{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T18:09:01Z","timestamp":1791396541278,"version":"4.3.3"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Fecal incontinence (FI) poses a significant clinical and economic challenge in the U.S. intensive care units (ICUs), affecting 9\u201340% of patients and contributing to billions of dollars in healthcare costs mainly towards complications such as incontinence-associated dermatitis (IAD), hospital-acquired pressure injuries (HAPI), and Clostridioides difficile infection (CDI). This review traces the evolution of FI management from rudimentary containment methods to the newest innovative Qoramatic Automated Stool Management (ASM) system with no balloon and zero radial pressure. We compared Qoramatic ASM to traditional absorbent pads and indwelling balloon catheters (IBCs) across four patients\u2019 subgroups Results demonstrate that Qoramatic ASM reduces per-patient care costs by 80\u201394.5% ($242\u2013$1,344 vs. $1,215\u2013$24,615 for pads\/IBCs), decreases nursing time 91\u201396% (6\u201314 vs. 66\u2013348\u202fmin\/day), and nearly eliminates leakage and device-related injuries. ASM also reduces HAPI and CDI incidence, shortening hospital stays by up to 30%. Qoramatic\u2019s improved clinical outcomes, enhanced patient dignity, and reduced staff burden positioning it is a transformative solution for FI management in ICUs, warranting broader global adoption.<\/jats:p>","DOI":"10.3389\/fmed.2026.1761399","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T10:31:28Z","timestamp":1776681088000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Evolution and economic evaluation of fecal incontinence management in United States intensive care units: from historical containment to automated diversion"],"prefix":"10.3389","volume":"13","author":[{"given":"Deanna","family":"Vargo","sequence":"first","affiliation":[{"name":"Independent Researcher, Chuyahoga","place":["Falls, OH, United State"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin","family":"Grimes","sequence":"additional","affiliation":[{"name":"Independent Researcher","place":["Phoenix, AZ, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiara","family":"Tickoo","sequence":"additional","affiliation":[{"name":"Consure Medical","place":["Carrollton, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1177\/1751143715589327","article-title":"Prevalence, clinical consequences and management of acute faecal incontinence with diarrhoea in the ICU: the FIRST\u2122 observational study","volume":"16","author":"Binks","year":"2015","journal-title":"J Intensive Care Soc"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/17511437130144S201","article-title":"Expert recommendations for managing acute faecal incontinence with diarrhoea in the intensive care unit","volume":"14","author":"Garcia","year":"2013","journal-title":"J Intensive Care Soc"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1097\/WON.0000000000000265","article-title":"Prevalence of fecal incontinence in the acute care setting","volume":"43","author":"Stokes","year":"2016","journal-title":"J Wound Ostomy Continence Nurs"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1341","DOI":"10.1007\/s10350-004-0593-0","article-title":"The prevalence of fecal incontinence in community-dwelling adults: a systematic review of the literature","volume":"47","author":"Macmillan","year":"2004","journal-title":"Dis Colon Rectum"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"afad181","DOI":"10.1093\/ageing\/afad181","article-title":"Incontinence during and following hospitalisation: a prospective study of prevalence, incidence and association with clinical outcomes","volume":"52","author":"Campbell","year":"2023","journal-title":"Age Ageing"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1097\/WON.0000000000000548","article-title":"Examining prevalence and risk factors of incontinence-associated dermatitis using the international pressure ulcer prevalence survey","volume":"46","author":"Kayser","year":"2019","journal-title":"J Wound Ostomy Continence Nurs"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1097\/WON.0000000000000390","article-title":"Incontinence-associated dermatitis, characteristics and relationship to pressure injury: a multisite epidemiologic analysis","volume":"45","author":"Gray","year":"2018","journal-title":"J Wound Ostomy Continence Nurs"},{"key":"ref8","first-page":"25","article-title":"Risk factors associated with having a pressure ulcer: a secondary data analysis","volume":"7","author":"Maklebust","year":"1994","journal-title":"Adv Wound Care"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"S22","DOI":"10.1186\/2110-5820-2-S1-S22","article-title":"Effect of mechanical ventilation on intra-abdominal pressure in critically ill patients without other risk factors for abdominal hypertension: an observational multicenter epidemiological study","volume":"2","author":"Soler Morej\u00f3n","year":"2012","journal-title":"Ann Intensive Care"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1186\/s40560-016-0156-1","article-title":"Risk factors for late defecation and its association with the outcomes of critically ill patients: a retrospective observational study","volume":"4","author":"Fukuda","year":"2016","journal-title":"J Intensive Care"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1136\/gut.50.4.480","article-title":"Prevalence of faecal incontinence in adults aged 40 years or more living in the