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Bates-Jensen BM, Crocker J, Nguyen V, Robertson L, Nourmand D, Chirila E, Laayouni M, Offendel O, Peng K, Romero SA, Fulgentes G, McCreath HE. Decreasing Intraoperative Skin Damage in Prone-Position Surgeries. Adv Skin Wound Care 2024; 37:413-421. [PMID: 39037095 DOI: 10.1097/asw.0000000000000186] [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
OBJECTIVE To determine if subepidermal moisture (SEM) measures help detect and prevent intraoperative acquired pressure injuries (IAPIs) for prone-position surgery. METHODS In this clinical trial of patients (n = 39 preintervention, n = 48 intervention, 100 historical control) undergoing prone-position surgery, researchers examined the use of multidimensionally flexible silicone foam (MFSF) dressings applied preoperatively to patients' face, chest, and iliac crests. Visual skin assessments and SEM measures were obtained preoperatively, postoperatively, and daily for up to 5 days or until discharge. Electronic health record review included demographic, medical, and surgery data. RESULTS Of the 187 total participants, 76 (41%) were women. Participants' mean age was 61.0 ± 15.0 years, and 9.6% were Hispanic (n = 18), 9.6% were Asian (n = 18), 6.9% were Black or African American (n = 13), and 73.8% were White (n = 138). Participants had a mean Scott-Triggers IAPI risk score of 1.5 ± 1.1. Among those with no erythema preoperatively, fewer intervention participants exhibited postoperative erythema on their face and chest than did preintervention participants. Further, fewer intervention participants had SEM-defined IAPIs at all locations in comparison with preintervention participants. The MFSF dressings overcame IAPI risk factors of surgery length, skin tone, and body mass index with fewer IAPIs in intervention participants. CONCLUSIONS Patients undergoing prone-position surgeries developed fewer IAPIs, and SEM measures indicated no damage when MFSF dressings were applied to sites preoperatively. The SEM measures detected more damage than visual assessment.
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Affiliation(s)
- Barbara M Bates-Jensen
- At the University of California, Los Angeles (UCLA), Los Angeles, California, US, Barbara M. Bates-Jensen, PhD, RN, FAAN, is Professor of Nursing and Medicine, Los Angeles School of Nursing and David Geffen School of Medicine; Jessica Crocker, BA, is Project Director, Division of Geriatrics, David Geffen School of Medicine; and Vicky Nguyen, MSN, is Graduate Student, School of Nursing. Lauren Robertson, BS, is Senior Quality Control Analytical Associate, ImmunityBio, Los Angeles, California. Deborah Nourmand, MSN, RN, is Registered Nurse, UCLA Santa Monica Surgery Center, Santa Monica, CA. At the School of Nursing, UCLA, Emily Chirila, BSN, is Nursing Student; Mohamed Laayouni, MSN, is Nursing Student; Ofelia Offendel, MSN, is Student Nurse; Kelly Peng, BA, is Graduate Student Research Assistant; and Stephanie Anne Romero, MSN, is Graduate Student Researcher. Gerry Fulgentes, MSN, RN, CWOCN, PCCN, is Clinical Manager, Wounds, Ostomy, and Continence Services, UCLA Santa Monica Medical Center. Heather E. McCreath, PhD, is Adjunct Professor, Division of Geriatrics, David Geffen School of Medicine, UCLA
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Abiakam NS, Jayabal H, Abbas S, Filingeri D, Bader DL, Worsley PR. The Effects of Incontinence Pad Application on Loaded Skin With Reference to Biophysical and Biochemical Parameters: An Exploratory Cohort Study Using a Repeated-Measures Design. J Wound Ostomy Continence Nurs 2023; 50:512-520. [PMID: 37966081 DOI: 10.1097/won.0000000000001032] [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: 11/16/2023]
Abstract
PURPOSE The purpose of this study was to evaluate temporal changes in skin responses following exposure to moisture alone or moisture in combination with mechanical loading. DESIGN Comparison cohort with a repeated-measures design. SUBJECTS AND SETTINGS The sample comprised 12 healthy volunteers. Participants were purposely sampled from 2 different age groups; half were 32 to 39 years old and half were 50 to 62 years old. Participants identified as White, Black, or mixed; 83% (n = 10) identified as White; 8 (67%) were female. METHODS Four sites at the sacrum were challenged with the application of specimens taken from 2 absorbent products; the pad specimens were applied dry or saturated with synthetic urine (SU; pH = 8); a further site from the sacral skin was also selected and used as a control. Skin assessments were performed at different points in time: (1) 60 minutes after exposure to dry or SU-saturated pad specimens; (2) 60 minutes after exposure to pads and mechanical loading (application of pressure in the form of 45°C high sitting); and (3) 30 minutes after removal of all pads (recovery period). Outcome measures were transepidermal water loss (TEWL), stratum corneum (SC) hydration, erythema, pH, and skin inflammatory biomarkers measured at each of the time points described earlier. RESULTS The control site and those exposed to dry pads showed minimal time-dependent changes irrespective of the parameter investigated. In contrast, significant increases in TEWL (P = .0000007) and SC hydration responses (P = .0000007) were detected at the sites under absorbent pad specimens after