1
|
Wang G, Wang X, Wang H, Wang L, Li W. Risk Factors for Incontinence-Associated Dermatitis in Critically Ill Patients with Incontinence: A Systematic Review and Meta-analysis. J Wound Ostomy Continence Nurs 2024; 51:313-323. [PMID: 39037164 DOI: 10.1097/won.0000000000001090] [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: 07/23/2024]
Abstract
PURPOSE This systematic review analyzed evidence related to risk factors for Incontinence Associated Dermatitis (IAD) in critically ill incontinent patients. METHOD Systematic review and meta-analysis. SEARCH STRATEGY Eight databases, including PubMed, Embase, CINAHL, Cochrane Library, and Web of Science, were searched for studies published in the English language. The China National Knowledge Infrastructure, WanFang Data, and Chinese Scientific Journal Database were also searched for studies evaluating risk of IAD in critically ill incontinent patients published in the Chinese language. FINDINGS Twenty-four studies with moderate-to-high methodological quality were included. Significant risk factors for developing IAD were being older [odds ratio (OR) = 1.06, 95% confidence interval (CI): 1.02-1.10, P = .007], fever (OR = 2.57, 95% CI: 1.87-3.57, P < .00001), diagnosed with consciousness disorder (OR = 5.70, 95% CI: 2.28-14.22, P = .0002), having higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR = 1.71, 95% CI: 1.25-2.35, P = .0009), lower Braden score (OR = 0.73, 95% CI: 0.56-0.96, P = .02), lower oxygen saturation (OR = 2.76, 95% CI: 1.52-5.00, P = .0008), double incontinence (OR = 4.10, 95% CI: 2.34-7.17, P < .00001), liquid stool (OR = 6.55, 95% CI: 4.12-10.41, P < .00001), frequent incontinence (OR = 1.21, 95% CI: 1.03-1.43, P = .02), and higher perineal assessment tool (PAT) score (OR = 3.18, 95% CI: 1.76-5.76, P = .0001). IMPLICATIONS Findings of this systematic review and meta-analysis suggest that healthcare providers should consider risk factors such as older age, fever, consciousness disorder, higher APACHE II score, lower Braden score and double incontinence matter when developing strategies for the prevention and management of IAD in critically ill incontinent patients.
Collapse
Affiliation(s)
- Guandong Wang
- Guandong Wang, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Xueying Wang, The College of Nursing and Health of Zhengzhou University, Zhengzhou, Henan, China
- Haibo Wang, BS, Head nurse, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Liang Wang, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Wenjuan Li, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Xueying Wang
- Guandong Wang, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Xueying Wang, The College of Nursing and Health of Zhengzhou University, Zhengzhou, Henan, China
- Haibo Wang, BS, Head nurse, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Liang Wang, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Wenjuan Li, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Haibo Wang
- Guandong Wang, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Xueying Wang, The College of Nursing and Health of Zhengzhou University, Zhengzhou, Henan, China
- Haibo Wang, BS, Head nurse, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Liang Wang, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Wenjuan Li, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Liang Wang
- Guandong Wang, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Xueying Wang, The College of Nursing and Health of Zhengzhou University, Zhengzhou, Henan, China
- Haibo Wang, BS, Head nurse, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Liang Wang, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Wenjuan Li, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Wenjuan Li
- Guandong Wang, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Xueying Wang, The College of Nursing and Health of Zhengzhou University, Zhengzhou, Henan, China
- Haibo Wang, BS, Head nurse, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Liang Wang, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Wenjuan Li, Department of Respiratory and Critical Care Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| |
Collapse
|
2
|
Sanaeifar N, Vechter O, Limam D, Kesselmeier R, Maurer T. Usability assessment of the MoliCare absorbent continence products by nursing specialists. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S18-S24. [PMID: 37830861 DOI: 10.12968/bjon.2023.32.18.s18] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Incontinence is a common disorder among older adults with a higher prevalence in nursing home settings than in community dwellings. There is a wide variety of absorbent continence products on the market used to manage continence. AIM The study aimed to investigate the experience of caregivers of residents with incontinence in care home settings using the new MoliCare Premium Form design and to compare some of the product features with the previous design. METHOD A questionnaire focusing on the key performance characteristics of the product was developed and administered to 74 nurses in Germany to obtain their opinions on the use of MoliCare Premium Form products. FINDINGS More than 90% of respondents rated each key performance aspect of the new product design as 'good' and 'OK'. More than 60% of the caregivers found the new product design to be better performing and 93% preferred the new design to the previous version. CONCLUSION The newly redesigned continence pad performed very well on each of the individual performance features, indicating the high quality and optimised design of the product. The new design was found to be suitable and effective for individuals with incontinence.
Collapse
Affiliation(s)
- Niuosha Sanaeifar
- Manager Clinical Application Studies, Paul Hartmann AG, Heidenheim, Germany
| | - Olga Vechter
- Global Senior Manager Product Development, Paul Hartmann AG, Heidenheim, Germany
| | - Deniz Limam
- Global Senior Manager Product Marketing, Paul Hartmann AG, Heidenheim, Germany
| | - Rüdiger Kesselmeier
- Global Vice President Product & Solution Innovations, Paul Hartmann AG, Heidenheim, Germany
| | | |
Collapse
|
3
|
Conceptual Framework for Incontinence-Associated Dermatitis Based on Scoping Review and Expert Consensus Process. J Wound Ostomy Continence Nurs 2021; 48:239-250. [PMID: 33951713 DOI: 10.1097/won.0000000000000754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Incontinence-associated dermatitis (IAD) has been studied over the last decades, but gaps in the knowledge related to its identification, etiological agents, and risk factors remain. We carried out a scoping review about IAD that included systematic reviews, experimental, and observational studies about IAD and its potential risk factors. We retrieved 24 articles that described 100 potential risk factors and which were synthesized by the authors and proposed to a panel of experts. Panelists used a structured process of consensus development to create a conceptual framework of factors associated with IAD. This framework proposes that liquid fecal material, when combined with exposure to urine and stool, and bacterial contaminated urine are etiological factors for development of IAD. The framework also proposes 2 pathophysiological mechanisms and 8 main risk factors for IAD development. The proposed model could improve the quality of care for patients with or at risk of IAD, assisting healthcare professionals to identify at-risk patients, diagnose the type of lesion, and establish adequate and effective prevention and treatment measures.
Collapse
|
4
|
Koudounas S, Bader DL, Voegeli D. Investigating the release of inflammatory cytokines in a human model of incontinence-associated dermatitis. J Tissue Viability 2021; 30:427-433. [PMID: 34144890 DOI: 10.1016/j.jtv.2021.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/25/2021] [Accepted: 06/07/2021] [Indexed: 11/26/2022]
Abstract
Incontinence-associated dermatitis (IAD) is a painful complication in elderly patients, leading to reduced quality of life. Despite recent attention, its underlying inflammatory mechanisms remain poorly understood. This study was designed to quantify the release of inflammatory cytokines in a human model of IAD. The left volar forearm of ten healthy volunteers was exposed to synthetic urine and synthetic faeces for 2 h, simulating the effects of urinary and faecal incontinence, respectively, and the subsequent cytokine response compared to that of an untreated control site. Inflammatory cytokines were collected using both the Sebutape® absorption method and dermal microdialysis and quantified using immunoassays. Results from the former demonstrated an upregulation in IL-1α, IL-1RA and TNF-α. Synthetic urine caused a higher median increase in IL-1α from baseline compared to synthetic faeces, whereas synthetic faeces were associated with significantly higher median TNF-α levels compared to synthetic urine (p = 0.01). An increase in IL-1α/IL-1RA ratio was also observed with significant differences evident following exposure to synthetic urine (p = 0.047). Additionally, microdialysis revealed a time-dependent increase in IL-1β and IL-8 following exposure of up to 120 min to synthetic urine and synthetic faeces, respectively. This study demonstrated the suitability of both sampling approaches to recover quantifiable cytokine levels in biofluids for the assessment of skin status following exposure to synthetic fluids associated with incontinence. Findings suggest some differences in the inflammatory mechanisms of IAD, depending on moisture source, and the potential of the cytokines, IL-1α and TNF-α, as responsive markers of early skin damage caused by incontinence.
