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Hochwalt AE, Abbinante-Nissen JM, Bohman LC, Hattersley AM, Hu P, Streicher-Scott JL, Teufel AG, Woeller KE. The safety assessment of tampons: illustration of a comprehensive approach for four different products. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1167868. [PMID: 37408999 PMCID: PMC10319135 DOI: 10.3389/frph.2023.1167868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/17/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction We illustrate a comprehensive tampon safety assessment approach that assures products can be used safely. Material biocompatibility, vaginal mucosa assessment, vaginal microbiome evaluation, and in vitro assessment of potential risk of staphylococcal toxic shock syndrome expressed through growth of Staphylococcus aureus (S. aureus) and production of TSST-1 are the four essential portions of the approach. Post-marketing surveillance informs of possible health effects that warrant follow up. The approach meets or exceeds US and international regulatory guidance and is described through the example of four tampon products. Methods/Results Each product is comprised mostly of large molecular weight components (cotton, rayon, polymers) that cannot pass the vaginal mucosa, are widely used across the industry, and replete with a vast body of safety data and a long history of safe use in the category. Quantitative risk assessment of all small molecular weight components assured a sufficient margin of safety supporting their use. Vaginal mucosa assessment confirmed that pressure points, rough edges and/or sharp contact points were absent. A randomized cross-over clinical trial (ClinicalTrials.gov Identifier: NCT03478371) revealed favorable comfort ratings, and few complaints of irritation, burning, stinging, or discomfort upon insertion, wear, and removal. Adverse events were few, mild in severity, self-limited and resolved without treatment. Vaginal microbiota assessment in vitro presented no adverse effect on microbial growth. Culture-independent microbiome analyses from vaginal swab samples obtained during the clinical trial showed no differences attributable to tampon usage, but instead due to statistically significant subject-to-subject variability. Growth of S. aureus and TSST-1 toxin production in the presence of any of the four products in vitro were statistically significantly reduced when compared to medium control alone. Discussion The data from the four elements of the comprehensive safety assessment approach illustrated herein confirm that tampons evaluated using this system can be used safely for menstrual protection. A post-marketing surveillance system that monitors and responds to in-market experiences indicated in-use tolerability of the product among consumers, thus confirming the conclusions of the pre-marketing safety assessment.
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Affiliation(s)
| | - Joan M. Abbinante-Nissen
- Baby, Feminine and Family Care, Global Product Stewardship, The Procter & Gamble Company, Cincinnati, OH, United States
| | - Lisa C. Bohman
- Data Modeling and Sciences, The Procter & Gamble Company, Mason, OH, United States
| | - Anne M. Hattersley
- Global Safety Surveillance and Analysis, The Procter & Gamble Company, Mason, OH, United States
| | - Ping Hu
- Corporate Biosciences, The Procter & Gamble Company, Mason, OH, United States
| | - Jan L. Streicher-Scott
- Baby, Feminine and Family Care Clinical Sciences, The Procter & Gamble Company, Cincinnati, OH, United States
| | - Amber G. Teufel
- Baby, Feminine and Family Care Microbiology, The Procter & Gamble Company, Cincinnati, OH, United States
| | - Kara E. Woeller
- Baby, Feminine and Family Care, Global Product Stewardship, The Procter & Gamble Company, Cincinnati, OH, United States
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Krause EL, Hattersley AM, Abbinante-Nissen JM, Gutshall D, Woeller KE. Support of adult urinary incontinence products: recommendations to assure safety and regulatory compliance through application of a risk assessment framework. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1175627. [PMID: 37361342 PMCID: PMC10285159 DOI: 10.3389/frph.2023.1175627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/15/2023] [Indexed: 06/28/2023] Open
Abstract
Urinary incontinence (UI) or involuntary loss of urine is a common chronic medical condition among women. It is estimated that 5%-70% of the population experiences incontinence with most studies suggesting 25%-45% of the population. Varying definitions of UI (e.g., stress, urgency, mixed) exist, and inconsistent symptom assessment tools, age, and gender can affect the estimate of incidence. Disposable Adult Incontinence products were first introduced into the market in the late 1970s and initially were used mostly in nursing homes and hospitals. However, during the 1980s, the market for incontinence products via retail outlets dramatically increased as awareness of the benefits of the products grew and stigma about their use declined. Today's products that manage urine loss have an extensive history and have evolved with time. Always products were introduced into the market in 2014 and are designed to meet the needs of women of all ages. Considered medical devices in some countries, regional regulations and global guidelines require clear planning, thorough assessment, and concise documentation of clinical safety. This manuscript will briefly review the regulatory landscape with a specific focus on European Union regulations. As previously published, the iterative, risk assessment framework used to assess the safety of Always incontinence products confirms that these products are compatible with skin and can be used safely. This manuscript will expand on the current literature highlighting additional steps that help assure the safety and compliance of the products from quality assurance programs through comprehensive post-market safety surveillance. Recommendations to help ensure several of the key regulatory requirements are met are outlined in the context of a risk assessment framework used to assure safety.
