No briefs?! Is this an ICU thing?

[paramedic-RN]

So up until a few months ago my only experience has been in the ED so frequent incontinence clean ups weren't a common occurrence until I started working in step down.

So to me it just makes sense that if someone's incontinent they get a brief and everyone on my unit must feel the same way because we ALL use briefs along with creams and all the pads under the pt and all that. However whenever I float to the ICU I can NEVER find briefs and when I ask other nurses always get the same response of something like "we don't really use those here" now I know habits can sometimes dominate a unit and become part of the culture for that unit but I'm starting to wonder is this just an ICU thing?

Two regular ICU agency nurses come to our unit they have the same feeling towards briefs. But why? I feel like it significantly reduces the risk of skin breakdown because the poop is more contained and less likely to spread up their back and down their legs, also it makes clean up faster. So why????? If anyone can find research on this that'd be great if not I'd like to hear all opinions as well.

[TheCommuter, BSN, RN]

I'm starting to wonder is this just an ICU thing?

I've never worked in ICU and probably never will.

I worked in LTC/nursing homes from 2006 to 2012. In that setting, due to state Department of Aging and Disability Services regulations we were not permitted to place briefs on residents if they had a pad or chux underneath. We either had to pick one (the chux / pad) or the other (briefs).

If a state surveyor caught a patient wearing a brief while laying on chux / pad, the facility would be cited or tagged. But since some residents and families preferred both the chux / pad and the brief for extra protection, we had to obtain a physician's order to cover us that read "May wear briefs and lay on pad while in bed."

[RainMom]

I don't care for briefs at all unless the pt is ambulatory. At my hospital, we mostly keep incontinent pts open to air. Briefs just tend to hold the moisture against the skin.

[paramedic-RN]

Interesting, I wonder why the DADS had that rule?

[paramedic-RN]

But don't a lot of briefs actually wick away the moisture? In fact some of the brands brag about that on their website, how many ml's they wick away.

[TheCommuter, BSN, RN]

Interesting, I wonder why the DADS had that rule?

I might be incorrect, but I was told that briefs on top of pads / chux is a roundabout form of "double diapering," which is a big no-no.

[calivianya, BSN, RN]

A brief on somebody holds the feces/urine against the skin. I can't imagine how they would wick away moisture, really, if you think about it. If a patient is totally immobile and laying on his back, where exactly is the moisture going to go? It's still in the brief. I would think if moisture wicked anywhere, it would wick around more of the skin than if a person is just laying on a pad because more of the skin would be in contact with the brief than would just be in contact with a pad.

I also think it's just flat out easier to tell if someone has been incontinent if there is no brief. Either the smell or sight will give it away very quickly... and if you're rushed and in a hurry, a patient with a brief might sit in incontinence longer if it's not immediately obvious from a distance that he/she has pooped.

[emtb2rn, BSN, RN, EMT-B]

Agree with calivianya. I'm in the ed & we do a LOT of incontinence cleanups. With the nursing home ams & septic work-up pt's, the briefs come off immediately. As i tell the families when they ask for diapers, we'd rather know what's going on & clean than not be sure & have dad/mom/gramps wearing a soiled brief.

[emb92250]

I'm an ICU nurse and I agree about not using briefs on ICU patients. In my mind, briefs are for those who are cognate and ambulatory, moving around, etc. ICU patients are usually bed bound and unable to tell if/when they've been incontinent. The pad allows the incontinent urine or stool to spread out. As in away from the skin. It also allows the healthcare provider to see/smell the incontinence sooner, allowing for quicker reaction and clean up.

Briefs hold that dirty moisture, stool on the skin, making breakdown more likely. Especially if they are not on a brief changing schedule and can not tell someone when they need a new one. I also feel like it is harder to change a brief on a bedbound patient than a pad, but that may just be because I am more used to the pads.

Also, just as an aside, it is usually the case that ICU patients are catheterized, for strict urine output measurement. Therefore, a brief gets in the way of the catheter, and we only really deal with stool incontinence. I.e. pads are usually preferred.

[heron, ASN, RN]

The question in my mind is, am I caring for a person or bed linen?

Briefs have their place, especially in preserving the dignity of mobile patients. But my purely empirical experience is that they promote breakdown, if only due to the delay in changing when bed linens are dry but brief is soiled. And I've had this experience in a number of settings, so it's not just one "bad" unit.

Chux aren't much better, since they're thinner and get hotter than wet briefs. When you add in any tendancy to pull a soiled brief out from under a patient, rather than roll them off it, you get macerated skin AND shear injuries.

Good times for the wound care nurse ...

[Larry3373]

In my icu we will place a fecal management system in the case of frequent incontinent bm and almost everyone has a foley with a temp probe (criticore). We have no policy against briefs that I'm aware of, but usually we use diapers, not briefs.

[AmyRN303, BSN, RN]

On my unit, if a pt comes from home with incontinence briefs, we/the pt can use them, if they're mobile. If the incontinence is a new onset or if the pt is bed bound, no briefs due to increased skin breakdown. We use many bed pads on our floor.