I would like to know what other nurses opinions are in the use of diapers vs. underpads for patients incontinent of bowel and/or bladder. Some coworkers believe diapers make patients skin more prone to breakdown, while others think that merely putting an underpad underneath a patient puts a patient more at risk of skin breakdown. What do you think?
Mar 9, '01
Hi there. I'd think underpads would present a much greater risk to skin breakdown. I'm talking about regular underpads, cloth with a plastic backing. A diaper absorbs urinary incontinence and takes it away from the skin under it's saturated. The underpad would be wet and stay wet until changed. I have seen specialized underpads that absorb however.
Mar 12, '01
I don't like diapers on incontinent beddridden patients, nor do I like the underpads next to the patients skin for long periods of time. To me, they both seem to encourage skin breakdown because the plastic seems to keep the heat in. I work in an ICU, so I often try to put a pillowcase or draw sheet between the underpad and the patients' skin to reduce the higher skin temperature of the patients' peri-area. I don't suppose this method would work as well in a long term facility where the nurse isn't at the bedside 24/7 and can change the patient as soon as they become incontinent, however. I had never considered the wicking effect of a diaper vs. an underpad in pulling away urine from the skin. Our underpads are disposable pads (often called "chux", which is a brand name but we use it as a generic term); some are more absorbable than others.
[This message has been edited by Jenny P (edited March 11, 2001).]
Mar 12, '01
I use whatever the patient prefers. I would think that either one of them would cause skin breakdown if left wet next to the skin for any period of time.
I hate having any patient wear any kind of incontinence brief or pad in bed. Doing that is just asking for skin breakdown.
Oh and don't forget not only to change the incontinence brief/pad, but make sure you clean and dry the skin thouroughly.
Jul 19, '01
after my 24 years of experience with incontinent pt's, i find that using a repellant ointment such as a&d works the best. after washing and drying always reapply the ointment. it works best when applied to skin that has no breakdowns and used everytime. it also aids in healing of any rashes.
Jul 20, '01
i work in rehab and although the diaper is necessary during the day for therapy i prefer the incon pad when the patient is in bed. alot of the nurses put diapers on the pts. that have a foley and are bowel aware and i feel this holds moisture in. they are anticipating an accident. either way if the pt lays in wet you are going to have breakdown. i am also not a fan of alot of powder. once it gets a little moisture it cakes up ./ that and critic aid. nurses tend to just add more instead of cleaning and reapplying. rather keep it clean and dry.
Last edit by tiger on Jul 20, '01
Jul 20, '01
We used a washable, absorbant cloth under pad. It was also used as the draw/pull sheet. They never felt wet, they could be changed easily and the use of diapers on bedridden patients was unnecessary. I think we also had very few problems with skin breakdown. The diapers not only hold in the wet, but they make it likely that no one checks for incontinence because it isnt visible with diapers.
Jul 22, '01
At my facility we also use the washable, aborbant cloth underpads, and they seem to work really well. If the patient is a "soaker", we might use a CHUX underneath the cloth pad to protect the undersheet and mattress.
Jul 25, '01
We use diapers in my unit. I work in a NICU though...
Haha, dumb joke I know, I couldn't resist.
Jul 25, '01
i have worked in alot of different areas. if the pt has a cath and no loose stools.only use a draw sheet. apply a&d. if loose or alot of inconts use a&d or epc cream. and a underpad.if a person is incont of urine when up use wicking briefs that gel and nuetralize urine. also a layer of a smith and nephew product called clove protective ung is excellent we affectionately call it blue goo. it nuetralizes urine to protect the skin and releases a clove smell. this is one of the most effective preventative measures i've seen. but remember it is a chemical barriar vs a physical barriar like a & d ung.less is more. as a general guideline only wicking briefs when up and a cloth pad when down(one and only one for several reasons. staff change 1 pad quicker to prevent the whole bed from being changed 2- the less between the pts and the air mattress the better. the more layers the less effective the mattress. 3 less layers,less wrinkles therby decreasing the changes to circulation and decreasing chance of skin breakdown. several rules to briefs.never use the bottom tabs on a nonambulatory pt. it leads to blisters since we all know when we lay down things fir better-and when we sit up they are tight(don't believe me put on tight jeans) on ambulatory pt it is preferable not to use briefs, but liners if possible. also the key to preventing skin breakdown and providing for comfort no matter what item you choose is to change the item frequently AND clean the pt. a changed brief or pad does no good if the chemical from urine or feces remains-even if unseen on the skin.
Jul 26, '01
When we lived in West Virginia, on my days off from the ER I sometimes filled in a the small community nursing home my husband worked at. We used absorbent cloth pads with our patients and the turn Q2hr was strickly adhered to. During the 2 years I was there we had less that a 1% skin breakdown in our patients. I didn't think that was that unusual because the hospital I worked at was also small town/ community and the other nursing homes were just as well run. Heck, the only diapers we had in the hospital were for the infants and they were cloth also.
When we moved to the Baltimore area boy was I in for a shock. Almost every patient we get from nursing homes in the area are wearing disposible diapers and most of them have terrible looking skin. My husband had gotten a job at a nursing home that was said to be a "Good" one. They put disposible diapers on all incontient patients and were very slack about turning them. He has since moved on to another field because I couldn't stand the lack of TLC.
Aug 16, '01
I have to agree with Debbyed on the issue of pads. Two thumbs up from me. I am a CNA and work in LTC facilities. The lack of TLC has caused me to switch jobs 3x in the last 2 yrs. I am now at a facility that uses NO disposible 'chux' nor briefs and they have absolutely NO skin breakdowns. By using a cloth pad it seems to ensure that the pt is turned and changed q2hr. It is very important to remember that not only do you change the pad but some soap and water is also needed. A&D does wonders as a barrier. So facilites seem to do things out of convience, Sorry but that is wrong. (just my opinion) Convience should NEVER come before quality of care. I wear my title of CNA very proudly and that will never be compromised for convience.
Aug 18, '01
I work in LTC, and we use pads, which I think are better than diapers. We do use diapers however on those pts who have been given a laxative or suppository, because some of them like to use their feces as "fingerpaint"!
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