community","volume":"50","author":"Perry","year":"2002","journal-title":"Gut"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1136\/fg.2009.001206","article-title":"Effective management of acute faecal incontinence in hospital: review of continence management systems","volume":"1","author":"Ousey","year":"2010","journal-title":"Frontline Gastroenterol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/j.ijnurstu.2016.04.005","article-title":"The burden of diarrhea in the intensive care unit (ICU-BD). A survey and observational study of the caregivers' opinions and workload","volume":"59","author":"Heidegger","year":"2016","journal-title":"Int J Nurs Stud"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"CD007408","DOI":"10.1002\/14651858.CD007408","article-title":"Absorbent products for moderate-heavy urinary and\/or faecal incontinence in women and men","volume":"2008","author":"Fader","year":"2008","journal-title":"Cochrane Database Syst Rev"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"4067","DOI":"10.2147\/IJGM.S424424","article-title":"Nurses' burden of elimination care: sequential explanatory mixed-methods design","volume":"16","author":"Jung","year":"2023","journal-title":"Int J Gen Med"},{"key":"ref16","first-page":"639","article-title":"A budget impact analysis comparing use of a modern fecal management system to traditional fecal management methods","volume":"39","author":"Howell","year":"2012","journal-title":"J Wound Ostomy Continence Nurs"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1097\/WON.0000000000000128","article-title":"Randomized controlled study of the effects of 2 fecal management systems on incidence of anal erosion","volume":"42","author":"Sammon","year":"2015","journal-title":"J Wound Ostomy Continence Nurs"},{"key":"ref18","first-page":"37","article-title":"A retrospective review of outcomes using a fecal management system in acute care patients","volume":"60","author":"Whiteley","year":"2014","journal-title":"Ostomy Wound Manage"},{"key":"ref19","year":""},{"key":"ref20","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1097\/NNA.0b013e3182895a3c","article-title":"The value of reducing hospital-acquired pressure ulcer prevalence: an illustrative analysis","volume":"43","author":"Spetz","year":"2013","journal-title":"J Nurs Adm"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1733","DOI":"10.1111\/j.1440-1746.2012.07242.x","article-title":"Impact of hospital-acquired Clostridium difficile","volume":"27","author":"Lipp","year":"2012","journal-title":"J Gastroenterol Hepatol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"11432","DOI":"10.3390\/ijerph182111432","article-title":"Prevalence, risk factors and burnout levels in intensive care unit nurses: a systematic review and meta-analysis","volume":"18","author":"Ram\u00edrez-Elvira","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"2175","DOI":"10.1001\/jama.2011.697","article-title":"Hospital mortality, length of stay, and preventable complications among critically ill patients before and after tele-ICU reengineering of critical care processes","volume":"305","author":"Lilly","year":"2011","journal-title":"JAMA"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"100607","DOI":"10.1016\/j.mayocpiqo.2025.100607","article-title":"A systematic review of length of stay linked to hospital-acquired falls, pressure ulcers, central line-associated bloodstream infections, and surgical site infections","volume":"9","author":"Hasan","year":"2025","journal-title":"Mayo Clin Proc Innov Qual Outcomes"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1186\/s12879-016-1786-6","article-title":"Cost of hospital management of Clostridium difficile infection in United States\u2014a meta-analysis and modelling study","volume":"16","author":"Zhang","year":"2016","journal-title":"BMC Infect Dis"},{"key":"ref26","volume-title":"Dis Colon Rectum","year":"2021"},{"key":"ref27","volume-title":"Cuff pressure and friction in the design of indwelling fecal drainage catheters","author":"Gloeckner","year":"2011"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1186\/1472-6963-11-135","article-title":"Impact of bleeding-related complications and\/or blood product transfusions on hospital costs in inpatient surgical patients","volume":"11","author":"Stokes","year":"2011","journal-title":"BMC Health Serv Res"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1924","DOI":"10.1111\/iwj.13482","article-title":"Risk of readmissions, mortality, and hospital-acquired conditions across hospital-acquired pressure injury (HAPI) stages in a US National Hospital Discharge database","volume":"17","author":"Wassel","year":"2020","journal-title":"Int Wound J"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/j.ijnurstu.2018.01.014","article-title":"Independent risk factors for the development of incontinence-associated dermatitis (category 2) in critically ill patients with fecal incontinence: a cross-sectional observational study in 48 ICU units","volume":"81","author":"Van Damme","year":"2018","journal-title":"Int J Nurs Stud"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1761399\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T10:31:29Z","timestamp":1776681089000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1761399\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,20]]},"references-count":30,"alternative-id":["10.3389\/fmed.2026.1761399"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1761399","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,20]]},"article-number":"1761399"}}