saturation with SU (exposure to moisture). In some participants, TEWL and SC hydration parameters were significantly higher during pressure application. Skin pH remained in the mildly acidic range throughout the test session, and no consistent trends were observed with erythema. Skin inflammatory biomarkers also exhibited considerable variability across participants; none changed significantly over time. Significant differences (P = .02) were also detected following the exposure of moisture in combination with pressure. CONCLUSION We evaluated an array of parameters to identify changes following skin exposure to 2 absorbent pads in the presence and absence of SU and mechanical loading. Analysis revealed changes in skin barrier properties in the presence of moisture and/or pressure. This observation suggests a need for frequent pad changing as well as periods of skin off-loading to protect the skin health of individuals with incontinence.
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Affiliation(s)
- Nkemjika S Abiakam
- Nkemjika S. Abiakam, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Hemalatha Jayabal, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Shabira Abbas, PhD, Essity AB, Gothenburg, Sweden
- Davide Filingeri, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Dan L. Bader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Peter R. Worsley, DSc, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Hemalatha Jayabal
- Nkemjika S. Abiakam, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Hemalatha Jayabal, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Shabira Abbas, PhD, Essity AB, Gothenburg, Sweden
- Davide Filingeri, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Dan L. Bader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Peter R. Worsley, DSc, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Shabira Abbas
- Nkemjika S. Abiakam, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Hemalatha Jayabal, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Shabira Abbas, PhD, Essity AB, Gothenburg, Sweden
- Davide Filingeri, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Dan L. Bader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Peter R. Worsley, DSc, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Davide Filingeri
- Nkemjika S. Abiakam, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Hemalatha Jayabal, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Shabira Abbas, PhD, Essity AB, Gothenburg, Sweden
- Davide Filingeri, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Dan L. Bader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Peter R. Worsley, DSc, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Dan L Bader
- Nkemjika S. Abiakam, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Hemalatha Jayabal, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Shabira Abbas, PhD, Essity AB, Gothenburg, Sweden
- Davide Filingeri, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Dan L. Bader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Peter R. Worsley, DSc, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Peter R Worsley
- Nkemjika S. Abiakam, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Hemalatha Jayabal, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Shabira Abbas, PhD, Essity AB, Gothenburg, Sweden
- Davide Filingeri, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Dan L. Bader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Peter R. Worsley, DSc, School of Health Sciences, University of Southampton, Southampton, United Kingdom
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McLaren-Kennedy A, Chaboyer W, Thalib L, Latimer S. The effect of head of bed elevation on sacral and heel subepidermal moisture in healthy adults: A randomised crossover study. J Tissue Viability 2023; 32:2-8. [PMID: 36732157 DOI: 10.1016/j.jtv.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/10/2023] [Accepted: 01/26/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Subepidermal moisture (SEM) changes may detect early tissue injury and enhance pressure injury risk assessments. However, little is known how modifiable factors, like head of bed elevation (HOBE), affect SEM. AIM This study investigated the influence of HOBE on sacral and heel SEM, using the Provizio ® SEM Scanner. METHOD A 2 × 2 randomised crossover study compared the effects of 30-min of 30⁰ versus 60⁰ HOBE on sacral and heel SEM in healthy adults. RESULTS 48 participants were randomly allocated to 30⁰ or 60⁰ HOBE and crossed over after a 60-min washout period. The mean age was 40.6 years (SD = 18.3). The study found the sacral and heel SEM values were not statistically different at 30⁰ versus 60⁰ HOBE. No clinically relevant association between SEM and characteristics of age, sex, body mass index and skin type were found. Baseline sacral and heel SEM values recovered after a 60-min washout period. Notably, half of the initial baseline measures suggested pressure injury risk. CONCLUSION The HOBE may not influence SEM at the sacrum and heels, in healthy adults after 30 min of loading. Standard operating procedures for measuring SEM for pressure injury risk assessment require a stronger body of evidence in varied populations and timeframes before this technology is widely adopted. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12622001456741.