Collapse
Affiliation(s)
- Sofoklis Koudounas
- Skin Health Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, SO16 6YD, UK.
| | - Dan L Bader
- Skin Health Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, SO16 6YD, UK.
| | - David Voegeli
- Faculty Health & Wellbeing, University of Winchester, Winchester, SO22 4NR, UK.
| |
Collapse
|
5
|
Konya I, Shishido I, Ito YM, Yano R. Combination of minimum wiping pressure and number of wipings that can remove pseudo-skin dirt: A digital image color analysis. Skin Res Technol 2020; 26:639-647. [PMID: 32180266 DOI: 10.1111/srt.12844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 02/29/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Excessive wiping friction in skin care may lead to skin damage. Bed baths are required to remove skin dirt without affecting the skin barrier function; the wiping pressure and number of wipings that satisfy these two requirements have not been clarified. This study aimed to determine the minimum wiping pressure and number of wipings that can remove skin dirt. MATERIALS AND METHODS In this quasi-experimental study, 50 healthy adults received an adhesion of pseudo-oily and aqueous dirt, randomly assigned to the left and right forearms. Each participant was wiped three times with wiping pressure classified into six randomly assigned categories. The dirt removal rate was calculated by color-analyzing images captured before and after each wiping, and its dependence on the combination of wiping pressure and number of wipings was assessed using a linear mixed model. RESULTS The combinations achieving oily dirt removal rates of 80% or more were wiping once and pressure ≥50 mmHg, wiping twice and pressure ≥40 mmHg, and wiping thrice and pressure ≥10 mmHg. Aqueous dirt was removed almost completely by wiping once, even with pressure ≥5 mmHg. CONCLUSION Wiping with at least 10 mmHg or more three times can sufficiently remove both oily and aqueous dirt. Dirt removal rates with weak pressure can be made about as effective as those achieved with strong pressure by increasing the number of wipings. This result can be applied to daily nursing, home care, and long-term care health facilities.
Collapse
Affiliation(s)
- Issei Konya
- Graduate School of Health Sciences, Hokkaido University, Hokkaido, Japan
| | - Inaho Shishido
- Graduate School of Health Sciences, Hokkaido University, Hokkaido, Japan
| | - Yoichi M Ito
- Research Center for Medical and Health Data Science, Institute of Statistical Mathematics, Tokyo, Japan
| | - Rika Yano
- Faculty of Health Sciences, Hokkaido University, Hokkaido, Japan
| |
Collapse
|
6
|
Konya I, Yamaguchi S, Sugimura N, Matsuno C, Yano R. Effects of differences in wiping pressure applied by nurses during daily bed baths on skin barrier function, cleanliness, and subjective evaluations. Jpn J Nurs Sci 2020; 17:e12316. [PMID: 31943810 DOI: 10.1111/jjns.12316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/03/2019] [Accepted: 12/04/2019] [Indexed: 11/28/2022]
Abstract
AIM To clarify the actual condition and examine the effects of differences in wiping pressure applied by clinical nurses during daily bed baths on skin barrier function, cleanliness, and subjective evaluations. METHODS For the purposes of the present quasi-experimental interventional study, "wiping pressure" was defined as the "force applied vertically to the skin surface during bed baths." Two types of bed baths, one using ordinary wiping (pressure: 23-25 mmHg) and the other using weak wiping (pressure: 12-14 mmHg), were performed on the forearms (right and left) of 30 healthy adult men and women, and the effects on transepidermal water loss, stratum corneum hydration, cleanliness, and subjective evaluations were examined. RESULTS The results showed no differences between ordinary and weak wiping pressure in regard to the effects on skin barrier function and cleanliness. In terms of subjective evaluations, a significant association was seen between wiping pressure and the "sensation of having dirt removed" (P = .036). Regarding "degree of pain," some participants reported that the wiping pressure felt "slightly painful" under both conditions (ordinary: 31.1%; weak: 10.7%), while some with sensitive skin reported feeling pain even during weak wiping pressure. CONCLUSIONS The results of the present study suggest that skin assessments should be performed before and after bed baths, and that wiping pressure should be controlled and evaluated while considering the patient's feelings.
Collapse
Affiliation(s)
- Issei Konya
- Graduate School of Health Sciences, Hokkaido University, Hokkaido, Japan
| | - Shinya Yamaguchi
- Graduate School of Health Sciences, Hokkaido University, Hokkaido, Japan
| | - Naotaka Sugimura
- Graduate School of Health Sciences, Hokkaido University, Hokkaido, Japan
| | | | - Rika Yano
- Faculty of Health Sciences, Hokkaido University, Hokkaido, Japan
| |
Collapse
|
7
|
Ferreira M, Abbade L, Bocchi SCM, Miot HA, Boas PV, Guimaraes HQCP. Incontinence-associated dermatitis in elderly patients: prevalence and risk factors. Rev Bras Enferm 2020; 73 Suppl 3:e20180475. [DOI: 10.1590/0034-7167-2018-0475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/23/2018] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To determine the prevalence and risk factors for incontinence-associated dermatitis in the elderly. Method: Cross-sectional exploratory study carried out in public hospitals. The dermatitis prevalence and associations were obtained by calculating the ratio. The effect dimension was estimated by the odds ratio with a 95% confidence interval and statistical significance p <0.05. Results: 138 elderly people were included, with an average age of 77.2 years old (± 9.3); 69 (50%) had combined fecal and urinary incontinence. The dermatitis prevalence was 36.2% (50); 28% (14) had pressure injuries; 14% (7), candidiasis. Risk factors were: longer hospital stay (Odds Ratio = 5.8 [2.6-12.9]), obesity (Odds Ratio = 3.6 [1.2-10.4]), high level of dependence (Odds Ratio = 2.4 [1,1-5,0]) and high risk for pressure injury (Odds Ratio = 6.1 [1,4-26,9]). Conclusion: The study found a high prevalence of dermatitis associated with incontinence. The early recognition of risk factors favors effective preventive actions.
