Fecal Management System Research Articles

Influence of resource planning practices in faecal sludge management system in Embu County

The study aimed to assess the influence resource planning influences the implementation of a faecal sludge management system in Embu County between March and December 2022, adopting a descriptive research design. The population included 655 individuals, with a sample size determined using Taro Yamane's formula for landlords and a census method for top managers, technical officers, contractors, and individuals involved in exhausting. Research instruments comprised scheduled questionnaires and interviews, with ethical considerations obtained from relevant authorities. Data analysis utilized SPSS Version 26 for both qualitative and quantitative data, employing thematic analysis for qualitative data and descriptive and inferential analyses for quantitative data. Findings revealed a notable gender imbalance and age-related impacts on perceptions in fecal sludge management. Resource planning effectiveness indicated strengths in objective setting, communication, and risk management, significantly influencing system implementation. Recommendations include strengthening the strategic framework, enhancing vision and mission statements, refining financial planning, addressing role comprehension gaps, aligning resource planning with project timelines, and implementing regular monitoring and evaluation for ongoing improvements. Overall, the study emphasizes the pivotal role of resource planning in the success of fecal sludge management projects and highlights areas for improvement to enhance effectiveness.

Analysis of the Availability and Sustainable Management of Clean Water and Sanitation in Bogor Regency

The provision of clean water includes several main components, including: raw water source unit, processing unit, production unit, transmission unit and production unit. Water is used by humans for various daily needs. Water needs for individual needs vary for each place and each level of need. The higher the standard of living in a place, the greater the need for water. The goal that must be achieved in managing clean water in stages is to have access to household drinking water services reaching 100% by 2030. The next achievement is the achievement and realization of sanitation and clean water management for vulnerable community groups at 68.77%, shown by this achievement in 2026. To achieve the number of sub-districts or villages implementing community-based total sanitation of 98%. Meanwhile, the achievement of the proportion of households served by a centralized clean water waste management system is 71.66% in 2026. The proportion of households served by a fecal sludge management system until this data is published has not been covered so the baseline set at 20% in 2021 will be achieved in 2023 The Bogor Regency Government's target in establishing this feces processing concept is very good.

Evaluating the Effectiveness and Safety of Fecal Management Systems among Severely Ill Patients Suffering from Fecal Incontinence: A Retrospective Cohort Study

Background. Few large‐sample studies have examined the use of fecal management systems (FMSs) in intensive care units (ICUs) or evaluated the associated complications. This study aims to assess the effectiveness and safety of FMS for stool diversion in ICU patients with fecal incontinence (FI). Methods. We enrolled 381 FI patients, assigning them to either an FMS group (n = 134), which used a fecal management device, or a usual care (UC) group (n = 247) that received standard care including regular perianal cleaning. Results. The FMS group reported lower incidence and severity of incontinence‐associated dermatitis (IAD) and higher Braden Scale scores (10.42 ± 2.77) compared to the UC group (9.71 ± 2.56), indicating reduced pressure ulcer risk. Notably, FMS‐associated complications were minimal, with only 5 patients (3.73%) affected; one required surgical intervention for rectal mucosal bleeding. Conclusions. FMS significantly reduced stool‐associated skin irritation, lowered the incidence of IAD and pressure injuries, and improved nurses’ convenience compared to UC.

