residents' needs, and to help provide staff education and training on incontinence care and related subjects."

Scott Sigler, Executive Vice-President, Medical Disposables: "The major essential, of course, is containment; without that, everything else is for naught. Also essential, in my view, would be high-quality taping, a wetness indicator and multistrand leg gathers. Another essential for market acceptance these days is what we call full sizing. Some manufacturers produce a cut-down brief, which is less costly, but which forces the user to move up to larger sizes. As a result, costs are driven back up. I don't think this approach is viable today.

"I think it is preferable that products have super-absorbent cores. As much as facilities would like to check-and-change every hour or two, sometimes this just isn't possible. Also, some residents' skin is so sensitive that it is preferable to have a super-absorbent core for dryness and for stabilizing the pH shift when incontinence occurs. Also preferable, and probably becoming essential, is reduced package size to save storage space and ease handling difficulties.

"As for environmental concerns, the so-called biodegradable diapers produced today simply don't work in today's landfill setting. We have worked to make products lighter, but no less absorbent, through the use of different designs and core materials. We have also developed incontinence control systems that use less material, such as pant-and-pad systems and undergarments. All of these are partial solutions -- I don't think the disposable problem will be solved in one giant leap, but rather step-by-step.

"As for 'optimal use,' while we think our briefs are the best made, we suggest that they be the last product used for managing incontinence. For nighttime use, for example, a good-quality bed pad will work for most residents. The more agitated residents will still need briefs, but most can use this approach. A good bed pad is less expensive, uses less material, and allows more air to reach the skin.

"For daytime use, most residents can use something other than a brief, such as a highly-absorbent undergarment designed for daytime use. If there is adequate containment, these products will work well and are easier for residents to use and will help them get involved in their own care. Undergarments don't have the same stigma as briefs regarding dignity. Also, they use less material and are less expensive.

"Only when underpads and undergarments prove to be inadequate do we suggest the use of full briefs."