Collapse
|
8
|
Bebiş H, Moorhead S, Gençbaş D, Özdemir S, Seven M. NOC/NIC Linkages to NANDA-I for Continence Care of Elderly People with Urinary Incontinence in Nursing Homes: A Systematic Review. Florence Nightingale Hemsire Derg 2019; 27:284-303. [PMID: 34267982 DOI: 10.26650/fnjn386150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/17/2019] [Indexed: 11/20/2022] Open
Abstract
Aim The aim of this study was to review interventional studies conducted by nurses about elderly people with urinary incontinence in nursing homes and to match the results to standardized nursing terminology using the Nursing Interventions Classification and the Nursing Outcomes Classification Linkages to the NANDA-I diagnoses guidelines. Method A systematic review of quantitative intervention studies was conducted using the PRISMA statement as a guide. The interventional research in English was scanned using the MEDLINE and CINAHL databases from January 2005 to May 2015. Fourteen studies that had at least one nurse researcher were conducted in nursing homes, excluding surgical and pharmacological interventions. The Nursing Outcome Classification and Nursing Intervention Classification Linkages to NANDA-I diagnoses and the Clinical Conditions Part II-U List were used as a guide to select North American Nursing Diagnosis Association International nursing diagnoses, Nursing Outcome Classification Scales, and Nursing Interventions from the data. Results We found the frequency of use of various NANDA-I diagnoses, Nursing Interventions, and Nursing Outcomes based on the Nursing Outcomes Classification and Nursing Interventions Classification Linkages to NANDA-I diagnoses and the Clinical Conditions List for incontinence. Conclusion Using the Nursing Outcomes Classification and Nursing Interventions Classification Linkages to NANDA-I diagnoses guide may provide new nursing perspectives on non-standardized research. In future studies, this may allow a comparison of data worldwide, enabling nurses to use the results in evidence-based practices.
Collapse
Affiliation(s)
- Hatice Bebiş
- Department of Public Health Nursing, Near East University, Nicosia, Cyprus
| | - Sue Moorhead
- The University of Iowa College of Nursing, Iowa City, Iowa, USA
| | - Dercan Gençbaş
- Department of Nursing, Atılım University Faculty of Health Sciences, Ankara, Turkey
| | - Serpil Özdemir
- Department of Public Health Nursing, Gülhane Faculty of Nursing Health Science University, Ankara, Turkey
| | - Memnun Seven
- Department of Obstetric and Gynecologic Nursing, Koç University, İstanbul, Turkey
| |
Collapse
|
9
|
Jafari A, Hassanajili S, Azarpira N, Bagher Karimi M, Geramizadeh B. Development of thermal-crosslinkable chitosan/maleic terminated polyethylene glycol hydrogels for full thickness wound healing: In vitro and in vivo evaluation. Eur Polym J 2019. [DOI: 10.1016/j.eurpolymj.2019.05.046] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
10
|
Kayser SA, VanGilder CA, Lachenbruch C. Predictors of superficial and severe hospital-acquired pressure injuries: A cross-sectional study using the International Pressure Ulcer Prevalence™ survey. Int J Nurs Stud 2019; 89:46-52. [DOI: 10.1016/j.ijnurstu.2018.09.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 08/09/2018] [Accepted: 09/04/2018] [Indexed: 01/15/2023]
|
11
|
Calixto LS, Maia Campos PM, Savary G, Picard C. Interactions between UV filters and active substances in emulsion: Effect on microstructure, physicochemical and in-vivo properties. Int J Pharm 2018; 553:220-228. [DOI: 10.1016/j.ijpharm.2018.10.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/03/2018] [Accepted: 10/09/2018] [Indexed: 10/28/2022]
|
12
|
Díaz E, Turégano C. Daily skin antisepsis and hygiene in the critically ill patient. Med Intensiva 2018; 43 Suppl 1:13-17. [PMID: 30482557 DOI: 10.1016/j.medin.2018.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 09/08/2018] [Accepted: 09/20/2018] [Indexed: 11/26/2022]
Abstract
Hygiene and skin care of patients admitted to the Intensive Care Unit (ICU) are part of basic care. For some years there has been evidence of skin colonization by multiresistant gramnegative and grampositive pathogens. The increase in nosocomial infections due to multiresistant microorganisms has led to evaluation of the role of the use of antiseptics, mainly chlorhexidine, as a strategy for reducing the number of such infections. This article reviews the current situation of this strategy, as well as the positioning of the authors in relation to the spreading of its use in ICUs. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.
Collapse
Affiliation(s)
- E Díaz
- Servicio de Medicina Intensiva, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España.
| | - C Turégano
- Servicio de Medicina Intensiva, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| |
Collapse
|
13
|
Falloon SS, Asimakopoulos V, Cottenden AM. An experimental study of friction between volar forearm skin and nonwoven fabrics used in disposable absorbent products for incontinence. Proc Inst Mech Eng H 2018; 233:35-47. [PMID: 30340442 DOI: 10.1177/0954411918802756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Incontinence-associated dermatitis is common among wearers of absorbent incontinence products and friction between product materials and skin is thought to be a contributing factor, but the details of its role are unclear. In this study, friction was measured between the dry volar forearm of 19 women (20-95 years) and five nonwovens typical of those in commercial disposable products. Euler's model/Amontons' law held to high precision for all person-fabric pairs for both static and dynamic friction, despite substantial variations in forearm size, soft tissue compliance and skin smoothness between subjects, sometimes substantial lateral contraction in fabric strips, and skin rucking beneath them. For a given subject, the highest coefficients of friction among the fabrics exceeded the lowest by ∼30% to 75%, while - for a given fabric - the highest coefficients of friction among the subjects exceeded the lowest by ∼55% to 85%. The order of coefficient of friction values across fabrics was similar for each subject, and across subjects for each fabric. There was no systematic variation with subject age. The data were well modelled by estimating the coefficients of friction for a given person-fabric combination as the product of the mean coefficient of friction across all fabrics for that person, and the mean coefficient of friction across all persons for that fabric, normalised to the mean coefficient of friction across all person-fabric combinations. Predicted values were within 10% of measured figures for ∼97% of person-fabric combinations. Stick-and-slip behaviour was observed with seven person-fabric combinations, but especially strongly for two subjects with each of two fabrics. It is not clear why and further investigation is merited. Comparison of the data with results from earlier work with the same fabrics and a skin surrogate (Lorica Soft) suggests that measurements with Lorica Soft may be helpful to screen, evaluate and compare candidate materials preparatory to human studies.
Collapse
Affiliation(s)
- Sabrina S Falloon
- Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London WC1E 6BT, UK
| | - Vasileios Asimakopoulos
- Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London WC1E 6BT, UK
| | - Alan M Cottenden
- Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London WC1E 6BT, UK
| |
Collapse
|
14
|
Šikić Pogačar M, Maver U, Marčun Varda N, Mičetić-Turk D. Diagnosis and management of diaper dermatitis in infants with emphasis on skin microbiota in the diaper area. Int J Dermatol 2017; 57:265-275. [PMID: 28986935 DOI: 10.1111/ijd.13748] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 08/02/2017] [Accepted: 08/14/2017] [Indexed: 12/22/2022]
Abstract
Diaper dermatitis is the most common inflammatory skin eruption within the diaper area in infants and toddlers. Although it rarely causes problems for prolonged periods of time, it causes considerable distress for both infants and parents. Diapered skin is exposed to friction, excessive hydration, varying pH, and is in constant contact with urine and feces, both of which are highly irritant to the skin. The three most common types of diaper dermatitis include chaffing dermatitis, irritant contact dermatitis, and diaper candidiasis. However, a variety of other skin conditions may manifest in the diaper area. Candida albicans and Staphylococcus aureus are most frequently isolated from the affected area and are thought to have a predominant role in diaper dermatitis. The review includes an overview of the epidemiology, etiology, and common skin microbiota in the diaper area. State-of-the-art strategies for diagnosis, management, and prevention of diaper dermatitis are also included. Appropriate skin care can help in the prevention of diaper dermatitis and can aid the reparation of the skin. This review discusses common causes, skin microbiota within the diapered area, differential diagnosis, and finally possible prevention and treatment recommendations. Recent findings have proven that the key to efficient eradication of irritant diaper dermatitis lies in its prevention.