Source separation of human excreta: Effect on resource recovery via pyrolysis

More people globally are now using on-site sanitation technologies than sewered connections. The management of faecal sludge generated by on-site facilities is still challenging and requires an understanding of all sanitation service chain components and their interactions; from source conditions to treatment and resource recovery. This study aimed to improve the current lack of knowledge regarding these interactions, by establishing a quantifiable relationship between human excreta source separation and resource recovery via pyrolysis. The effects of source separation of faeces and urine on biochar quality were investigated for different pyrolysis temperatures (450 °C, 550 °C, 650 °C) and this information was used to assess energy and nutrient recovery. Results quantify the benefits of urine diversion for nitrogen recovery (70% of total N losses during thermal treatment avoided) and show an increase in the liming potential of the produced faecal-based biochars. The quality of produced solid fuels is also improved when source-separated faeces (SSF) are used as a feedstock for pyrolysis, including a 50% increase in char calorific value. On the other hand, biochars from mixed urine and faeces (MUF) are more rich in phosphorus and potassium, and surface morphology investigation indicates higher porosity compared to SSF biochars. The high salinity of MUF biochars should be considered before agricultural applications. For both biochar types (SSF, MUF), the presence of phosphate compounds of high fertiliser value was confirmed by X-ray diffraction analysis, and temperatures around 500 °C are recommended to optimise nutrient and carbon behaviour when pyrolysing human excreta. These findings can be used for the design of circular faecal sludge management systems, linking resource recovery objectives to source conditions, and vice-versa. Ultimately, achieving consistent resource recovery from human excreta can act as an incentive for universal access to safe and sustainable sanitation.

296 Identifying Gaps in Elderly Fecal Incontinence Management

OBJECTIVES/GOALS: Fecal incontinence is associated with increased caregiver strain, reduced patient dignity and diminished quality of life. A spectrum of incontinence exists, along with a paucity of available solutions for patients and their caregivers. This research aims to stratify this space and identify gaps within the existing solution landscape. METHODS/STUDY POPULATION: To understand this problem, a literature review was performed with key search terms specific to fecal incontinence. These included, anal incontinence epidemiology, fecal incontinence in nursing homes, and incontinence management. To determine gaps within the existing solution landscape, key search terms related to existing solutions for fecal incontinence were also included. These included, fecal management systems, rectal incontinence therapies, and anorectal incontinence procedures.' To perform a population segmentation, white papers, review articles, and cross-sectional studies were reviewed to break down the burden of incontinence in older adults living in nursing facilities and in the community. RESULTS/ANTICIPATED RESULTS: Two unaddressed populations were identified, the first being independent adults over the age of forty, particularly women, who suffer from frequent, bothersome incontinence. These 1.2 million patients are active, living at home, and they restrict their daily activities due to incontinence. However, there are several durable and effective solutions for patients who have sufficient sphincter tone or who are surgical candidates. The second population identified are caregiver dependent older adults residing in nursing facilities who suffer from severe incontinence. This population of 160,000 is affected more severely by consequences of fecal and are poorly served by solutions that are largely absorptive such as diapers and pads. DISCUSSION/SIGNIFICANCE: Although two populations were identified, caregiver dependent older adults residing in nursing homes were identified to have a significant unmet need within incontinence care. Current solutions are onerous and transient, preventing ease and duration for use by caregivers and nurses.

Using illustrated system analysis for qualitative risk assessment of emptying of pit latrines

Pit latrines as the primary means of sanitation for billions of people. Fecal sludge must be removed regularly when pit latrines fill up, and the workers who empty these latrines are essential service providers. Pit latrine emptying services and approaches are highly variable, ranging from highly trained teams using vacuum trucks with a suite of personal protective equipment to individuals with no protection using simple manual tools like buckets and shovels. While national governments and nonprofits endeavor to make pit latrine emptying safer, the people making day-to-day decisions such as local pit emptying associations, sanitation businesses, utilities, and local governments have limited resources to evaluate how different emptying practices vary in terms of risk. In this paper we describe the development of an open-source Illustrated System Analysis tool for the fecal sludge management community. This tool can be used in conjunction with a simple risk assessment matrix to help decision makers describe, compare, and prioritize risks for mitigation. We demonstrate this process by outlining how a pit emptying team can compare mechanical and manual emptying with respect to ingestion of fecal material and inhalation of fecal bioaerosols. Illustrated System Analysis can be a tool to analyze fecal sludge management systems, and the associated challenges and opportunities so that they could be understood and referenced by the wider public and used to spark innovation. We provide a library of graphics freely under creative commons.