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Affiliation(s)
- Edburga L. Krause
- Baby, Feminine and Family Care, Global Product Stewardship, The Procter & Gamble Company, Schwalbach, Germany
| | - Anne M. Hattersley
- Global Safety Surveillance and Analysis, The Procter & Gamble Company, Mason, OH, United States
| | - Joan M. Abbinante-Nissen
- Baby, Feminine and Family Care, Global Product Stewardship, The Procter & Gamble Company, Cincinnati, OH, United States
| | - Denise Gutshall
- Baby, Feminine and Family Care, Global Product Stewardship, The Procter & Gamble Company, Cincinnati, OH, United States
| | - Kara E. Woeller
- Baby, Feminine and Family Care, Global Product Stewardship, The Procter & Gamble Company, Cincinnati, OH, United States
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Lindsay C, Wolfe L, Ductan C, LeBlanc K. The Influence of Absorbent Products on Skin Integrity: A Scoping Review. J Wound Ostomy Continence Nurs 2023; 50:151-160. [PMID: 36867039 DOI: 10.1097/won.0000000000000957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PURPOSE Absorbent products are commonly used to absorb urine and fecal matter and to mitigate potential skin complications such as incontinence-associated dermatitis (IAD). Evidence concerning the effect these products have on skin integrity is limited. This scoping review aimed to explore the evidence/literature on the effect of absorbent containment products on skin integrity. METHOD A scoping literature review. SEARCH STRATEGY The electronic databases CINAHL, Embase, MEDLINE, and Scopus were searched for published articles between 2014 and 2019. Inclusion criteria were studies that focused on urinary and/or fecal incontinence, use of incontinent absorbent containment products, impact on skin integrity, and published in English. The search identified a total of 441 articles that were identified for the title and abstract review. FINDINGS Twelve studies met inclusion criteria and were included in the review. Variability in the study designs did not allow firm conclusions regarding which absorbent products contributed to or prevented IAD. Specifically, we found variations in assessment of IAD, study settings, and types of products used. IMPLICATIONS There is insufficient evidence to support the effectiveness of one product category over another for maintaining skin integrity in persons with urinary or fecal incontinence. This paucity of evidence illustrates the need for standardized terminology, a widely used instrument for assessment of IAD, and identification of a standard absorbent product. Additional research using both in vitro and in vivo models, along with real-world clinical studies, is needed to enhance current knowledge and evidence of the impact of absorbent products on skin integrity.
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Affiliation(s)
- Carly Lindsay
- Carly Lindsay, RN, BNSc, MClSc-WH, NSWOC, WOCC(C), Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
- Lauren Wolfe, RN, BSN, MClSc-WH, NSWOC, CWOCN, Vancouver Coastal Health, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Charline Ductan, RN, BScN, MClSc-WH, CGN(C), Sunnybrook St. Michael's Hospital - Unity Health, Toronto, Ontario, Canada
- Kimberly LeBlanc, PhD, RN, NSWOC, WOCC (C), FCAN, Academic Chair, Wound, Ostomy and Continence Institute; Association of Nurses Specialized in Wound, Ostomy and Continence Canada; Advanced Practice Nurse, KDS Professional Consulting; Adjunct Professor, Faculty of Health Sciences, Western University; Affiliate Faculty, Ingram School of Nursing; Faculty of Medicine, McGill University, Orléans, Ontario, Canada and Honorary Senior Lecturer, School of Medicine, Cardiff University, Wales, United Kingdom
| | - Lauren Wolfe
- Carly Lindsay, RN, BNSc, MClSc-WH, NSWOC, WOCC(C), Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
- Lauren Wolfe, RN, BSN, MClSc-WH, NSWOC, CWOCN, Vancouver Coastal Health, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Charline Ductan, RN, BScN, MClSc-WH, CGN(C), Sunnybrook St. Michael's Hospital - Unity Health, Toronto, Ontario, Canada
- Kimberly LeBlanc, PhD, RN, NSWOC, WOCC (C), FCAN, Academic Chair, Wound, Ostomy and Continence Institute; Association of Nurses Specialized in Wound, Ostomy and Continence Canada; Advanced Practice Nurse, KDS Professional Consulting; Adjunct Professor, Faculty of Health Sciences, Western University; Affiliate Faculty, Ingram School of Nursing; Faculty of Medicine, McGill University, Orléans, Ontario, Canada and Honorary Senior Lecturer, School of Medicine, Cardiff University, Wales, United Kingdom
| | - Charline Ductan
- Carly Lindsay, RN, BNSc, MClSc-WH, NSWOC, WOCC(C), Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
- Lauren Wolfe, RN, BSN, MClSc-WH, NSWOC, CWOCN, Vancouver Coastal Health, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Charline Ductan, RN, BScN, MClSc-WH, CGN(C), Sunnybrook St. Michael's Hospital - Unity Health, Toronto, Ontario, Canada
- Kimberly LeBlanc, PhD, RN, NSWOC, WOCC (C), FCAN, Academic Chair, Wound, Ostomy and Continence Institute; Association of Nurses Specialized in Wound, Ostomy and Continence Canada; Advanced Practice Nurse, KDS Professional Consulting; Adjunct Professor, Faculty of Health Sciences, Western University; Affiliate Faculty, Ingram School of Nursing; Faculty of Medicine, McGill University, Orléans, Ontario, Canada and Honorary Senior Lecturer, School of Medicine, Cardiff University, Wales, United Kingdom
| | - Kimberly LeBlanc
- Carly Lindsay, RN, BNSc, MClSc-WH, NSWOC, WOCC(C), Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
- Lauren Wolfe, RN, BSN, MClSc-WH, NSWOC, CWOCN, Vancouver Coastal Health, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Charline Ductan, RN, BScN, MClSc-WH, CGN(C), Sunnybrook St. Michael's Hospital - Unity Health, Toronto, Ontario, Canada
- Kimberly LeBlanc, PhD, RN, NSWOC, WOCC (C), FCAN, Academic Chair, Wound, Ostomy and Continence Institute; Association of Nurses Specialized in Wound, Ostomy and Continence Canada; Advanced Practice Nurse, KDS Professional Consulting; Adjunct Professor, Faculty of Health Sciences, Western University; Affiliate Faculty, Ingram School of Nursing; Faculty of Medicine, McGill University, Orléans, Ontario, Canada and Honorary Senior Lecturer, School of Medicine, Cardiff University, Wales, United Kingdom
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