Delivering Value Through Prevention: Female External Catheter Improves Patient Outcomes and Reduces Cost at University Hospitals of Leicester

The Challenge

University Hospitals of Leicester NHS Trust (UHL), one of the largest NHS trusts in England, identified a gap in continence care for female patients. While male patients benefit from external urinary devices, options for females are limited to absorbent pads. UHL Continence Service noted that this disparity creates health inequalities and exposes female patients to significant risks.

Moisture-Associated Skin Damage (MASD)¹ refers to skin breakdown caused by prolonged exposure to moisture, such as urine or sweat. A key subset of MASD is Incontinence-Associated Dermatitis (IAD) – a painful condition where skin becomes inflamed and damaged due to contact with urine. IAD is not only distressing for patients but also increases the likelihood of secondary complications, including:

• Pressure injuries due to compromised skin integrity. 
• Catheter-associated urinary tract infections (CAUTIs) when indwelling catheters are used as an alternative. 
• Extended hospital stays and higher treatment costs.

Evidence shows that patients treated for IAD incur an average of 3.3 additional bed days², costing approximately £1,761 per case³. Beyond financial impact, these complications reduce patient dignity, comfort, and quality of life – key outcomes that Value Based Procurement (VBP) seeks to improve.

Enquire Now About the PurewickTM Female External Catheter (FEC)

Complete our two minute enquiry form and your regional Care Pathway Specialist or Clinical Care Pathway Manager will respond with further details.

• Improve patient safety by reducing complications caused by moisture exposure, such as MASD and IAD.
• Introduce an effective, non-invasive urine management solution specifically for female patients.
• Help tackle health inequalities by providing better access to innovative care solutions.
• Enhance patient comfort and overall quality of life during treatment. 

The Purewick^TM Female External Catheter (FEC) was selected by UHL for evaluation. Key features include the following:

Non-invasive, dignity-preserving design
Positioned externally between the labia, the Purewick^TM Female External Catheter avoids surgical insertion and adhesives. This makes application simple for staff and more comfortable for patients, helping maintain dignity and reduce stress.

Continuous low-pressure suction for moisture control
The device gently wicks urine away into a collection canister, keeping skin dry and reducing the risk of MASD and IAD. This supports better patient outcomes and helps to prevent complications that can extend hospital stays.

Adhesive-free fit for comfort and skin protection
With no tapes or adhesives required, the device minimises friction and pressure on sensitive skin. This makes it ideal for patients at risk of pressure injuries or those with fragile skin, ensuring safer, more comfortable care.

The benefits are:

• Helps maintain skin health by drawing urine away from the body and into a secure collection system, keeping skin dry and reducing risk of irritation.
• Reduces night-time bathroom visits⁴ and risk of fall, supporting patient safety and comfort.
• Can be used while lying down or seated, making it suitable for patients with limited mobility.

HSJ Partnership Awards 2026 Nominee

This product has been nominated in the ‘Most Impactful Project Addressing Health Inequalities’ category, as part of the Health Service Journal (HSJ) awards.

Introducing an FEC required a shift from traditional continence management practices – historically, all female patients relied on adsorbent pads or indwelling catheters, which often led to skin complications and increased infection risk.

To support this pilot, University Hospitals of Leicester selected two wards with a high proportion of female patients experiencing continence issues.

What changed operationally for the trust?

Staff training and support
Nursing teams received face-to-face training from the supplier’s clinical specialists. This included guidance on assessing patient suitability, updating care plans, and applying new inclusion criteria. Training was streamlined, taking around 20 minutes per staff member, and supported by videos and written materials for easy reference.

New care pathways
Care plans were updated to incorporate FEC as an option alongside existing methods. This gave staff a structured approach to selecting the most appropriate solution for each patient, reducing reliance on pads and invasive catheters.

Data-driven monitoring
The evaluation ran from April 2024 to September 2024, during this period 45 female patients used FEC. To measure impact, baseline data on IAD was collected for the previous six months, and monthly monitoring of MASD was introduced. This ensured the pilot was evidence-based and aligned with VBP principles.

• Pre-evaluation: 798 female patients admitted; 43 cases of IAD.
• Evaluation period: 885 female patients admitted; 3 cases of IAD (a 93% reduction overall).
• Of these 885 patients, 45 met the criteria to use the FEC, and none of these 45 developed IAD.

Currently, FEC is not listed on the FP10 Drug Tariff, meaning patients cannot continue its use in primary care unless purchased privately.

We are currently working with services on a delivery to community clinics offer, with the view of reviewing our Home Delivery Service to bridge this gap. For further information on this please contact us:

Urology Team

urology@supplychain.nhs.uk

Enquire Now About the PurewickTM Female External Catheter (FEC)

Complete our two minute enquiry form and your regional Care Pathway Specialist or Clinical Care Pathway Manager will respond with further details.

1. [1] Fan S et al. Risk factors of incontinence-associated dermatitis in older adults. BMJ Open 2023. [https://bmjopen.bmj.com/content/13/e078375]; Kayser S et al. Incontinence and Incontinence-Associated Dermatitis in Acute Care. J Wound Ostomy Continence Nurs. 2021; Beeckman D. Proceedings of the Global IAD Expert Panel. Wounds International 2015 [https://woundsinternational.com/].
2. Kayser S, Koloms K, Murray A, Khawar W, Gray M. Incontinence and Incontinence-Associated Dermatitis in Acute Care: A Retrospective Analysis of Total Cost of Care and Patient Outcomes From the Premier Healthcare Database. J Wound Ostomy Continence Nurs. 2021;48(6):545-552.
3. The cost of each incident of IAD is provided by (Kayser et al., 2021), who estimate a cost of $5,851 per case of IAD. Converting to pound values using the average exchange rate of US dollars to UK pounds in 2021 and adjusting for inflation to 2023 prices gives £4,758.44.
4. Oliver D, Daly F, Martin FC, McMurdo ME. Risk factors and risk assessment tools for falls in hospital in-patients: a systematic review. Age Ageing. 2004;33(2):122-30; López-Soto PJ, Manfredini R, Smolensky MH, Rodríguez-Borrego MA. 24-hour pattern of falls in hospitalized and long-term care institutionalized elderly persons: A systematic review. Chronobiol Int. 2015;32(4):548-56; Roberts M. Patient falls while under supervision: trends from incident reporting. British Journal of Nursing, 2023, Vol 32, No 11: 508-513; NHS Improvement. Preventing healthcare-associated Gram-negative bloodstream infections: an improvement resource. 2017 [https://www.nric.org.uk/node/54125]; NICE. Falls in older people: assessing risk and prevention. Clinical guideline [CG161] 2013 [https://www.nice.org.uk/guidance/cg161/chapter/introduction]   
5. Kayser S, Koloms K, Murray A, Khawar W, Gray M. Incontinence and Incontinence-Associated Dermatitis in Acute Care: A Retrospective Analysis of Total Cost of Care and Patient Outcomes From the Premier Healthcare Database. J Wound Ostomy Continence Nurs. 2021;48(6):545-552.