S698 Bleeding Complications From Fecal Management Systems in the COVID Era: A Single Center Experience

Introduction: Fecal Management Systems (FMS) have become common practice in hospitalized patients with severe diarrhea, or pressure wounds. These devices allow diversion of stool away from the body in an enclosed system. Contraindications to FMS placement include hemorrhoids, anal strictures, rectal mucosal impairment and device use for greater than 29 days. Although FMS are generally safe and effective, severe rectal bleeding has been reported in a small number of studies and case reports though characteristics not well-defined. The goal of this study was to investigate patient characteristics with FMS use and subsequent development of severe bleeding complications. Methods: We reviewed endoscopy reports for rectal ulcerations and identified 16 patients who developed severe rectal bleeding from FMS at a large medical center from August 1, 2019 to August 1, 2021. Severe rectal bleeding was defined as requirement of blood transfusion, endoscopy or embolization. Demographics, medications, and hospitalization characteristics were extracted from the medical record. Mean, standard deviation, and percentages were calculated for variables of interest. Results: Patients who bled with FMS had prolonged hospitalizations (mean 67.4 days), and 50% (8/16) died during hospitalization (Table). 43.8% (7/16) had COVID-19 infection, and 75% (12/16) were cared for in intensive care units. 18.8% (3/16) were on antiplatelets, and 50% were on anticoagulation. 93.8% (15/16) of patients who bled with FMS required blood transfusion, receiving 6.1±6.3 units of blood during their hospital admission. 81.3% (13/16) required endoscopy, 12.5% (2/16) required second endoscopy for hemostasis, and 6.3% (1/16) required embolization by Interventional Radiology. Of note, 18.8% (3/16) patients had hemorrhoids, 18.8% (3/16) had FMS for longer than 29 days, and only 37.5% (6/16) had an order for a rectal tube placed. No severe bleeding complications occurred in the 10 months prior to COVID-19 pandemic. (Figure) Conclusion: FMS has clinical utility but carries risks of severe bleeding complications. It remains unclear how COVID-19 impacted rates of these complications as baseline utilization could not be assessed in our center. Careful attention to hemorrhoids, FMS placement > 29 days, and other relative contraindications like coagulopathy is important to improve patient safety. Interventions should be developed to ensure safe, appropriate FMS placement and timely removal of FMS to avoid adverse events.Figure 1.: Total number of fecal management system (FMS) severe bleeding complications from August 1, 2019-August 1, 2021. Table 1. - Characteristics of patients undergoing sigmoidoscopy or colonoscopy for bleeding from rectal tubes (n =16) Variable N (%) or mean (SD) Length of hospitalization (days) 67.4 (30.6) Death during hospitalization 8 (50.0) Hospitalization in intensive care unit (ICU) 13 (81.3) Age (years) 63.4 (14.9) Male sex 13 (81.3) RaceWhite or CaucasianBlack or African-AmericanAsian 8 (50.0)6 (37.5)2 (12.5) Body mass index 26.9 (6.7) History of hemorrhoids 3 (18.8) Immobility 12 (75.0) Mechanical ventilation 11 (68.8) Aspirin use 10 (62.5) Antiplatelet use 3 (18.8) Anticoagulant use 8 (50.0) NSAID use 2 (12.5) Bowel regimen use 12 (75.0) Vasopressor use 9 (56.3) COVID-19 diagnosis 7 (43.8) Rectal tube order placement 6 (37.5) Duration of rectal tube use (days) 18.5 (14.5) Rectal tube placement >29 days 3 (18.8) Receipt of blood transfusion 15 (93.8) Number of blood transfusions 6.1 (6.3)

Commentary: After the flush: What is the best fecal waste management system for Addis Ababa?

• Management of faecal waste. • diversity of system in this case. • Involvement of local authorities. • Possibility of using this waste management system in education.

Climate Change Impacts on Urban Sanitation: A Systematic Review and Failure Mode Analysis.