Collapse
Affiliation(s)
- Maja Šikić Pogačar
- Faculty of Medicine, Department of Pediatrics, University of Maribor, Maribor, Slovenia
| | - Uroš Maver
- Faculty of Medicine, Institute of Biomedical Sciences and Department of Pharmacology, University of Maribor, Maribor, Slovenia
| | | | - Dušanka Mičetić-Turk
- Faculty of Medicine, Department of Pediatrics, University of Maribor, Maribor, Slovenia
| |
Collapse
|
15
|
Pilot study on benefits of applying a hot towel for 10 s to the skin of elderly nursing home residents during bed baths: Towards safe and comfortable bed baths. Geriatr Nurs 2017; 38:442-447. [PMID: 28366230 DOI: 10.1016/j.gerinurse.2017.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 02/13/2017] [Accepted: 02/16/2017] [Indexed: 11/22/2022]
Abstract
This study examined the effects of applying a hot towel to the skin of elderly people for 10 s (AHT10s) during a bed bath. We hypothesized from our previous studies that AHT10s would increase the stratum corneum water content and improve the skin barrier function of the elderly and invited residents (n = 21) of long-term care facilities to participate in this crossover study. Each participant received a bed bath with AHT10s and also a bed bath without hot towel application. The stratum corneum water content and transepidermal water loss (TEWL) were measured during bed bathing sessions and the experience was subjectively evaluated by participants. The TEWL increased significantly when bed bath did not involve AHT10s, but there was no such significant increase when AHT10s was performed. AHT10s also raised the skin surface temperature and provided warmth and comfort to all participants. These results suggest that, in the target population, AHT10s will lead to TEWL advantages and provide warmth and comfort.
Collapse
|
16
|
Incidence of moisture-associated skin damage in an intensive care unit. ENFERMERIA INTENSIVA 2017; 28:13-20. [PMID: 28110903 DOI: 10.1016/j.enfi.2016.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/02/2016] [Accepted: 11/09/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To determine the incidence of moisture-associated skin damage (MASD) in the nappy area, identify predisposing factors and know the preventive measures and nursing records. METHOD Descriptive longitudinal study (June 2014-April 2015) in a general ICU. Patients whose stay >48hours and without skin lesions were included. The skin was assessed daily until the appearance of MASD, discharge or a maximum of 14 days. Demographics, stay, MASD type, incontinence, number and consistency of stools, obesity, Braden scale and prevention were recorded. RESULTS 145 patients (66.2% male) were studied, median age was 69 (P25=56.5, P75=76) and median length of stay was five days (P25=3, P75=11.25), 29.9% were obese. Incontinence-associated dermatitis (IAD) was detected in 26.2% and intertriginous dermatitis (ITD) in 15.9%. MASD was recorded in 23.8%. The variables causing IAD to develop were faecal incontinence, number of stools, liquid stools, and stay. Those for ITD were obesity and score on the Braden scale. Multivariate analysis selected faecal incontinence (OR=5.4, CI95%: 1.1-26) and the number of stools (OR=1.1, CI95%:1.0-1.2) as independent variables for developing IAD and obesity (OR=2.8, CI95%:1.0-8.2) and Braden (OR=0.8, CI95%:0.7-1.0) for developing ITD. Prevention to 23.8% of obese and 42.9% of incontinent was performed. CONCLUSIONS There is a high incidence in MASD. Faecal incontinence and higher number of stools are the risk factors for developing IAD. Obesity and a lower score on the Braden scale may affect susceptibility to ITD. Recording of MASD and its prevention in patients at risk is insufficient.
Collapse
|
17
|
Brooks J, Cowdell F, Ersser SJ, Gardiner ED. Skin cleansing and emolliating for older people: A quasi-experimental pilot study. Int J Older People Nurs 2017; 12. [PMID: 28078772 DOI: 10.1111/opn.12145] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 11/04/2016] [Indexed: 01/15/2023]
Abstract
AIMS The aims of this study were to (i) assess the effect of low-cost hygiene and emollient regimens on the skin barrier function (SBF) of people aged >65 year with xerosis (dry skin) on their lower legs; (ii) to assess the utility of portable measures of skin barrier function in terms of stratum corneum hydration (SCH) and transepidermal water loss (TEWL) in community settings; and iii) to provide evidence for a randomised controlled trial on the treatment of adults in a resource-poor country with dry skin on their lower legs which causes and exacerbates the skin disease podoconiosis (non-filarial elephantiasis). BACKGROUND Age increases the risk of impaired skin barrier function which can precipitate skin breakdown. Older skin is frequently characterised by troublesome xerosis and pruritus (itching). Hygiene and emollient practices are central to maintaining skin integrity but are currently under-researched. METHOD A quasi-experimental pilot study of five combinations of cleansing and emollient interventions was applied to the xerotic lower legs of ten participants with no skin disease for five consecutive days. Stratum corneum hydration and transepidermal water loss were measured at baseline and day six. Products were chosen because of effectiveness, low cost and availability in a poor-resource country. RESULTS The greatest difference in transepidermal water loss pre-intervention-postintervention was indicated by the regimen of soapy water, 2% glycerine soak and Vaseline™ (mean 1.14, SD 1.27). This regimen also indicated the greatest difference in stratum corneum hydration (mean 7.92, SD 3.93). The improvement in stratum corneum hydration was significantly greater than for the control (p = .011), soap (p = .050) or water soak (p = .011). CONCLUSION A regimen of washing skin with soapy water, soaking in 2% glycerine for 30 min and applying Vaseline™ has a beneficial effect on the skin barrier function in older people. The study supports previous findings on the positive effects of glycerine on skin barrier function. IMPLICATIONS FOR PRACTICE AND RESEARCH Skin barrier function in older people can be improved using a regimen of washing, soaking in 2% glycerine and applying Vaseline™ .
Collapse
|
18
|
|
19
|
Abstract
UNLABELLED Pressure ulcers (PrUs) remain a concern for clinicians, patients, caregivers, and researchers. Although data on prevalence and incidence are available, as well as evidence-based prevention and management intervention, PrU healing time is underreported. OBJECTIVE The objective of this study was to evaluate the healing time of Stage II PrUs. METHODS Secondary analysis of data collected from a multicenter randomized clinical trial was undertaken. Patients (a) with a Stage II PrU, (b) older than 18 years, and (c) who had given informed consent were included. The endpoints of the study were complete re-epithelialization of the PrU measured with the Pressure Ulcer Scale for Healing Tool 3.0 and the healing time. A network of 46 healthcare centers located in northern Italy participated in the study. RESULTS Two hundred seventy patients with an average age of 83.9 years (95% confidence interval [CI], 82.71-85.10) were recruited. Among 270 Stage II PrUs included, 153 lesions healed (56.7%), whereas 74 (27.4%) were still present after 10 weeks of follow-up. For 43 lesions (15.9%), the follow-up evaluation was interrupted because of patient death or transfer to units not included in the study. The PrUs healed on an average of 22.9 days (95% CI, 20.47-25.37 days), with a median of 18 days. The average healing time for PrUs of less than 3.1 cm was significantly shorter (19.2 days; 95% CI, 16.6-21.8) compared with those 3.1 cm or greater (31.0 days; 95% CI, 26.4-35.6 days) (P = .000). CONCLUSIONS To achieve complete re-epithelialization in Stage II PrUs, it takes approximately 23 days. This is quite a long time if we consider that pressures of only 60 to 70 mm Hg for between 30 and 240 minutes are needed to cause tissue damage. On average, a small ulcer heals 12 days faster compared with those with a surface of 3.1 cm or greater.
