The development of national quality performance standards for disposable absorbent products for adult incontinence

Disposable absorbent products are widely used in inpatient care settings and in the community to manage adult urinary and fecal incontinence, but few product standards exist to help guide their production or optimal use. Increasing costs and reduced revenues have caused a number of states to evaluate absorbent product use among persons who receive care at home with the assistance of the Medicaid Waiver Program, further increasing concerns about the lack of product performance standards. To address these issues, the National Association For Continence (NAFC) formed a council of experts and key stakeholders with the objective of establishing national, independent quality performance standards for disposable absorbent products provided by states to Waiver Program recipients. The Council consisted of representatives from five purposefully selected states, technical directors from six nonwoven product manufacturers, an officer of the nonwoven manufactures trade association, a delegate from an academic nursing program and professional societies, a family caregiver, and a patient representative. Following a consensus method and guidelines for use, nine specific recommendations were developed, posted for public comment, and further refined. Final recommendations for product performance assessment include: rewet rate (a measure of a product's ability to withstand multiple incontinent episodes between changes), rate of acquisition (a measure of the speed at which urine is drawn away from the skin by a product, product retention capacity (a measure of a product's capacity to hold fluid without rewetting the skin), sizing options, absorbency levels, product safety, closure technology, breathable zones (a measure of the air permeability across a textile-like fabric at a controlled differential pressure), and elasticity. The Council also set values for and recommended four quantifiable parameters, and the testing methodology associated with each, to help consumers and states evaluate absorbent products (medium adult size): Maximum Rewet Rate: <1.0-2.0 g for briefs and <0.5-1.0 g for underwear; Maximum Rate of Acquisition: <50-60 seconds for briefs and <35-45 seconds for underwear; Minimum Retention Capacity: >250 g for standard briefs or underwear and >400 g for premium briefs or underwear; and Breathability of Zones: Minimum of >100 cubic feet per minute. As these recommendations are implemented, research is needed to evaluate the impact on both cost and quality of care for further refinement and modifications, particularly as technology and knowledge is advanced.