- Created on Friday, 03 October 2003 04:04
- Written by Susan Capparelle
Both the reusable and disposable textile camps seem to wage their most heated battles in the environmental and monetary arenas. However, few good definitive studies focus on the disposable industry’s impact on the huge cost of improper care to patients, eroding healthcare morale and the loss of healthcare givers to “easierâ€? jobs, says Karen Paradee, clinical director, The Sewing Source, a healthcare textile manufacturer.
REUSABLE MYTHS -- THEN AND NOW
In the past, many incontinence caregivers have used the “old” reusables. They were mainly cotton, stained badly and were hand-rinsed to remove fecal matter prior to laundering. “This sounds like a small issue, but consider being assigned to 10 patients, all being changed every two hours,” said Paradee. “That becomes 40 soiled underpads to wash every day on top of the rest of your work. When a bright salesperson from a disposable company came along in 1980 and promised to take caregivers away from that, they jumped.
According to Paradee, disposables became the norm and reusables needed to be sold. But today’s reusables have improved and the trends are changing -- but slowly. “It takes education, product trials and hands on work with the caregivers to make the change,” she says. “It is costly, difficult and laundries are somewhat complacent. A laundry makes product decisions without the input of the caregivers is likely to choose a product that is less expensive per piece, but costly beyond measure in the long run.“
HIDDEN COSTS OF DISPOSABLES: ERODING MORALE
Paradee feels that inferior products coupled with management barriers have led to overwhelming caregiver frustration, poor care and high costs in incontinence care. In order to regain the value of our caregivers, they must feel as if they are of value, she adds. “There is nothing like success to make morale high and constantly seeing poor outcomes in patients because they are using inferior products, i.e. a disposable which can cause pressure ulcers and other problems erodes nursing morale.”
Diapers are known to be clinically improper in bed for an incontinent person, since the added heat from a diaper is detrimental to already at-risk skin. Paradee suggests “getting back to the basics of skin care” to raise success rates, increase morale, and nurse retention. She adds that the use of a good reusable product leads directly to good care for patients and nursing satisfaction. She adds that clinical and physiological reasons behind the need to turn patients must be also be stressed.
PATIENT CARE OR “CARE AVOIDANCE”
“In the case of adults in a facility, the issue is not the time it takes to wash the briefs, because the caregivers don’t do that, but it has to do with the realities of the care given, says Paradee. “Once a patient is briefed, the phenomenon of ‘care avoidance” takes over, an out-of-sight out-of-mind thing that occurs.”
“In all socio-economic strata, once a brief is introduced the number of times an incontinent patient is changed goes down. Disposable briefs for adults have the same technologies as baby diapers, with the gel-locking core, etc. and when left for a length of time, can absorb much more urine than a reusable that depends upon surface area in the soaker for absorption,” Paradee explains. “Rare is the facility that boasts low skin breakdown that routinely briefs adults. Reducing brief use in facilities is a very good way to reduce bed sores, not because of the briefs themselves, but because of the care patients receive when briefed.”
INCONTINENCE COMING FULL CIRCLE
Paradee believes the use of diapers has emerged as a response to advertising. “The sale of diapers is made easier by the statistical fact that by and large, nurses are women and we bought into the idea that disposable diapers keep our babies dryer. So why not for elderly, incontinent adults? The care given them sometimes seems like the care given to infants so why not treat their incontinence the same?
“But adults, who have become so debilitated that they are incontinent, and need others to turn them in bed, have underlying disease processes that render their skin much more susceptible to injury. Blood flow to tissues is diminished; the fatty layer under the skin, over bony prominences is diminished; nutrition and hydration may also be compromised,” Paradee explains. “Internal factors are so altered that it is now up to the caregiver to battle the ‘external’ forces that threaten the loss of skin integrity.”
“The human side of this is what a shame it becomes that older adults, who have lived a life protecting their children and grandchildren from harm, earned a living, laughed, cried, and contributed are now reduced to the possibility of living and dying with open wounds on them, only because they became dependent themselves”.
Quick Rinse - News From Around The World
A Gruesome Laundry Surprise
PHOENIX, Ariz. — A body in a bin was discovered by employees at a Sodexo commercial laundry facility. The body arrived on a delivery truck from medical facilities in Tucson. Team members who were unloading the bins first noticed blood on the sheets then discovered the body in one of the bins. The man, a transient, had previously slept in the laundry-bag area near the Tucson medical facility. It is believed that the man either died from a medical condition or was suffocated by the plastic bags. The body showed no signs of trauma or foul play.