Collapse
|
20
|
|
21
|
Damián J, Pastor-Barriuso R, García López FJ, de Pedro-Cuesta J. Urinary incontinence and mortality among older adults residing in care homes. J Adv Nurs 2016; 73:688-699. [DOI: 10.1111/jan.13170] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2016] [Indexed: 01/25/2023]
Affiliation(s)
- Javier Damián
- National Centre for Epidemiology; Carlos III Institute of Health; Madrid Spain
- Consortium for Biomedical Research in Neurodegenerative Diseases (CIBERNED); Madrid Spain
| | - Roberto Pastor-Barriuso
- National Centre for Epidemiology; Carlos III Institute of Health; Madrid Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP); Madrid Spain
| | - Fernando J. García López
- National Centre for Epidemiology; Carlos III Institute of Health; Madrid Spain
- Consortium for Biomedical Research in Neurodegenerative Diseases (CIBERNED); Madrid Spain
| | - Jesús de Pedro-Cuesta
- National Centre for Epidemiology; Carlos III Institute of Health; Madrid Spain
- Consortium for Biomedical Research in Neurodegenerative Diseases (CIBERNED); Madrid Spain
| |
Collapse
|
22
|
Trowbridge MM, Wang B, Gutshall D, Rodenberg CA, Farage MA. A randomized, controlled trial comparing skin health effects and comfort of two adult incontinence protective underwear. Skin Res Technol 2016; 23:202-211. [DOI: 10.1111/srt.12320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 11/28/2022]
Affiliation(s)
- M. M. Trowbridge
- Department of Global Clinical Sciences; The Procter & Gamble Co; Cincinnati OH USA
| | - B. Wang
- Department of Quantitative Sciences; The Procter & Gamble Co; Cincinnati OH USA
| | - D. Gutshall
- Department of Central Product Safety; The Procter & Gamble Co; Cincinnati OH USA
| | - C. A. Rodenberg
- Department of Quantitative Sciences; The Procter & Gamble Co; Cincinnati OH USA
| | - M. A. Farage
- Department of Global Clinical Sciences; The Procter & Gamble Co; Cincinnati OH USA
| |
Collapse
|
23
|
Humbert P, Dréno B, Krutmann J, Luger TA, Triller R, Meaume S, Seité S. Recommendations for managing cutaneous disorders associated with advancing age. Clin Interv Aging 2016; 11:141-8. [PMID: 26929610 PMCID: PMC4758790 DOI: 10.2147/cia.s96232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The increasingly aged population worldwide means more people are living with chronic diseases, reduced autonomy, and taking various medications. Health professionals should take these into consideration when managing dermatological problems in elderly patients. Accordingly, current research is investigating the dermatological problems associated with the loss of cutaneous function with age. As cell renewal slows, the physical and chemical barrier function declines, cutaneous permeability increases, and the skin becomes increasingly vulnerable to external factors. In geriatric dermatology, the consequences of cutaneous aging lead to xerosis, skin folding, moisture-associated skin damage, and impaired wound healing. These problems pose significant challenges for both the elderly and their carers. Most often, nurses manage skin care in the elderly. However, until recently, little attention has been paid to developing appropriate, evidence-based, skincare protocols. The objective of this paper is to highlight common clinical problems with aging skin and provide some appropriate advice on cosmetic protocols for managing them. A review of the literature from 2004 to 2014 using PubMed was performed by a working group of six European dermatologists with clinical and research experience in dermatology. Basic topical therapy can restore and protect skin barrier function, which relieves problems associated with xerosis, prevents aggravating moisture-associated skin damage, and enhances quality of life. In conclusion, the authors provide physicians with practical recommendations to assist them in implementing basic skin care for the elderly in an integrated care approach.
Collapse
Affiliation(s)
- Philippe Humbert
- Research and Studies Centre on the Integument (CERT), Clinical Investigation Centre (CIC BT506), Department of Dermatology, Besançon University Hospital, University of Franche-Comté, Besançon, France
| | - Brigitte Dréno
- Department of Dermato-Cancerology, Nantes University Hospital, Nantes, France
| | - Jean Krutmann
- IUF-Leibniz Research Institute for Environmental Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Raoul Triller
- International Centre of Dermatology, Hertford British Hospital, Levallois, France
| | - Sylvie Meaume
- Geriatric Service, Wounds and Healing, Rothschild Hôspital, Paris, France
| | - Sophie Seité
- La Roche-Posay Dermatological Laboratories, Asnières, France
| |
Collapse
|
24
|
Bardsley A. Principles of skin cleansing in continence management. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2015; 24:S36-8. [PMID: 26450820 DOI: 10.12968/bjon.2015.24.sup18.s36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alison Bardsley
- Senior Lecturer and Course Director for Non-Medical Prescribing and BSc in Professional Practice, Coventry University
| |
Collapse
|
25
|
Schoonhoven L, van Gaal BG, Teerenstra S, Adang E, van der Vleuten C, van Achterberg T. Cost-consequence analysis of “washing without water” for nursing home residents: A cluster randomized trial. Int J Nurs Stud 2015; 52:112-20. [DOI: 10.1016/j.ijnurstu.2014.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/27/2014] [Accepted: 08/01/2014] [Indexed: 10/24/2022]
|
26
|
Cowdell F, Jadotte YT, Ersser SJ, Danby S, Walton S, Lawton S, Roberts A, Gardiner E, Ware F, Cork M. Hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Fiona Cowdell
- Birmingham City University; Faculty of Health, Education and Life Sciences; City South Campus Westbourne Road, Edgbaston Birmingham UK B15 3TN
| | - Yuri T Jadotte
- Rutgers, The State University of New Jersey - School of Nursing; Northeast Institute for Evidence Synthesis and Translation, a collaborating centre of the Joanna Briggs Institute; 65 Bergen Street, Room GA-190 Newark New Jersey USA 07101
| | - Steven J Ersser
- University of Leeds; School of Healthcare, Faculty of Medicine and Health; Room 1.12, Baines Wing Woodhouse Lane Leeds UK LS2 9JT
| | - Simon Danby
- The University of Sheffield; Academic Unit of Dermatology Research, Department of Infection and Immunity; Beech Hill Road Sheffield UK S10 2RX
| | - Shernaz Walton
- Hull and East Yorkshire Hospitals NHS Trust; Department of Dermatology; Hull Royal Infirmary Analby Road East Yorkshire UK HU3 2JZ
| | - Sandra Lawton
- Nottingham University Hospitals NHS Trust; Department of Dermatology; Queen?s Medical Centre, South Block Nottingham UK NG7 2UH
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema; Nottingham UK NG5 4FG
| | - Eric Gardiner
- University of Hull; Faculty of Health and Social Care; Cottingham Road Hull UK HU6 7RX
| | - Fiona Ware
- University of Hull; Library and Learning Innovation; Cottingham Road Hull UK HU6 7RX
| | - Michael Cork
- The University of Sheffield; Academic Unit of Dermatology Research, Department of Infection and Immunity; Beech Hill Road Sheffield UK S10 2RX
| |
Collapse
|
27
|
Associations between individual characteristics and incontinence-associated dermatitis: A secondary data analysis of a multi-centre prevalence study. Int J Nurs Stud 2014; 51:1373-80. [DOI: 10.1016/j.ijnurstu.2014.02.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 02/11/2014] [Accepted: 02/14/2014] [Indexed: 11/22/2022]
|
28
|
Cowdell F, Garrett D. Older people and skin: challenging perceptions. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2014; 23:S4-8. [PMID: 25075384 DOI: 10.12968/bjon.2014.23.sup12.s4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this article we set out to challenge perceptions about older people and skin. We examine current portrayals of older people and skin, both in the media and in the nursing literature. We describe the ‘normal’ process of skin ageing and highlight the importance of maintaining skin integrity and effective barrier function for health and wellbeing, particularly in older people. One element of maintaining skin integrity is ensuring that personal hygiene and emollient needs are met. Effective skin hygiene and emollient care will reduce the risk of breakdown, with all its burdensome and costly consequences. We therefore offer a summary of the current evidence base for skin-hygiene practice. We make a case for nurses considering skin health from a wider societal and human perspective, and identify opportunities to enhance nursing practice through skin-care advice and health education for all older people.