Climate change will stress urban sanitation systems. Although urban sanitation uses various infrastructure types and service systems, current research appears skewed toward a small subset of cases. We conducted a systematic literature review to critically appraise the evidence for climate change impacts on all urban sanitation system types. We included road-based transport networks, an essential part of fecal sludge management systems. We combined the evidence on climate change impacts with the existing knowledge about modes of urban sanitation failures. We found a predominance of studies that assess climate impacts on centralized sewerage in high-income contexts. The implications of climate change for urban nonsewered and complex, fragmented, and (partially) decentralized sanitation systems remain under-researched. In addition, the understanding of the impacts of climate change on urban sanitation systems fails to take a comprehensive citywide perspective considering interdependencies with other sectors and combinations of climate effects. We conclude that the evidence for climate change impacts on urban sanitation systems is weak. To date, research neither adequately represents the variety of urban sanitation infrastructure and service systems nor reflects the operational and management challenges of already stressed systems.

Getting Ready for Wound Certification: Promoting Skin Health and Preventing Injuries.

Getting Ready for Wound Certification: Promoting Skin Health and Preventing Injuries.

An experimental study probing moisture kinetics and indices of microwave dried fecal sludge with an insight on real world applications

ABSTRACT The ever-increasing population rate, followed by resource deficiency, has made innovations crucial in sanitation. The deteriorating hygiene, particularly in the population’s low strata, is of great concern in most developing countries. As the current fecal sludge management system is linear, it needs to be transformed into a closed-loop circular system like any other waste management system. This study examines the potential of using microwaves to dry feces before transporting and reduce the spread of disease. The microwave output power; sample load; feces-urine composition, were adjusted between 100 and 300 W; 20 and 40 g; and 10% and 90% respectively. Drying kinetics were determined using empirical drying data modeling and the standard error analysis was used to select the best model. Under a range of experimental conditions, the effective moisture diffusivity of drying was determined to be on the order of 10−9, and the effect of process parameters on the effective moisture diffusivity was investigated. Furthermore, thorough tests were performed to determine the microwave drying process’ efficiency and energy consumption (6.782 MJ.kg−1 to 29.268 MJ.kg−1), determining its feasibility for large-scale deployment as a fecal sludge pretreatment method. This study provides a solution for modern sanitation by successfully closing the nutrient loop.

Out of sight, out of mind: Understanding the sanitation crisis in global South cities

Global monitoring efforts do not provide a clear picture of the challenge of managing human waste at the city scale. Where cities do not provide universal access to publicly managed sanitation systems, households and communities find their own solutions resulting in a patchwork of approaches to removing human waste from places where people live. In dense urban environments, the absence of a coordinated approach can create serious public health problems. In the absence of comparable city-level data, we analyze primary and secondary data from 15 cities and 15 informal settlements in sub-Saharan Africa, South Asia, and Latin America. Across these regions, our study finds that 62 percent of human waste is not safely managed. We also find that, while many cities have a proportion of households connected to sewers, none of the 15 cities safely manage human waste at scale. In the absence of sewers, on-site fecal sludge management systems place enormous responsibility on households and private providers, and unaffordable sanitation options result in risky sanitation practices.

Factors influencing physicochemical characteristics of faecal sludge in Phnom Penh, Cambodia

Abstract Comprehensive knowledge of faecal sludge characteristics is needed for sludge management planning, but it is lacking for the city of Phnom Penh, Cambodia. Thus, this study characterised physicochemical properties of faecal sludge from households in Phnom Penh and related these to sludge containment unit type, unit age, connectedness to the urban drainage network, type of wastewater captured, watertight containment units, number of users, and emptying practices. In total, 194 faecal sludge samples collected during containment unit emptying were analysed for physicochemical parameters. Information on containment units was collected in a survey of emptiers and users. Mean values of faecal sludge chemical parameters were found to be slightly lower than previously reported values for low-/middle-income countries, whereas physicochemical properties were within similar ranges. The main factor influencing organic matter content in faecal sludge was containment unit connection to the urban drainage network, whereas emptying practice and capture of only blackwater affected nutrient levels. The concentrations of nutrients and organic pollutants greatly exceeded Cambodian discharge standards for wastewater. This causes environmental impacts, so treatment is needed before discharge. The faecal sludge characteristics and influencing factors identified here can serve as a baseline for sanitation stakeholders planning faecal sludge management systems in Phnom Penh and similar cities.

