To the Editor:We have read with interest Dr Teh-wei Hu et al 's study, "The Cost Effectiveness of Disposable Versus Reusable Diapers," in the February issue of the Journal of Gerontological Nursing (1990; 16(2): 19-24). We were impressed with the thoroughness of the data collection and the attention to the issues affecting validity. The data presented substantiate the conclusion that the use of disposable diapers is more economical.
However, we could not dismiss as insignificant the finding that more washcloths were used on patients wearing disposable diapers. This raised questions that could have a bearing on the findings regarding skin condition. Were the unsoiled portions of the bed linen and pads used to wipe the patients' skin on the lower abdomen, buttocks, and thighs? Did this reduce the frequency of washing with soap and water? Were washcloths used for the same purpose for patients wearing disposable diapers? Were the washcloths dry when used or were they first prepared with soap and water?
The data seemed to suggest that the patients wearing disposable diapers may have been washed more frequently, which could have a significant effect on skin condition. We feel this was a critical omission in the discussion.
Susan L. Joslin, RN, MS, CS
and Gerontological Nursing
Rose Kurz-Cringle, RN, PhD, CS
Department of Veterans Affairs
Perry Point Medical Center
The Authors Respond: We would like to respond to the four questions raised by Joslin and Kurz-Cringle concerning our article.
We are not aware of bed linens being used to wipe the patients' skin on the lower abdomen, buttocks, and thighs, but the cloth pads worn instead of disposable products by the comparison group were used for clean-up. The disposable product used in our study did not lend itself to such clean-up. Thus, a washcloth was often used (following toilet paper) to clean patients, particularly those witfi fecal incontinence, prior to the regular washing done on all patients. We have no data concerning whemer this reduced the frequency of washing with soap and water.
Were washcloths used for the same purpose for patients wearing disposable diapers? After patients had been given the "first" cleaning with either the cloth pad or washcloth, then the procedure used on all patients was the same. That is, all patients were washed using washcloths. The nursing home's protocol was to use soap and water when washing patients; we observed that being done.
In conclusion, although more washcloths were used with the group assigned the disposable product, we reject the notion that these patients were kept cleaner thus contributing to the better skin condition observed with the disposable group. Rather, we believe that the extra washcloths resulted from the initial cleaning of the patients who did not have the cloth pads to provide that service.
Teh-wei Hu, PhD
Professor of Health Economics
University of California, Berkeley
D. Lynne Kaltreider, MEd
Institute for Policy Research and Evaluation
The Pennsylvania State University
Jessie F. igou, RN, DrPH
Pennsylvania Nurses Association