An Interventional Study of Bowel Management Methods to Decrease Incontinence Associated Dermatitis

Problem: Fecal incontinence is a major cause of incontinence associated dermatitis (IAD) and is associated with pressure ulcer development. Gray (2007) reported that the prevalence of incontinence in the hospital setting has been estimated to be as high as 27%.  Fecal incontinence in the intensive care setting is a serious concern. There is little evidence in the literature regarding the benefits of various bowel management methods.

Purpose/Aim: We compared three methods of bowel management for the patient with diarrhea in the intensive care unit; 1) Bowel management system catheter (BMS); 2) nasopharyngeal trumpet (NT) utilized as a fecal incontinence device, and 3) usual care (UC). We compared the 3 methods on the development of new or worsening IAD, prevalence and incidence of pressure ulcers and nurse satisfaction. In addition, we explored the relationships between demographic, clinical characteristics, IAD and pressure ulcers.

Method: A convenience sample of 52 patients in 8 critical care units in a large urban teaching healthcare system participated. Subjects were randomized to 1 of the 3 groups/methods. Subjects were seen daily by the Research Team and data collected included: IAD severity, pressure ulcer stage, Braden score, and other related medical information. In addition, staff satisfaction surveys were collected randomly.

Analysis/Outcome: Baseline demographic/clinical data was examined using descriptive statistics, t-test and Pearson chi-square. Other exploratory analyses will be reported.

No statistically significant relationships were found between the bowel management methods, IAD or pressure ulcers. However, no new pressure ulcers developed during this study in any of the patients. In addition, no safety concerns were identified with either internal bowel management device methods. Staff satisfaction differences between groups/methods were found to be statistically significant.

Conclusion: This study adds to the growing body of knowledge regarding best practice for those with persistent fecal incontinence in the intensive care unit.