Incidence and Characterization of Rectal Complications From Fecal Management Systems.

Fecal management systems have become ubiquitous in hospitalized patients with fecal incontinence or severe diarrhea, especially in the setting of perianal wounds. Although fecal management system use has been shown to be safe and effective in initial series, case reports of rectal ulceration and severe bleeding have been reported, with a relative paucity of clinical safety data in the literature. The purpose of this study was to determine the rate of rectal complications attributable to fecal management systems, as well as to characterize possible risk factors and appropriate management strategies for such complications. This was a retrospective cohort study. The study was conducted at a large academic medical center. All medical and surgical patients who underwent fecal management system placement from December 2014 to March 2017 were included. We measured any rectal complication associated with fecal management system use, defined as any rectal injury identified after fecal management system use confirmed by lower endoscopy. A total of 629 patients were captured, with a median duration of fecal management system use of 4 days. Overall, 8 patients (1.3%) experienced a rectal injury associated with fecal management system use. All of the patients who experienced a rectal complication had severe underlying comorbidities, including 2 patients on dialysis, 1 patient with cirrhosis, and 3 patients with a recent history of emergent cardiac surgery. In 3 patients the bleeding resolved spontaneously, whereas the remaining 5 patients required intervention: transanal suture ligation (n = 2), endoscopic clip placement (n = 1), rectal packing (n = 1), and proctectomy in 1 patient with a history of pelvic radiotherapy. The study was limited by its retrospective design and single institution. This is the largest study to date evaluating rectal complications from fecal management system use. Although rectal injury rates are low, they can lead to serious morbidity. Advanced age, severe comorbidities, pelvic radiotherapy, and anticoagulation status or coagulopathy are important factors to consider before fecal management system placement. See Video Abstract at http://links.lww.com/DCR/B698. ANTECEDENTES:Los sistemas de manejo fecal se han vuelto omnipresentes en pacientes hospitalizados con incontinencia fecal o diarrea severa, especialmente en el contexto de heridas perianales. Aunque se ha demostrado que el uso del sistema de tratamiento fecal es seguro y eficaz en la serie inicial, se han notificado casos de ulceración rectal y hemorragia grave, con una relativa escasez de datos de seguridad clínica en la literatura.OBJETIVO:Determinar la tasa de complicaciones rectales atribuibles a los sistemas de manejo fecal. Caracterizar los posibles factores de riesgo y las estrategias de manejo adecuadas para tales complicaciones.DISEÑO:Estudio de cohorte retrospectivo.ENTORNO CLINICO:Centro médico académico de mayor volumen.PACIENTES:Todos los pacientes médicos y quirúrgicos que se sometieron a la colocación del sistema de manejo fecal desde diciembre de 2014 hasta marzo de 2017.PRINCIPALES MEDIDAS DE VALORACION:Cualquier complicación rectal asociada con el uso del sistema de manejo fecal, definida como cualquier lesión rectal identificada después del uso del sistema de manejo fecal confirmada por endoscopia baja.RESULTADOS:Se identificaron un total de 629 pacientes, con una duración media del uso del sistema de manejo fecal de 4,0 días. En general, 8 (1,3%) pacientes desarrollaron una lesión rectal asociada con el uso del sistema de manejo fecal. Todos los pacientes que mostraron una complicación rectal tenían comorbilidades subyacentes graves, incluidos dos pacientes en diálisis, un paciente con cirrosis y tres pacientes con antecedentes recientes de cirugía cardíaca emergente. En tres pacientes el sangrado se resolvió espontáneamente, mientras que los cinco pacientes restantes requirieron intervención: ligadura de sutura transanal (2), colocación de clip endoscópico (1), taponamiento rectal (1) y proctectomía en un paciente con antecedentes de radioterapia pélvica.LIMITACIONES:Diseño retrospectivo, institución única.CONCLUSIONES:Este es el estudio más grande hasta la fecha que evalúa las complicaciones rectales del uso del sistema de manejo fecal. Si bien las tasas de lesión rectal son bajas, pueden provocar una morbilidad grave. La edad avanzada, las comorbilidades graves, la radioterapia pélvica y el estado de anticoagulación o coagulopatía son factores importantes a considerar antes de la colocación del sistema de manejo fecal. Consulte Video Resumen en http://links.lww.com/DCR/B698.

