Expert Recommendations for Managing Acute Faecal Incontinence with Diarrhoea in the Intensive Care Unit

Acute faecal incontinence with diarrhoea (AFId) has been reported to affect up to 40% of patients in the intensive care unit (ICU). The clinical challenges of AFId include the risk of perineal skin breakdown and cross-contamination with nosocomial infections, such as Clostridium difficile. In addition, the management of AFId is a burden on nursing time and hospital resources. Despite these challenges, there is currently no standard way of managing AFId. To address this problem, an international panel of intensive care specialists was convened to discuss AFId management recommendations. The collective knowledge of the specialists combined with literature searches from online medical databases were used to create a set of guidelines together with an accompanying management algorithm to aid healthcare providers in deciding the most appropriate care for patients with AFId in the ICU. These guidelines have been specifically designed to take into account patient severity of illness and comorbidities, which coupled with common AFId-associated clinical complications, can influence management choices. A comprehensive review of current AFId management strategies, taking into account the spectrum of patients and hospital economic limitations, has been included as a reference guide. It is hoped that the wider adoption of these recommendations will be a step forward in improving the current management of AFId in the ICU.