Comparison of two indwelling bowel catheters on economic impact by number of bedding and dressing changes per day

Introduction

Fecal incontinence is prevalent in patients in the acute/ICU setting [1, 2]. The primary objective of this study was to assess and compare the economic impact on fecal containment with use of catheter A or catheter B at 12 sites (A, seven sites; B, five sites) in the acute/ICU setting. Catheter A is Zassi Bowel Management System (Hollister Inc.) and catheter B is Flexi-Seal Fecal Management System (ConvaTec, Inc.).

Methods

An analysis of 146 patients (A, 76 patients; B, 70 patients) on the number of bedding and dressing change visits per patient-day (frequency of nursing visits per day spent changing bedding/dressings due to fecal contamination) can be used as an indirect economic measure of catheter leakage and containment. Routine daily bedding/dressing changes were not included, only catheter-related bedding/dressing changes were recorded.

Results

A nearly 30% reduction (1.20 vs. 1.71) in the rate of bedding/dressing changes per patient-day were observed for catheter A compared with catheter B (P = 0.0035). For catheter A sites, 735 bedding/dressing change visits occurred over 612 patient-days; and for catheter B sites, 705 bedding/dressing change visits occurred over 413 patient-days. Although non-significant, lower observed rates of leakage (A, 1.1; B, 1.4), repositions due to leakage (A, 0.25; B, 0.39), and devices expelled (A, 0.02; B, 0.07) may have contributed to the significant reduction in bedding/dressing changes associated with the use of catheter A compared with catheter B.

Conclusion

The use of indwelling bowel management systems to divert, collect, and contain liquid stools may provide an economic advantage in an acute/ICU setting for patients with fecal incontinence. These results suggest that catheter A may have a greater economic value compared with catheter B by decreasing the number of nursing visits per patient-day.