Collapse
|
29
|
Schoenleber MM. Commentary on Shin YS, Kim HJ, Moon N-K, Ahn YH and Kim K-O (2012) The effects of uncoated paper on skin moisture and transepidermal water loss in bedridden patients. Journal of Clinical Nursing
21, 2469-2476. J Clin Nurs 2014; 23:2080-1. [DOI: 10.1111/jocn.12102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
30
|
Scientific and Clinical Abstracts From the WOCN® Society's 46th Annual Conference. J Wound Ostomy Continence Nurs 2014. [DOI: 10.1097/won.0000000000000037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
31
|
Cai W, Wang J, Wang L, Wang J, Guo L. Prevalence and risk factors of urinary incontinence for post-stroke inpatients in Southern China. Neurourol Urodyn 2013; 34:231-5. [PMID: 24375823 DOI: 10.1002/nau.22551] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 11/26/2013] [Indexed: 11/09/2022]
Abstract
AIMS The prevalence and risk factors of urinary incontinence (UI) for post-stroke inpatients remain unclear. In this study, we aimed to investigate the risk factors associated with the development of UI for post-stroke inpatients in southern China. DESIGN Cross-sectional survey. SUBJECTS AND METHODS A total of 711 post-stroke patients from neurological units at 8 different hospitals in Guangzhou, a city in southern China, were interviewed face to face. Data were collected by a self-designed questionnaire which includes sociodemographic variables, characteristics of stroke, and medical history. RESULTS The prevalence of UI among post-stroke inpatients was 44.3%. By multivariate logistic regression, we found that major risk factors for UI included health care assistant care (OR = 3.935), hemorrhagic stroke (OR = 1.755), mixed stroke (OR = 2.802), parietal lobe lesion (OR = 1.737), chronic cough (OR = 2.099), aphasia (OR = 3.541), and post-stroke depression (OR = 3.398). CONCLUSIONS The prevalence of UI among post-stroke inpatients is high. Stroke inpatients looked after by health care assistant, hemorrhagic stroke, mixed stroke, parietal lobe lesion, chronic cough, aphasia, and post-stroke depression were high-risk groups for UI. These patients should be targeted when planning intervention programs.
Collapse
Affiliation(s)
- Wenzhi Cai
- School of Nursing, Southern Medical University, Guangzhou, China; Nanfang Hospital, Southern Medical University, Guangzhou, China
| | | | | | | | | |
Collapse
|
32
|
Cowdell F, Steventon K. Skin cleansing practices for older people: a systematic review. Int J Older People Nurs 2013; 10:3-13. [DOI: 10.1111/opn.12041] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 07/29/2013] [Indexed: 11/26/2022]
|
33
|
The effect of slurry on skin permeability to methylene blue dye in dairy cows with and without a history of digital dermatitis. Animal 2013; 7:1731-7. [PMID: 23822976 DOI: 10.1017/s1751731113001274] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This study aimed to determine whether there was a difference in skin permeability to methylene blue dye or skin morphology between dairy cows that differed in their susceptibility to digital dermatitis (DD) and to assess the effect of contact with slurry on skin permeability. Twenty nine dairy cows were monitored for DD during the winter housing period and classed as DD+ (previous DD infection, n = 17), or DD- (no recorded infection, n = 12). The animals were culled and a skin sample was taken from above the heel of each hind foot and frozen. Samples were later defrosted and one sample from each cow was tested for permeability, whereas the other was treated with slurry for 24 h before permeability testing. To test permeability, methylene blue dye was applied to the skin surface in a Franz diffusion cell. After 48 h, the amount of dye that had passed through the skin was estimated. The stratum corneum thickness and the density of hair follicles were determined from additional heel skin samples. Skin permeability to methylene blue dye was significantly greater for samples that had been treated with slurry but did not differ between DD+ and DD- animals. No difference was found in the stratum corneum thickness or density of hair follicles between DD+ and DD- animals. These findings imply that individual differences in general skin permeability are not a major factor in determining DD susceptibility and suggest that contact with slurry could contribute to DD infection by increasing the permeability of the skin, which may facilitate pathogen entry. Further work is required to clarify the role played by slurry in the pathogenesis of DD.
Collapse
|
34
|
Incontinence-associated dermatitis: consensus statements, evidence-based guidelines for prevention and treatment, and current challenges. J Wound Ostomy Continence Nurs 2012; 39:303-15; quiz 316-7. [PMID: 22572899 DOI: 10.1097/won.0b013e3182549118] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In 2010, an international consensus conference was held to review current evidence regarding the pathology, prevention, and management of incontinence-associated dermatitis (IAD). The results of this literature review were published in a previous issue of this Journal. This article summarizes key consensus statements agreed upon by the panelists, evidence-based guidelines for prevention and management of IAD, and a discussion of the major challenges currently faced by clinicians caring for these patients. The panelists concur that IAD is clinically and pathologically distinct from pressure ulcers and intertriginous dermatitis, and that a consistently applied, structured, or defined skin care program is effective for prevention and management of IAD. They also agreed that differential assessment of IAD versus pressure ulceration versus intertriginous dermatitis remains a major challenge. Panel members also concur that evidence is lacking concerning which products and protocols provide the best outcomes for IAD prevention and treatment in individual patients. Issues related to differential assessment, product labeling and utilization, staff education, and cost of care are the primary focus of this article.
