Prevalence, management and clinical challenges associated with acute faecal incontinence in the ICU and critical care settings: The FIRST™ cross-sectional descriptive survey

Objective To evaluate the prevalence, awareness and management of acute faecal incontinence with diarrhoea (AFId) in the Intensive Care Unit. Design Cross-sectional descriptive survey design of intensive care units across Germany, Italy, Spain and the United Kingdom. Results 962 questionnaires were completed by nurses (60%), physicians (29%) and pharmacists or purchasing personnel (11%). The estimated prevalence of AFId ranged from 9 to 37% of patients on the day of the survey. The majority of respondents reported a low-moderate awareness of the clinical challenges associated with AFId. Patients with AFId commonly had compromised skin integrity, which included perineal dermatitis, moisture lesions or sacral pressure ulcers. Reducing the risk of cross-infection and protecting skin integrity were rated as the most important clinical challenges. 49% had no hospital protocol or guideline for AFId management. There was also a low awareness of nursing time spent managing AFId; 60% of respondents estimated that 10–20 minutes are required for managing an AFId episode by 2–3 healthcare staff. Conclusions AFId in the critical care setting may be an underestimated problem which is associated with a high use of nursing time.