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American Journal of Critical Care. 2009;18: 2-14 doi:10.4037/ajcc2009521
Copyright © 2009 by the American Association of Critical-Care Nurses.
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CE Article

Fecal Containment in Bedridden Patients: Economic Impact of 2 Commercial Bowel Catheter Systems

By Areta Kowal-Vern, MD, Stathis Poulakidas, MD, Barbara Barnett, RN, Deborah Conway, RN, Daniel Culver, DO, Michelle Ferrari, RN, Bruce Potenza, MD, Michael Koenig, RN, John Mah, MD, Mary Majewski, RN, Linda Morris, PhD, APN, CCNS, Jan Powers, RN, PhD, Elizabeth Stokes, RN, Michael Tan, MD, Sara-Jane Salstrom, BS, Cindy Zaletel, RN, Shirley Ambutas, RN, MS, Kathleen Casey, MD, Jayne Stein, RN, BSN, Mary DeSane, RN, Kathy Berry, WOCN, Elizabeth C. Konz, PhD, RD, Michael R. Riemer, MS and Malford E. Cullum, PhD. Areta Kowal-Vern and Stathis Poulakidas are physicians at John H. Stroger Hospital of Cook County, Chicago, Illinois. Barbara Barnett is a nurse and Deborah Conway is a director at the University of Virginia Health System, Charlottesville. Daniel Culver is a physician and Michelle Ferrari is a nurse at Cleveland Clinic Foundation, Cleveland, Ohio. Bruce Potenza is a physician and Michael Koenig is a nurse at the University of California, San Diego, Medical Center. John Mah is a physician at Hartford Hospital, Hartford, Connecticut. Mary Majewski is a nurse and Linda Morris is an advanced practice nurse at Northwestern Memorial Hospital, Chicago, Illinois. Jan Powers is a director at St Vincent Hospital of Indianapolis, Indiana. Elizabeth Stokes is a nurse at Sisters of Charity Providence Hospital, Columbia, South Carolina. Michael Tan is a physician and Sara-Jane Salstrom is a study coordinator at Summa Health System, Akron, Ohio. Cindy Zaletel and Shirley Ambutas were nurses at Provena Saint Joseph Medical Center, Joliet, Illinois, when this study was conducted. Kathleen Casey is a physician, Jayne Stein is a study coordinator, and Mary DeSane is a nurse at Jersey Shore University Medical Center, Neptune, New Jersey. Kathy Berry is a nurse at Banner Estrella Medical Center, Phoenix, Arizona. Elizabeth C. Konz is a senior clinical research scientist, Michael R. Riemer is a senior statistician, and Malford E. Cullum is a senior clinical research scientist at Hollister Incorporated, Libertyville, Illinois.

Corresponding author: Malford E. Cullum, PhD, 2000 Hollister Drive, Libertyville, IL 60048 (e-mail: malford.cullum{at}hollister.com).

Background Fecal contamination is a major challenge in patients in acute/critical care settings that is associated with increased cost of care and supplies and with development of pressure ulcers, incontinence dermatitis, skin and soft tissue infections, and urinary tract infections.

Objectives To assess the economic impact of fecal containment in bedridden patients using 2 different indwelling bowel catheters and to compare infection rates between groups.

Methods A multicenter, observational study was done at 12 US sites (7 that use catheter A, 5 that use catheter B). Patients were followed from insertion of an indwelling bowel catheter system until the patient left the acute/critical care unit or until 29 days after enrollment, whichever came first. Demographic data, frequency of bedding/dressing changes, incidence of infection, and Braden scores (risk of pressure ulcers) were recorded.

Results The study included 146 bedridden patients (76 with catheter A, 70 with catheter B) who had similar Braden scores at enrollment. The rate of bedding/dressing changes per day differed significantly between groups (1.20 for catheter A vs 1.71 for catheter B; P = .004). According to a formula that accounted for personnel resources and laundry cycle costs, catheter A cost $13.94 less per patient per day to use than did catheter B. Catheter A was less likely than was catheter B to be removed during the observational period (P = .03). Observed infection rates were low.

Conclusion Catheter A may be more cost-effective than catheter B because it requires fewer unscheduled linen changes per patient day.

Notice to CE enrollees:A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Understand the economic impact of 2 commercial bowel catheter systems.
  2. Determine if it is possible to state with statistical significance that the 2 commercial bowel catheter systems affect the incidence of skin/soft tissue and urinary tract infections.
  3. Recognize if the 2 commercial bowel catheter systems affect pressure ulcer risk.
To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.






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Copyright © 2009 by the American Association of Critical-Care Nurses.