Collapse
|
35
|
Shin YS, Kim HJ, Moon NK, Ahn YH, Kim KO. The effects of uncoated paper on skin moisture and transepidermal water loss in bedridden patients. J Clin Nurs 2012; 21:2469-76. [DOI: 10.1111/j.1365-2702.2012.04160.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
36
|
A 3-in-1 perineal care washcloth impregnated with dimethicone 3% versus water and pH neutral soap to prevent and treat incontinence-associated dermatitis: a randomized, controlled clinical trial. J Wound Ostomy Continence Nurs 2012; 38:627-34. [PMID: 21952346 DOI: 10.1097/won.0b013e31822efe52] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE We compared the effectiveness of a 3-in-1 perineal care washcloth versus standard of care (water and pH neutral soap) to prevent and treat incontinence-associated dermatitis (IAD). The product under study was a soft, premoistened washcloth, including a 3% dimethicone formula, with cleansing, moisturizing, and barrier protection properties. DESIGN Randomized, controlled clinical trial. SUBJECTS AND SETTING The study sample comprised a random sample of 11 nursing home wards (6 experimental and 5 control) in a convenience sample of 4 nursing homes in Belgium. The sample included nursing home residents at risk for and/or affected by IAD defined as incontinent of urine, feces, urine/feces, and/or having erythema of the perineal skin (not caused by pressure/shear), and/or having an edematous skin in the genital area. METHODS Participants in the experimental group were treated according to a standardized protocol, including the use of a 3-in-1 perineal care washcloth impregnated with a 3% dimethicone skin protectant. Participants in the control group received perineal skin care with water and pH neutral soap, the standard of care in Belgian nursing homes. The study period was 120 days. Data were collected between February and May 2010. Incontinence-associated dermatitis prevalence and severity were assessed using the IAD Skin Condition Assessment Tool. The surface (cm), redness, and depth of the perineal lesion were assessed daily by the nurses. This tool generates a cumulative severity score (maximum score = 10) based on area of skin affected, degree of redness, and depth of erosion. RESULTS Four hundred sixty-four nursing home residents were assessed and 32.9% (n = 141) met the criteria for inclusion, including 73 subjects in the experimental group and 68 in the control group. Baseline IAD prevalence was comparable in both groups (experimental: 22.3% vs control: 22.8%, P = .76). Baseline IAD severity was 6.9/10 in the experimental group and 7.3/10 in the control group. A significant intervention effect on IAD prevalence was found (experimental: 8.1% vs control: 27.1%, F = 3.1, P = .003). A nonsignificant effect on IAD severity could be determined (experimental: 3.8/10 vs control: 6.9/10, F = 0.8, P = .06). CONCLUSION The use of a 3-in-1 washcloth, impregnated with a 3% dimethicone formula, resulted in a significantly reduced prevalence of IAD and a trend toward less severe lesions. These findings provide indicative evidence for the use of 3-in-1 perineal care washcloth as an effective intervention against the use of water and a pH neutral soap to prevent and/or treat IAD.
Collapse
|
37
|
Relation between pressure, friction and pressure ulcer categories: A secondary data analysis of hospital patients using CHAID methods. Int J Nurs Stud 2011; 48:1487-94. [DOI: 10.1016/j.ijnurstu.2011.07.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 04/02/2011] [Accepted: 07/06/2011] [Indexed: 11/20/2022]
|
38
|
Heaney F. Nurse decision to insert a urinary catheter in a female patient in orthopaedic speciality: The development of a protocol to guide care. Int J Orthop Trauma Nurs 2011. [DOI: 10.1016/j.ijotn.2011.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
39
|
Beeckman D, Woodward S, Gray M. Incontinence-associated dermatitis: step-by-step prevention and treatment. Br J Community Nurs 2011; 16:382-389. [PMID: 21841630 DOI: 10.12968/bjcn.2011.16.8.382] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Incontinence-associated dermatitis (IAD) is one of the clinical manifestations of moisture-associated skin damage. It is a common problem in community dwelling patients with faecal and/or urinary incontinence, and IAD management is an important challenge for community nurses. The aim of this practice focused article is to provide a brief update about the evidence of: (1) the pathophysiology of IAD, (2) the differentiation between IAD and pressure ulcers, and (3) the prevention/treatment of IAD. Recommendations for patient care in the community is described with reference to a patient case study.
Collapse
|
40
|
Beeckman D, Woodward S, Rajpaul K, Vanderwee K. Clinical challenges of preventing incontinence-associated dermatitis. ACTA ACUST UNITED AC 2011; 20:784-6,788,790. [DOI: 10.12968/bjon.2011.20.13.784] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Dimitri Beeckman
- King's College London, Florence Nightingale School of Nursing & Midwifery, London, UK, Researcher, Ghent University, Nursing Science Unit, Department of Public Health, Ghent, Belgium, Visiting Professor, Artevelde University College, Bachelor in Nursing Department, Ghent, Belgium
| | - Sue Woodward
- King's College London, Florence Nightingale School of Nursing & Midwifery, London, UK
| | - Kumal Rajpaul
- King's College Hospital, Tissue Viability Team, London, UK
| | - Katrien Vanderwee
- Ghent University, Nursing Science Unit, Department of Public Health, Ghent, Belgium
| |
Collapse
|
41
|
Geraghty J. Introducing a new skin-care regimen for the incontinent patient. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2011; 20:409-415. [PMID: 21537257 DOI: 10.12968/bjon.2011.20.7.409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Maintaining skin integrity and preventing skin breakdown and moisture lesions in the incontinent patient is an everyday challenge for nurses in the acute setting. The management of incontinence is often a socially or culturally prohibited topic Fletcher (2008); it is frequently attributed to ill health, the aging process or hospitalization, and often overlooked. The concept of cleansing should be commonplace, but it is complicated by the ritualism that underpins this ordinary yet fundamental aspect of patient care (Voegeli, 2010). The use of traditional methods of cleansing with soap and water in the management of skin integrity consumes significant amounts of nursing time. However, this procedure conflicts with infection control measures and predisposes the patient to further skin breakdown. This article looks at the use of an evaluation of a skin-cleansing emollient product in an elderly-care setting to provide evidence enabling an innovation that would lead to a change in practice. It highlights the importance of the implementation of a skin-care regimen as part of basic nursing care for the incontinent patient within the acute setting, and challenges ritualistic practice with evidence-based care.
Collapse
|
42
|
Jordan LA, Mackey E, Coughlan K, Wyer M, Allnutt N, Middleton S. Continence management in acute stroke: a survey of current practices in Australia. J Adv Nurs 2010; 67:94-104. [DOI: 10.1111/j.1365-2648.2010.05480.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
43
|
|
44
|
Abstract
PURPOSE This study was designed to assess the ability of 2 skin cleaning procedures to remove transient microbial flora from the skin. DESIGN The study is a direct comparison of 2 washing procedures: soap and water washing versus cleansing with a no-rinse cleanser. SETTING AND SUBJECTS The trial was performed at the research facilities of the Department of Clinical Bacteriology at the University of Göteborg. Forty-five healthy adult volunteers were recruited to participate in the study. METHODS A solution of test bacteria, either Escherichia coli or Staphylococcus aureus, was applied to both forearms of the test subject. After a 15-minute incubation period, one arm was cleaned using soap and water and the other arm was cleaned with no-rinse cleanser. Both the arms were dried with a disposable cloth. The amount of residual bacteria on the skin was assessed using contact agar plates. RESULTS Both methods of cleaning resulted in 4-to 5-fold log reductions in bacterial count. The number of residual bacteria after both procedures ranged from 1 to 4 colony-forming units/cm after washing. The amount of residual bacteria was comparable for both washing procedures. CONCLUSIONS Both washing procedures resulted in a low level of residual bacteria on the skin. No-rinse cleansers can be safely used as an alternative to soap and water washing of fragile skin.
