A Study Comparing Materials, Nursing Time, and Costs of Five Incontinence Skin Care Barriers and Cleansers

PURPOSE: To compare treatment costs of barrier/cleanser products A, B, C, and D to product E for use in an economic model.

BACKGROUND: Current standards for preventing/treating Incontinence Associated Dermatitis is timely removal of urine/feces from skin and the judicial use of skin barriers and gentle cleansers.

METHODS: Forty CNAs from 3 long-term care facilities were enrolled into this materials/time study. The investigators accompanied the CNAs on rounds and recorded weights of the barriers/cleansers and time to complete each incontinence care episode. Each CNA used all five product pairs following manufacturer directions in a randomized order on incontinent patients as they become available for study. Differences in the data were assessed with linear regression modeling of log-transformed values for the outcomes. Adjustments for baseline imbalances were done using propensity score matching. Cost modeling was based on a 100 bed facility with 60% of residents receiving incontinence care and following manufacturer product instructions.

RESULTS: The regression analysis of 199 episodes of incontinence care revealed the following ratios for each of the products relative to product E. Positive ratios favor E and negative ratios do not favor E. Significant differences from product E are denoted with a p-value.

• Barrier Amount: A = +6%; B = +33%; C = +65% (P<0.0004); D = +25%
• Cleanser Amount: A = -22%; B = -5%; C = +4%; D = -14%
• Barrier Application Time: A = -2%; B = +31% (P=0.0276); C = -2%; D = +28%
• Cleanser Time: A = -2%; B = +12%; C = -5%; D = +8%

 Cost models using manufacturer recommended treatment protocols with a variety of contract product prices and estimated materials/time values derived from the study favored product E.

 CONCLUSIONS: Cost modeling with input based on clinically collected time/material data favor product E over the other products tested.