Prevent Infection, Preserve Dignity

• By J. Daniel Hull, Jeff Conrad
• Sep 01, 2005

It can be uncomfortable, inconvenient, embarrassing, and a catalyst for infection and other serious health problems. It is incontinence and it is negatively affecting the quality of life for an estimated 25 million Americans. While people of any age can experience incontinence, it is most common among seniors and may affect up to 50 percent of all nursing home residents.

As the percentage of older Americans is on the rise, incontinence is bound to be suffered by increasing numbers of Americans. In fact, according to United States Census Bureau projections, by the year 2030, the number of Americans over age 65 will more than double to 71 million—indicating that the number of people who suffer incontinence may increase dramatically in years to come.

Incontinence is defined as the loss of bladder or bowel control that is a symptom of various health conditions and disorders. Incontinence may result from injury to the spinal cord or pelvic area, neurological diseases, multiple sclerosis, infection and other degenerative changes that are associa ted with aging.

Incontinence strikes in various forms.

• Urge incontinence, also described as overactive bladder, is defined as the inability to get to the washroom in time to urinate. It happens when nerve passages along the path from the bladder to the brain are damaged, causing sudden bladder contraction that cannot be inhibited.
• Stress incontinence happens when pelvic muscles have been damaged, causing the bladder to leak during exercise, sneezing, laughing or other body movements that put pressure on the bladder.
• Mixed incontinence is very common and occurs when symptoms of both stress and urge types are present.
• Overflow incontinence refers to leakage that occurs when the quantity of urine produced exceeds the bladder's capacity to hold waste.
• Fecal incontinence is the inability to control the passage or loss of gas, liquid and solid stool. This condition varies from partial to entire loss of entire solid bowel movement.
• Functional incontinence is secondary to other factors that would affect normal urinary tract function. It may be related to physical weakness, poor mobility, dexterity, cognitive problems such as dementia, or various medications such as diuretics. Incontinence also can result from environmental factors such as distance to the restroom, poor lighting or low-sitting toilets.

Many seniors experience episodes of incontinence following surgery or if mobility is restricted for any reason. In these cases, incontinence is not generally diagnosed because conditions are temporary conditions or may be eased with mobility aids including raised toilets.

No matter the severity or cause, incontinence impacts a person's quality of life and can lead to urinary tract infections and other serious health problems.

New Guidelines from CMS

In late June, the Centers for Medicare and Medicaid Services (CMS) issued new guidelines on caring for people with incontinence to prevent infection and preserve dignity.

The new guidelines dictate that long-term care residents receive the proper treatment and services to restore as much bladder function as soon as possible or to treat and manage incontinence. These guidelines are helpful to home medical equipment providers (HMEs) in order to understand all the factors that play a role in patient incontinence as well as for providing education to potential customers seeking incontinence products.

The new guidelines state that at admission or any change in cognition, physical ability or urinary tract function, a thorough assessment of each resident must be completed. The assessment should indicate the type of incontinence and whether the cause is reversible or irreversible. During the assessment, CMS guidelines require the following to be considered:

• Prior history of incontinence
• Voiding patterns
• Medication review
• Patterns of fluid intake
• Use of urinary tract stimulants
• Pelvic and rectal exam
• Functional and cognitive abilities
• Pertinent diagnosis
• Identification of potential or developing complications
• Environmental factors that restrict the resident and assistive devices that can help

CMS is requiring long-term care facilities to take numerous steps to promote dignity, comfort, protection and improved quality of care. An essential step following assessment is record keeping and complete evaluation. Facilities are now required to have procedures in place that promote achieving the highest level of functioning as well as preventing or minimizing a decline or lack of improvement in continence. Facilities are therefore required to:

• Manage pain and provide adaptive equipment to improve function for residents suffering from arthritis, contractures, neurological impairments and other conditions.
• Remove or improve environmental impediments that affect the resident's level of continence, for example improved lighting or use of a bedside commode.
• Treat underlying conditions.
• Consider adjusting medications that affect continence.
• Implement a fluid or bowel management program that may include use of incontinent products.

Having witnessed the rising need for products to assist with incontinence, many medical supply manufacturers and distributors have developed services and products to help. These programs and products help improve a patient?s quality of life and meet the new CMS requirements. For example, numerous toileting aids, including bedside commodes and raised toilet seats with handles and grip bars, can help seniors with functional incontinence.

Products such as protective underwear (known generally as ?pull-ups?) make it easier for seniors to avoid the embarrassment of incontinent problems. These products are absorbent and help draw the moisture away from the skin, helping to prevent skin break down and tearing. Numerous other liner products also can help seniors with small episodic urine leakage and encourage self-toileting.

Some advanced incontinent products help wick away moisture while simultaneously protecting a patient?s bedding. These types of products help maintain consumer dignity by keeping them dry and comfortable.

The new CMS Incontinence Guidance document F(315) notes that managing skin moisture is critical to maintaining skin integrity and reducing the incidence of pressure ulcers. The guidance document also notes that provision of care must take into account and respect resident dignity. Dignity issues can include embarrassment or discomfort, which can result from lying in wet, cold urine as well as from odor. If facilities are cited for violations of the new guidelines, they could face thousands of dollars in fines.

It is also important that patients receive products that are properly fitted for optimum usage and care. If a brief or pull-up is too small or too big, it could cause leakage that can compromise a patient?s skin and dignity.

Seniors are often embarrassed and even humiliated by incontinence problems, and CMS will cite a facility for compromising a patient?s dignity. Having the right personal care products can go a long way in helping seniors to stay comfortable and maintain their dignity.

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Incontinence Products

Mattress Cover

MES offers a high-quality zippered mattress cover that is available in two sizes.

Incontinence Management

The FoleX™ incontinence and urine management device from Arcus Medical is an external apparatus that features an open-sided brief or leg strap that can drain into a standard collection bag.

Mesh Pants

The Protection Plus® bariatric-sized mesh pants from Medline Industries Inc. are made of Lycra®, which breathes and stretches for optimal patient comfort.

This article originally appeared in the September 2005 issue of HME Business.