Planning fecal sludge management systems: Challenges observed in a small town in southern India

Fecal Sludge Treatment or Septage Management is increasingly being recognised as an effective and appropriate method to scale urban sanitation systems to achieve safe sanitation, particularly in small towns and cities. As implementation progresses, data-based evidence is emerging, highlighting the challenges faced on the ground, and the requisite planning necessary to address them. This paper presents the findings, challenges and possible ways ahead from a study conducted to provide data for Fecal Sludge Management (FSM) planning for a small town in a state in southern India. With the objective of understanding the nature of containment structures and on-ground desludging practices, 8,001 households and 1,667 establishments were studied in Periyanaicken-Palayam (PNP), a non-sewered Town Panchayat in Coimbatore District, Tamil Nadu, to provide evidence for effective decision-making. The study showed wide variations in the sizing and design of the containment systems, which, when combined with the irregular frequency of desludging, has implications for FSM planning by municipal bodies. This study also highlights the methodological difficulties in studying containment systems, exposes a significant response bias given the limited understanding of containment systems within households, and spotlights the difficulty in physically verifying the reported data given the underground nature of these systems.

AN UNUSUAL CAUSE OF RECURRENT MASSIVE GASTROINTESTINAL BLEEDING IN THE MICU

SESSION TITLE: Global Case Report Posters SESSION TYPE: Global Case Reports PRESENTED ON: October 18-21, 2020 INTRODUCTION: Fecal incontinence is a commonly encountered condition occurring in up to 33% of critically ill patients. The etiology of diarrhea or fecal incontinence is usually multifactorial and can lead to skin breakdown, ulceration, and infection. Managing diarrhea in the intensive care unit(ICU) patients can be a challenging problem. Flexi-Seal Fecal Management system(FSMS) is commonly used in ICU settings, and provide a safe and effective diversion of stool away from the skin. CASE PRESENTATION: 32-year-old Hispanic female, with a past medical history of insulin-dependent diabetes mellitus, who initially presented with shortness of breath found to have influenzas B, also had diabetic ketoacidosis (DKA). She was admitted initially to the medical ICU for DKA management, her ICU course was complicated by hypoxic respiratory failure requiring mechanical ventilation, septic shock, and developed bilateral basilic and cephalic vein thrombosis, for which she was started on heparin infusion. Because of the prolonged stay and acute diarrhea, a FSMS was placed and remained in place for 16 days. She developed acute blood loss anemia and significant hematochezia. Flexible sigmoidoscopy showed rectal bleeding ulcer secondary to prolonged rectal tube placement, the bleeding was controlled with two clips, but she continued to have recurrent bleeding with hemodynamic instability, requiring multiple blood transfusions. The patient underwent colonoscopy, no other source of bleeding was identified except the rectal ulcer, so another clipping was placed, however, the patient continued to have recurrent bleeding per rectum, a second flexible sigmoidoscopy was performed, which didn’t show active bleeding and three clips were still in place. Eventually, the bleeding stopped without any further intervention. She required a total of three units of packed RBCs. DISCUSSION: The use of fecal management systems in ICU has been more commonly utilized, because of their effectiveness in diverting fecal material away from the patient. The Flexi-Seal fecal management system is the most widely used device designed which can be used up to 30 days. It involves a balloon inflated with saline to secure the tube in place. Although Flexi-Sealdevice is considered safe overall. However, it is important to caution with prolonged use of this device. There have been few reported cases in literature for lower gastrointestinal bleeding secondary to the fecal management system, either in the setting of anticoagulation use or without it. The ulcer is usually caused by direct pressure of the balloon on rectal mucosa, and semisolid fecal build up above the balloon. Patients on anticoagulation should be closely monitored for any signs of lower gastrointestinal hemorrhage. CONCLUSIONS: FSMS is overall a safe system, but the continued need for the utilization of FSMS should be assessed daily with a low threshold for removal once the indication resolved. Reference #1: Tiwari A, Sharma H, Qamar K, Alastal Y, Sodeman T, Nawras A. The Traumatic Tube: Bleeding Rectal Ulcer Caused by Flexi-Seal Device. Case reports in gastrointestinal medicine. 2017;2017. Reference #2: Beitz JM. Fecal incontinence in acutely and critically ill patients: options in management. Ostomy Wound Manage. 2006 Dec 1;52(12):56-66. DISCLOSURES: No relevant relationships by Rami Ahmad, source=Web Response

