Imagine lying in an intensive care unit bed, unable to move, completely dependent on others—even to use the bathroom. For many critically ill women, urinary incontinence is not just uncomfortable—it is humiliating, painful, and dangerous. Left unmanaged, it can lead to severe skin damage, pressure ulcers, and life-threatening infections. But what if one simple, non-invasive device could change all of that?

In intensive care settings, immobile patients rely on staff to meet all basic needs, including hygiene and elimination. A major challenge is managing urinary incontinence (UI), which can cause emotional distress and serious skin complications like incontinence-associated dermatitis (IAD) and pressure ulcers (PUs) (Avsar & Karadag, 2018). These issues delay recovery and reduce the quality of care.

Traditionally, female ICU patients are treated with indwelling urinary catheters (IUCs), which carry a significant risk of catheter-associated urinary tract infections (CAUTIs) (Gupta et al., 2017) – a possibly life-threatening condition (Zavodnick et al., 2020). These infections contribute to more than 13,000 deaths annually and cost the U.S. healthcare system over $340 million each year (Centers for Disease Control and Prevention [CDC], 2022). As healthcare shifts toward safer, evidence-based practices, female external urinary catheters (FEUCs) have emerged as a promising alternative (Baxter et al., 2025).

Historically, external urinary devices were designed primarily for men, leaving female patients with limited options. However, recent innovations—known as external urinary diversion and female absorbent (EUDFAs) devices—have been developed for the female anatomy and have shown strong potential to reduce IUC use and improve outcomes (Beeson et al., 2023).

Beeson et al. (2023) showed that EUDFAs successfully diverted 85.5% of urine, while IUC usage decreased from 43.9% to 36.6% over three years. The incidence of IAD dropped from 69.2% to 39.5%. A study by Pryor et al. (2024) reported a 54% decrease in CAUTI rates with the use of structured FEUC protocols. These results demonstrate that success relies not just on the device itself, but also on its thoughtful integration into clinical workflows.

Multidisciplinary collaboration is essential. Nurses and aides manage device application and monitoring. Hospital leadership must support the effort with staff education and adequate supplies. Informatics teams track metrics like IUC rates and CAUTI incidence. Together, these components ensure sustainability and patient-centered success.

When implemented using Pressure Ulcer and Continence Strategies (PUCS), the shift to FEUCs offers multiple benefits: less bacterial entry into the urethra, fewer IAD and hospital-acquired pressure injuries (HAPIs), and greater patient comfort. An ICU nurse in our pilot unit shared, “FEUCs save time and reduce patient stress. I wish we’d had them years ago.” Nurses report that the devices are easy to use, improve urine output accuracy, and reduce time spent on IAD management.

Improving incontinence management is not just a clinical priority—it’s a moral one. Female external urinary catheters, when integrated thoughtfully into care protocols, offer a compelling, evidence-based solution. As nurses, we must lead efforts that uphold dignity, safety, and quality. Adopting FEUCs brings us one step closer to a more compassionate and effective standard of care.

References

Avsar, P., & Karadag, A. (2018). Efficacy and cost-effectiveness analysis of evidence-based nursing interventions to maintain tissue integrity to prevent pressure ulcers and incontinence-associated dermatitis. Worldviews on Evidence-Based Nursing, 15(1), 54–61. https://doi.org/10.1111/wvn.12264

Baxter, C. M., Matthews, C. L., Zamarripa, C., Johnston, J. R., Lane, R., Chung, A., Palladino, K., Kip, P. L., Zapf, R. L., Wagester, S., & Snyder, G. M. (2025). Implementation of an external female urinary catheter strategy on prevention of skin breakdown in acute care: A quality improvement study. Journal of Clinical Nursing, 34(1), 299–307. https://doi.org/10.1111/jocn.17356

Beeson, T., Pittman, J., & Davis, C. R. (2023). Effectiveness of an external urinary device for female anatomy and trends in catheter-associated urinary tract infections. Journal of Wound, Ostomy, and Continence Nursing, 50(2), 137–141. https://journals.lww.com/jwocnonline/fulltext/2023/03000/effectiveness_of_an_external_urinary_device_for.10.aspx

Centers for Disease Control and Prevention. (2025). Urinary tract infection (Catheter-associated urinary tract infection [CAUTI] and non-catheter-associated urinary tract infection [UTI]) events. U.S. Department of Health and Human Services. https://www.cdc.gov/nhsn/pdfs/pscmanual/7psccauticurrent.pdf

Gupta, S., Irukulla, P., Shenoy, M., Nyemba, V., Yacoub, D., & Kupfer, Y. (2017). Successful strategy to decrease indwelling catheter utilization rates in an academic medical intensive care unit. American Journal of Infection Control, 45(12), 1305–1307. https://doi.org/10.1016/j.ajic.2017.06.020

Pryor, N., Wang, J., Young, J., Townsend, W., Ameling, J., Henderson, J., & Meddings, J. (2024). Clinical outcomes of female external urine wicking devices as alternatives to indwelling catheters: A systematic review and meta-analysis. Infection Control & Hospital Epidemiology, 45(9), 1–9. Advance online publication. https://doi.org/10.1017/ice.2024.73

Zavodnick, J., Harley, C., Zabriskie, K., & Brahmbhatt, Y. (2020). Effect of a female external urinary catheter on incidence of catheter-associated urinary tract infection. Cureus, 12(8), e11113. https://doi.org/10.7759/cureus.11113