An Ottawa long-term care home was logging a steady run of family complaints about overnight leaks, even though the supply room was stocked and staff were changing residents on a posted schedule. When the care director walked the routine from the 11 p.m. check through morning care, no single breakdown explained the pattern. Instead the review found a stack of small mismatches — the wrong absorbency rating on the wrong shift, briefs sized by habit, underpads laid edge-to-edge, and change times set by the clock.
This is a composite of several Ontario facilities, so read the figures as a typical pattern rather than one site's results. The corrective steps recur whenever a home rebuilds its LTC incontinence supplies program from the supply room outward.
Start with the complaint pattern, not the product
The first instinct was to blame the briefs. That is rarely where the problem starts or ends. Families described soaked sheets, residents waking cold, and a smell that lingered after morning care. Two residents were named repeatedly; the rest of the complaints were spread thinly across a 32-bed unit — the tell that a system is drifting rather than one person failing.
What the audit actually covered
A three-part review worked better than a product swap, and it pairs well with the LTC point-of-care PPE checklist:
- Product audit: every brief, pull-up, and underpad on the unit, sorted by absorbency, size, and actual use.
- Fit check: waist and hip measurements for the residents named in complaints, and where the elastics landed.
- Routine timing: when the last change happened, when the resident was repositioned, and how long the product had to hold.
Finding 1: a 3,000 mL daytime product was used overnight
The stockroom carried a mid-range pull-up rated at roughly 3,000 mL and a 5,000 mL overnight brief. The 3,000 mL product is a sound daytime choice for a heavy daytime pattern with frequent checks. It had been assigned to overnight care by default, because night staff reached for the nearer of two products on the same shelf. A resident repositioned once between 9 p.m. and 6 a.m. needs a core built for a long unsupervised stretch, and a six-hour daytime product is the wrong tool for a nine-hour night.
How an absorbency rating in millilitres is measured
The number printed on the bag is not a promise about a single wear. It comes from whole-product lab testing, broadly along the lines of the ISO 11948-1 test method for urine-absorbing aids: the product is loaded with test fluid and total capacity is recorded. Working capacity is lower than total capacity, so a product is changed well before it reaches its lab number. Capacity is also spread unevenly — the SAP core in the centre holds the great majority, while side panels and leg cuffs hold very little. A rating that looks generous can still leak at the leg opening once the core is loaded.
Briefs are built around a superabsorbent polymer (SAP) core blended with fluff pulp: the SAP locks fluid into a gel, and the pulp gives the core its shape and wicking path. A 5,000 mL overnight brief carries more SAP and a longer core than a 2,000 mL daytime product, so it sits differently and costs more per piece. Matching the rating to the shift costs less than using the highest-capacity brief everywhere.
Pull-up or tab brief: the format has to match the resident
A pull-up (protective underwear) suits residents who can stand, bear weight, and take part in dressing; it goes on like underwear and supports a toileting plan. A tab-style brief opens flat, is applied while the resident lies on one side, and can be adjusted without a full undress. For someone repositioned in bed overnight, the tab brief is the more workable format. Our walkthrough of adult diapers vs underpads by care scenario covers that decision.
Finding 2: sizing was done by habit, not measurement
Two of the named residents were in the size that matched the old stock label, not their current body. Weight loss and reduced mobility move the waist and hip, and a product one size off behaves badly: too large, and the leg cuffs gap and fluid escapes before the core can catch it; too small, and the tabs pull and staff loosen the fit for comfort. The correction was a measured waist and hip for each flagged resident and a care-plan note so the next order did not drift back.
Finding 3: underpads were laid edge-to-edge, not overlapped
The unit was using a single 60 x 90 cm underpad centred under the hips. When the resident turned side to side, the pad edge travelled with them and the sheet underneath took the overflow. Format matters as much as count: a 30 x 36 in pad covers a wider surface and leaves an overlap margin, which is what a turning or sliding resident needs. The fix was to overlap the pad layer so coverage follows the turning zone.
| Underpad format | Coverage | Where it fits |
|---|---|---|
| 60 x 90 cm | Central bed area under the hips | Moderate overnight use; frequent changes |
| 30 x 36 in | Wider area with overlap margin | Heavier overnight use; turning residents |
One view of severity, format, and rating
The four findings collapse into one mapping. Ratings below are typical Canadian ranges; confirm the figure on the bag, since labelling varies by manufacturer.