Collapse
|
45
|
Abstract
AIMS AND OBJECTIVES The aim of this study was to examine interrater reliability and agreement of the diagnosis of moisture lesions as defined by the European Pressure Ulcer Advisory Panel. BACKGROUND Differentiation between superficial pressure ulcers and moisture-related skin damages is difficult. To enhance the precision of the identification of moisture lesions, the European Pressure Ulcer Advisory Panel provided wound- and patient-related characteristics. Empirical evidence regarding interrater reliability and agreement among nurses for the detection of moisture-related skin damages in clinical practice is lacking. DESIGN Observational. METHODS Home care clients (n = 339) were independently assessed twice by trained nurses. A head to toe skin inspection was conducted. RESULTS For the diagnosis of moisture lesion (yes/no), nurses exactly agreed in 95% of all assessed clients. Interrater reliability was intraclass correlation coefficient (1,1) = 0.67 (95% CI 0.61-0.73). CONCLUSIONS Nurses were able to differentiate between home care clients with and without moisture lesions but assessment results contained a high degree of measurement error. It seems that the descriptions for the identification of moisture lesions provided by the European Pressure Ulcer Advisory Panel do support the diagnostic process but reliability must be enhanced. RELEVANCE TO CLINICAL PRACTICE Because of low interrater reliability, it is questionable whether the diagnosis of moisture lesions in clinical practice is valid. Measurement error is too high to make adequate inferences for individuals. Definitions and descriptions provided by the European Pressure Ulcer Advisory Panel, provisions of a single training and images are not sufficient to achieve acceptable interrater reliability in clinical practice.
Collapse
Affiliation(s)
- Jan Kottner
- Centre for Humanities and Health Sciences, Department of Nursing Science, Charité Universitätsmedizin Berlin, Berlin, Germany.
| | | |
Collapse
|
46
|
Voegeli D. Care or harm: exploring essential components in skin care regimens. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2010; 19:810, 812, 814, passim. [PMID: 20606609 DOI: 10.12968/bjon.2010.19.13.48855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Skin care is a fundamental aspect of basic nursing care, with the outcome of these interventions often used to gauge the quality of the care provided. However, possibly as a result of the 'basic' nature of this aspect of care, little attention has been paid to developing a firm evidence base to guide decision-making in this area. This is compounded by the wide variety of products now available, ranging from simple cleansers and moisturizers, to more complex agents that cleanse, moisturize and protect all in one, which can add to the confusion. This article explores the basic principles of skin care, and considers the evidence available to support the nursing interventions used, and the range of products available. Finally, it suggests the adoption of clear skin care protocols, and recommends actions that should form part of these.
Collapse
Affiliation(s)
- David Voegeli
- Continence Technology and Skin Health Group, School of Health Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
47
|
Elpern EH, Killeen K, Ketchem A, Wiley A, Patel G, Lateef O. Reducing use of indwelling urinary catheters and associated urinary tract infections. Am J Crit Care 2009; 18:535-41; quiz 542. [PMID: 19880955 DOI: 10.4037/ajcc2009938] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Use of indwelling urinary catheters can lead to complications, most commonly catheter-associated urinary tract infections. Duration of catheterization is the major risk factor. These infections can result in sepsis, prolonged hospitalization, additional hospital costs, and mortality. OBJECTIVES To implement and evaluate the efficacy of an intervention to reduce catheter-associated urinary tract infections in a medical intensive care unit by decreasing use of urinary catheters. METHODS Indications for continuing urinary catheterization with indwelling devices were developed by unit clinicians. For a 6-month intervention period, patients in a medical intensive care unit who had indwelling urinary catheters were evaluated daily by using criteria for appropriate catheter continuance. Recommendations were made to discontinue indwelling urinary catheters in patients who did not meet the criteria. Days of use of a urinary catheter and rates of catheter-associated urinary tract infections during the intervention were compared with those of the preceding 11 months. RESULTS During the study period, 337 patients had a total of 1432 days of urinary catheterization. With use of guidelines, duration of use was significantly reduced to a mean of 238.6 d/mo from the previous rate of 311.7 d/mo. The number of catheter-associated urinary tract infections per 1000 days of use was a mean of 4.7/mo before the intervention and zero during the 6-month intervention period. CONCLUSIONS Implementation of an intervention to judge appropriateness of indwelling urinary catheters may result in significant reductions in duration of catheterization and occurrences of catheter-associated urinary tract infections.
Collapse
Affiliation(s)
- Ellen H. Elpern
- Ellen H. Elpern and Kathryn Killeen are advanced practice nurses in adult critical care nursing, Alice Ketchem and Amanda Wiley were senior clinical nurses in the medical intensive care unit, Gourang Patel is a clinical pharmacist in the medical intensive care unit, and Omar Lateef is medical director of the medical intensive care unit at Rush University Medical Center, Chicago, Illinois
| | - Kathryn Killeen
- Ellen H. Elpern and Kathryn Killeen are advanced practice nurses in adult critical care nursing, Alice Ketchem and Amanda Wiley were senior clinical nurses in the medical intensive care unit, Gourang Patel is a clinical pharmacist in the medical intensive care unit, and Omar Lateef is medical director of the medical intensive care unit at Rush University Medical Center, Chicago, Illinois
| | - Alice Ketchem
- Ellen H. Elpern and Kathryn Killeen are advanced practice nurses in adult critical care nursing, Alice Ketchem and Amanda Wiley were senior clinical nurses in the medical intensive care unit, Gourang Patel is a clinical pharmacist in the medical intensive care unit, and Omar Lateef is medical director of the medical intensive care unit at Rush University Medical Center, Chicago, Illinois
| | - Amanda Wiley
- Ellen H. Elpern and Kathryn Killeen are advanced practice nurses in adult critical care nursing, Alice Ketchem and Amanda Wiley were senior clinical nurses in the medical intensive care unit, Gourang Patel is a clinical pharmacist in the medical intensive care unit, and Omar Lateef is medical director of the medical intensive care unit at Rush University Medical Center, Chicago, Illinois
| | - Gourang Patel
- Ellen H. Elpern and Kathryn Killeen are advanced practice nurses in adult critical care nursing, Alice Ketchem and Amanda Wiley were senior clinical nurses in the medical intensive care unit, Gourang Patel is a clinical pharmacist in the medical intensive care unit, and Omar Lateef is medical director of the medical intensive care unit at Rush University Medical Center, Chicago, Illinois
| | - Omar Lateef
- Ellen H. Elpern and Kathryn Killeen are advanced practice nurses in adult critical care nursing, Alice Ketchem and Amanda Wiley were senior clinical nurses in the medical intensive care unit, Gourang Patel is a clinical pharmacist in the medical intensive care unit, and Omar Lateef is medical director of the medical intensive care unit at Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
48
|
Du Moulin MFMT, Hamers JPH, Ambergen AW, Halfens RJG. Urinary incontinence in older adults receiving home care diagnosis and strategies. Scand J Caring Sci 2009; 23:222-30. [DOI: 10.1111/j.1471-6712.2008.00610.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
49
|
Gélis A, Dupeyron A, Legros P, Benaïm C, Pelissier J, Fattal C. Pressure ulcer risk factors in persons with spinal cord injury Part 2: the chronic stage. Spinal Cord 2009; 47:651-61. [DOI: 10.1038/sc.2009.32] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
50
|
Affiliation(s)
- D. McDonagh
- Southern Health and Social Care Trust, Northern Ireland, UK
| |
Collapse
|