A randomized clinical trial was conducted at three acute care facilities between August and December 1993 to compare cost outcomes between patients managed with diapers or with underpads. The 166 patients were divided into five groups: polymer or nonpolymer underpads, polymer or nonpolymer diapers, and cloth underpads. Among other results, the average number of nonpolymer underpads used (3.4) compared to other products used (1.4 polymer underpads, 1.1 cloth underpads, 1.0 nonpolymer diapers, 1.0 polymer diapers) quantified nurses' perceptions that nonpolymer pads were not as effective as their polymer counterparts in absorbing incontinence. The nonpolymer underpad was, however, the least expensive of the products studied, even taking into account the volume of product used. The nonpolymer underpad group also took the most time for cleanup. The cloth underpad group consistently used all of the linen items, suggesting that complete bed changes were necessary. The polymer underpad group consistently used the least linen, suggesting that the incontinence episodes were successfully contained by the product. When all costs were combined for time (at $13.50 hourly aide wage), linen use and product type, there was a statistically significant difference between the five treatment groups (F 9.3, p < 0.0000). Total costs (product, linen and staff time) for diaper products were higher than either the polymer or cloth underpad groups. Recommendations, based on both parts 1 and 2 of this study are that the polymer diaper is the product of choice for the ambulatory patient, and the polymer underpad is the product of choice for the bedridden patient. The nonpolymer underpad should no longer have a place in incontinence management.

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