Moisture associated skin damage (MASD) in intensive care patients: A Norwegian point-prevalence study

BackgroundCritically ill patients are at risk of developing moisture associated skin damage and pressure ulcers. These conditions may co-exist and be difficult to distinguish, but a simultaneous investigation may provide a true prevalence. ObjectivesTo investigate the prevalence of moisture associated skin damage and associated factors among Norwegian intensive care patients. MethodsA multi-centre one-day point-prevalence study. ResultsTotally, 112 patients participated in the study. Overall, 15 patients (13%, 15/112) had some type of moisture associated skin damage of which six cases (5%, 6/112) were related to faeces and/or urine (incontinence associated dermatitis). Skin breakdown occurred primarily in the pelvic area. Overall, 87% (97/112) had an indwelling urinary catheter. Stools were reported in 42% (47/112) of the patients on the study day, mostly liquid or semi-liquid. Overall, 11% (12/112) had a faecal management system. Only a few care plans for moisture associated skin damage prevention and care existed. ConclusionPatients in this study were vulnerable to skin breakdown in the pelvic area. Nevertheless, a low prevalence of skin breakdown existed. This may relate to intensive care nurses’ qualifications, the 1:1 nurse-patient staffing, the high prevalence of urinary catheters and few patients having stools.

Examining Prevalence and Risk Factors of Incontinence-Associated Dermatitis Using the International Pressure Ulcer Prevalence Survey.

PURPOSE:To evaluate prevalence and risk factors of incontinence-associated dermatitis (IAD).DESIGN:Retrospective analysis of 2016 International Pressure Ulcer Prevalence survey data.SUBJECTS AND SETTING:Adult patients who were in acute care, long-term acute care, long-term care, and rehabilitation facilities in the United States and Canada.METHODS:IAD prevalence was calculated among all patients surveyed, among the incontinent patients only, across multiple care settings, and by incontinence type. A logistic regression examined risk factors for IAD in the incontinent population.RESULTS:Nearly 1 in 5 incontinent patients had IAD documented. Incontinence-associated dermatitis prevalence in the entire patient population was 4.3% while incontinence prevalence was 18%. Of incontinent patients, prevalence of IAD ranged from 8.4% in long-term care facilities to 19% in acute care facilities. Facilities with higher rates of incontinence did not necessarily have higher prevalence of IAD. Incontinence-associated dermatitis prevalence by incontinence type ranged from 12% for patients with urinary incontinence to 26% for patients with fecal management systems. Regression results support the association of the following factors with an increased likelihood of IAD documented: all types of incontinence, fecal management systems, higher body weight, diminished mobility, additional linen layers, longer length of stay, and lower Braden Scale scores.CONCLUSIONS:Incontinence-associated dermatitis remains a concern in acute care settings. Risk factors associated with IAD were similar to risk factors previously reported for hospital-acquired pressure injuries, such as limited mobility, longer lengths of stay, and additional linen layers. By consistently documenting IAD as well as pressure injury prevalence, facilities may benchmark overall skin prevention models.