| Leakage pattern | Recommended format | Absorbency rating | Wear window |
|---|---|---|---|
| Light, occasional leakage; resident toilets with assistance | Light pull-up or shaped liner | 200–500 mL | 3–4 h, daytime |
| Moderate daytime, ambulatory with a toileting plan | Pull-up (protective underwear) | 800–1,500 mL | 4–6 h, daytime |
| Heavy daytime or moderate overnight, limited mobility | High-absorbency pull-up or tab brief | 2,000–3,500 mL | 6–8 h |
| Heavy overnight, bed-based care | Tab brief plus 60 x 90 cm underpad | 4,000–5,000 mL | Overnight check; commonly 8 h |
Finding 4: change times were set by the clock
The posted schedule said every two hours overnight. The log showed gaps of four to five hours, because two residents were heavy and slow to change and the round ran long. The schedule had been written for an average resident who did not exist. The revised routine put those two residents first and tied checks to evening fluid intake rather than a fixed clock. Nothing about that required more staff hours; it required the round order to match the workload.
Quick Facts
- Check the millilitre figure against the shift, not the resident's label; daytime ratings used overnight are a common mismatch.
- Total absorbency is a lab number, not a wear time, and the core does most of the holding.
- Pull-ups suit residents who stand and toilet; tab briefs suit bed-based care.
- Underpads need overlap — a single 60 x 90 cm pad moves with a resident who turns.
- Measure size at every review; weight and mobility change faster than reorder cycles.
What the home saw by the 90-day mark
Rechecking the complaint log, the unit recorded a clear drop in overnight leak complaints, with most remaining reports traced to two residents whose needs had shifted again. Supply cost per resident did not rise: the home moved the 5,000 mL product to the residents and shifts that needed it and kept the mid-range pull-ups in daytime use. If you are benchmarking that mix, our summary of what Canadian LTC homes spend on incontinence supplies in 2026 gives a starting range.
No clinical protocol is implied here, and no single product change removes every leak. The pattern worth copying is the sequence: audit the product, measure the fit, fix the pad layer, then rebuild the round.
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Related Reading
- LTC point-of-care PPE checklist
- Adult diapers vs underpads by care scenario
- What Canadian LTC homes spend on incontinence supplies in 2026
- CliniEco Learning Hub
- free sterilization log tool
- long-term care supplies
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Frequently asked questions
What does the absorbency rating on a brief actually measure?
It reflects whole-product lab testing, broadly along the lines of the ISO 11948-1 method for urine-absorbing aids: the product is loaded with test fluid and total capacity is measured. It is a comparison figure between products, not a wear time, and working capacity sits below the printed total.
When should a facility choose tab briefs over pull-ups?
Pull-ups (protective underwear) suit residents who can stand, bear weight, and take part in toileting and dressing. Tab-style briefs open flat, are applied during side-lying care, and can be adjusted without a full undress — the practical format for bed-based residents and higher overnight ratings.
What is the difference between a 60 x 90 cm and a 30 x 36 in underpad?
Coverage. A 60 x 90 cm underpad protects the central bed area under the hips and suits moderate overnight use. A 30 x 36 in pad covers a wider area and leaves an overlap margin, which helps when a resident turns or slides.
Does a higher millilitre rating always mean fewer leaks?
No. Capacity has to match the shift, the fit, and the pad layer. A 5,000 mL brief that is a size too large, worn longer than its core can hold, or paired with a single centred underpad can still leak at the leg opening.
How often should incontinence products be re-sized for a resident?
Re-measure at every care conference and after any notable change in weight, mobility, or continence pattern, and note the size in the care plan so reorders follow the resident.
Related supplies for this workflow: 60x90 cm 5-Layer Underpads with SAP (50-Pack) is stocked in our Ontario warehouse and ships across Canada.
Last updated: September 2026. CliniEco Medical is a licensed medical device establishment (MDEL #35334).
An overnight routine starts with the product that carries the night: CliniEco Night Plus overnight adult incontinence briefs, 5,000 mL, 60-pack. Pair it with the right underpad layer, then browse the CliniEco Learning Hub for scenario-by-scenario guidance on adult diapers in Canada and LTC incontinence supplies.
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