Is this a new trend?

[hppygr8ful]

A local hospital has been sending us residents with severe diaper dermatitis - I mean deep red excorriation so bad that the redisident in one case was bleeding. When I spoke to a family member I was told the nurses at the hospital did not use disposable briefs but instead put bath blankets of towels between the patient's legs and actually told the patients to go ahead and pee in their beds and they would clean them up after. But patients are sitting in their own waste.

When we called the hospital with the client/family complaint they denied the practice and said the parient had clear skin when they were discharged. There was a meeting with the CEO of the hospital today to discuss this problem.

I am just wondering if this a new practice I haven't heard of.

hppy

[CelticGoddess, BSN, RN]

In my major hospital system, we are no longer allowed to use briefs. We are to use bed pans or bed side commodes. For our incontinent patients we use a towel and a chuck.

The reasoning is that briefs hold moisture and lead to skin breakdown. With no brief, it is believed that the stool or urine will be caught sooner and taken care of quicker.

We aren't allowed to use briefs either, however, we are using covidien pads. WE are allowed to use a newborn diaper (it covers the member, to prevent the entire bed from getting soaked) but it can't be wrapped, only placed. I like the covidien pads because they are strong (we can move a patient in the bed with them) and if we can't get to them immediately (say we have code) the pad keeps them dry until we can get them cleaned up. I can only speak for my unit and my shift, but we are very good about changing patients quickly. We have a good record for no skin breakdown (and we have quite a few long termers on our unit)

Unfortunately, I have seen residents coming from certain LTC facilities who have horrid breakdown, and it wouldn't surprise me if they wrap towels/chucks or multiple briefs so they don't have to change their residents as often.

[whichone'spink, BSN, RN]

This is definitely not a trend in the two hospitals I have worked in.

[NursesRmofun, ASN, RN]

In my major hospital system, we are no longer allowed to use briefs. We are to use bed pans or bed side commodes. For our incontinent patients we use a towel and a chuck.

The reasoning is that briefs hold moisture and lead to skin breakdown. With no brief, it is believed that the stool or urine will be caught sooner and taken care of quicker.

I guess this explains the problem. Had not heard of this until just now. I think it's a very bad idea. How is it working in your hospital?

[mmc51264, BSN, MSN, RN]

In acute care, we get pts that are not happy that we won't let them wear their briefs. We emphasize that we would rather clean them frequently than let them sit in a soiled garment. usually it takes a little while for them to believe this. The situation described by OP is horrid. That is neglect. This is also we photograph any skin irregularities upon admission.

[Here.I.Stand, BSN, RN]

Ooohh...wet terrycloth on fragile skin sounds like a recipe for breakdown. I used cloth diapers with my babies for a while; my youngest had such sensitive skin that I had to switch to disposables w/ barrier cream because he was getting blisters even w/ q 1 hr diaper changes. Like a PP mentioned, the absorbent material in disposables wicks moisture from the skin and turNS it into a gel, whereas wet cloth keeps the skin wet. Plus terrycloth is so bumpy. Sit on a towel for two hours--you're going to have an impression on your bum.

My hospital discourages briefs too, but we have disposable Chux which are smooth and are supposed to allow for air flow.

[xoemmylouox, ASN, RN]

I suppose I get the "idea" of eliminating briefs, but using scratchy towels is not the answer. How about having resonable staffing and absorbent pads? I suppose I don't have the answer, but I do know those awful towels are not it.

[kungpoopanda]

The reason they are discouraging briefs is because they cost more than toweling and Chux. A bean counter somewhere is probably charging the health care insurer for briefs but instructing staff to use towel. It all comes down to the mighty dollar.

[LPN With An Attitude]

Having developed a systemic yeast infection from a long course of antibiotics, I am betting that most of those excoriated patients need a few days of Lotrisone cream. Be sure to thoroughly document that redness/excoriation on admission, because of course the hospital will deny responsibility. What occurs...we have good and bad bacteria in our digestive system. Antibiotics do not discriminate. They eradicate the bad bacteria causing the infection as well as the good or friendly bacteria that keep the yeast organisms in check. Abdominal and breast folds are dark, moist areas where yeast frequently manifests, as well as the peri area. It is the cause of jock itch, athlete's foot, and thrush (oral yeast infection). Nystantin liquid and powder work, but I found that Lotrisone cream works after just one or two applications. A story comes to mind. The last LTC facility where I worked, this poor elderly woman was scratching herself until she bled. The pig headed physician ignored my pleas for Nystatin or Lotrisone cream, thinking it was some reaction to her briefs or some other bizarre cause. Now don't get me wrong, I will never say I know more than a doctor, but when you have had an actual condition and were treated for it, it is easy to recognize it in others. Also, I liked this doctor, but he was stubborn on this. He went on one of his exotic vacations, so I persuaded the physician covering for him to write a script for Lotrisone. The patient started to clear up, she was visibly less anguished. First thing her regular doctor did when he came back was to D/C the anti-fungal cream that I begged him to give her. The redness and later bleeding came back, the anguished look on her face as she clawed away at her skin. He sent the lady out for a dermatological consult, and guess what the dermatologist sent her back with? You guessed it. A script for Lotrisone cream. It worked a second time and she completely cleared up.

Now with mega/predatory corporations like Monsanto acquiring a monopoly on their weed killer "round up", it leeches its way into the food we ingest and target the bacteria that keep the Candida or yeast organism in check, disturbing the flora and bringing on more and more gastrointestinal issues and yeast infections. So although the hospitals denying responsibility is certainly no trend, patients coming in with yeast infections may well be a trend that will only get worse as our elected officials our corrupted, bought and sold by the big guys, special interests.

[annie.rn]

Posted in error.

[NurseSpeedy, ADN, LPN, RN]

My grandmother was recently in the hospital and has urinary incontinence due to a number of issues but a major one is her prolapsed uterus. She has little control of her urine and will flood suddenly when she changes position. She asked for a brief and of course her doctor told her that the nurses would get her one. The only problem is, the hospital system does not use briefs.

She was in a very good hospital and I understand the rationale (briefs are wet and hold in moisture (the cheep type that the hospitals had) and can lead to skin breakdown especially if it goes unnoticed. When entering the patient room and interacting with a patient that is not wearing one, it is likely to be noticed sooner). The problem I see with it is she is mobile and cognizant and not having the option left her afraid to get out of bed to go to the bathroom because she would leak (a puddle) and be embarrassed (not to mention the fall hazard of slipping on the now suddenly slick and wet floor) and contributed to her mobility decline while she was there...leading to a month in an inpatient rehab. I think if the patient can tell someone when they are wet and want one, it should be their choice.

I will say that this hospital did not use the towel technique. I have seen it elsewhere though and it is total neglect and not something that is going to help the patient preserve skin integrity. I have seen the larger than life disposable chux now being used that cover the majority of the bed that have replaced the bed pad of years ago. I remember several years back when I would float to the rehab floor that they had done away with the bed pad because 'it weighed to much and cost a lot to clean because the moisture made it heavier' and they were using a draw sheet and thin paper chux. It didn't last long because it took to long for the mattress to dry out afterwards and it can only be flipped once before it would be back to the other side that was still drying (gross).

[la_chica_suerte85, BSN, RN]

I've seen that, for the most part, a lot of hospitals are getting away from briefs d/t breakdown. However, using a towel or bath blanket is not the alternative. Generally it's just the chux under the pt that are what is used for incontinent folks. But, gosh, that sounds horrific.

[Libby1987]

Any of the methods/products need to be changed timely but I would rather pee/poop into a better quality closed system brief than all over a flat less absorbent chux.