A Comprehensive Study on the Physicochemical Characteristics of Faecal Sludge in Greater Accra Region and Analysis of Its Potential Use as Feedstock for Green Energy

Design of treatment plants for faecal sludge management systems relies on a comprehensive accurate knowledge of FS (faecal sludge) characteristics, but this information is lacking. Developing countries like Ghana, where large proportion of the urban population (Accra) rely on onsite sanitation systems, face a lot of FSM (faecal sludge management) design challenges as a result of lack of a comprehensive study data on physicochemical characteristics of raw faecal sludge after primary dewatering. Achieving a fully operational FSM chain would imply a well understanding of the characteristics of the FS and its dynamics after primary dewatering. A study was carried out to determine the characteristics of faecal sludge brought to the Lavender Hill treatment plant, Accra Metropolis, and environs to ensure the treatability and uses of the products after treatment. The treatment plant receives an average of 150 trucks (1350m3) a day with 58% coming from private homes and 42% from public toilets. Composite samples were made from both public and private toilets facilities. Samples were taken from a reservoir holding faecal sludge from both public and private facilities, examined on daily basis and characterized. The values obtained showed high concentrations of BOD and COD values. The COD: BOD ratios showed that the faecal sludge is not stabilized yet and can be further degraded. The calorific value for the dry sludge was found to be 15.16-15.82 MJ/kg and 16.39–18.31 MJ/kg for the wet sludge. The calorific value of the sludge is adequate enough to be used as potential feedstock for green energy generation. The high concentrations of COD and organic matter of the faecal sludge make it suitable enough for biogas generation. A good correlation (r=0.909,R2=82.6%) between the calorific value and the TVS was found to be CV=0.122TVS+7.44. Heavy metal concentrations were low and satisfied the EPA Ghana guidelines for sludge. Thus products from the treatment can be used for agricultural purposes.

Agent-Based Modelling for Simulation-Based Design of Sustainable Faecal Sludge Management Systems.

Re-using faecal sludge (FS) to generate value has the potential to contribute towards solving the issue of long term sanitation solutions in growing urban areas across sub-Saharan Africa; however, hitherto, no design tools have been available that are capable of simulating a system involving economic factors, complex social issues and environmental circumstances. We hypothesized that Agent-Based Modelling (ABM), when deployed with appropriate rigour, can provide such a tool. Extensive field work was carried out in a Malawian city, investigating the adoption of Skyloo above-ground composting toilets by households, and the operation of the municipal FS site. 65 semi-structured interviews and 148 household interviews, together with observations, were carried out to characterize these processes, with the data acquired being used to construct two separate ABMs. The Skyloo ABM was run for various scenarios of start-up capital for business and payback of loans against the toilet cost to households. The municipal FS Site ABM was run for different patterns of dumping fee and enforcement structure. The field work demonstrated that there is potential for further expansion of FS reuse, with a market for agricultural application. The Skyloo ABM identified the significance of start-up capital for a business installing the toilet technology; the municipal FS Site ABM showed that existing fees, fines and regulatory structure were insufficient to reduce illegal dumping of FS to any useful degree, but that a monthly permit system would provide enhanced revenue to the city council compared with per-visit charging of disposal companies at the municipal FS site. Whilst each ABM ideally requires some additional data before full application, we have, for the first time, shown that ABM provides a basis for the simulation-based design of FS management systems, including complex social, economic and environmental factors.