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Affiliation(s)
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland and School of Nursing and Midwifery Griffith University, Gold Coast, Australia
| | - Lukman Thalib
- Department of Biostatistics, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey
| | - Sharon Latimer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland and School of Nursing and Midwifery Griffith University, Gold Coast, Australia
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Bone MA, Gillespie BM, Latimer S, Walker RM, Thalib L. Variations in sacral oedema levels over continuous 60-degree head of bed elevation positioning in healthy adults: An observational study. J Tissue Viability 2023; 32:158-162. [PMID: 36369143 DOI: 10.1016/j.jtv.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/27/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Subepidermal moisture (SEM) scanning is a novel technology that measures changes in localised oedema. Accumulation of subepidermal oedema is associated with early tissue damage that may lead to a pressure injury. AIM The primary study objective was to observe the variations in sacral subepidermal oedema levels over a continuous period of 60-degree head of bed elevation positioning. METHODS Healthy adult participants were recruited in this prospective observational study. Participants were positioned at 60-degree head of bed elevation for 120 min and sacral SEM measurements were collected at baseline and in 20 min increments. RESULTS A total of 20 participants with a mean age of 39.3 years (SD = 14.7) were recruited. The mean SEM delta value increased 6.3% from 0.46 SEM delta at baseline to 0.49 SEM delta after 120 min, however these differences are not statistically significant (p = .21). There were also no significant findings between SEM delta variations and demographic factors. CONCLUSION In a sample of healthy individuals, 120 min of continuous loading with a 60-degree head of bed elevation did not lead to a significant change in sacral subepidermal oedema levels. Further research on the response of healthy adult tissue under external forces associated with different angles of head of bed positioning may further contribute to our understanding pressure injury prevention.
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Affiliation(s)
- Madeline A Bone
- NHMRC Wiser Wounds Centre in Research Excellence, Griffith University, Gold Coast, Australia.
| | - Brigid M Gillespie
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Gold Coast University Hospital, Gold Coast, Australia
| | - Sharon Latimer
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Rachel M Walker
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; The Princess Alexandra Hospital, Brisbane, Australia
| | - Lukman Thalib
- Department of Biostatistics, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey
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Ousey K, Stephenson J, Blackburn J. Sub-epidermal moisture assessment as an adjunct to visual assessment in the reduction of pressure ulcer incidence. J Wound Care 2022; 31:208-216. [PMID: 35199598 DOI: 10.12968/jowc.2022.31.3.208] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the effectiveness of sub-epidermal moisture (SEM) assessment technology as an adjunct to visual assessment to reduce pressure ulcer (PU) incidence alongside standard PU care pathways. METHOD Data were obtained from wards located within 28 institutions in the UK, Canada, Belgium, Spain and Ireland. At each ward, the proportion of patients scanned who were observed to have one or more PUs of Category 2 or above during a pre-Pressure Ulcer Reduction Programme (PURP) implementation period starting between November 2017 and July 2018 was recorded. The proportion of patients scanned who were observed to have one or more PUs of Category 2 or above during a post-PURP implementation period starting between November 2018 and July 2019 was also recorded. A meta-analysis was conducted on the data using wards as the unit of analysis, to facilitate overall estimate of the PURP. A sensitivity study was also conducted to assess the sensitivity of results to data from specific institutions. RESULTS A synthesised estimate of the overall relative risk (RR) was calculated to be 0.38 (95% confidence interval 0.26 to 0.56). Hence the risk of PU in the post-PURP cohort was about one-third that of the corresponding risk in the pre-PURP cohort. The sensitivity analysis revealed no evidence that any individual ward exerted excessive influence on the findings. CONCLUSION The analysis has revealed strong evidence that implementation of the PURP was associated with reduction in incidence of Category 2 or above PUs across a wide range of clinical settings.
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Affiliation(s)
- Karen Ousey
- School of Human & Health Sciences, University of Huddersfield, UK.,Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - John Stephenson
- School of Human & Health Sciences, University of Huddersfield, UK.,Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - Joanna Blackburn
- School of Human & Health Sciences, University of Huddersfield, UK.,Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
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