Assessing absorbent products' effectiveness for the prevention and management of incontinence-associated dermatitis caused by urinary, faecal or double adult incontinence: A systematic review

Prevention and care for moisture-associated skin damage: A scoping review

OBJECTIVE

Moisture-associated skin damage (MASD) is an inflammatory skin condition caused by long-term exposure to a moist environment, which can compromise the integrity of the barrier and increase pain. This scoping review aimed to systematically analyze the research status of prevention and care for MASD.

METHODS

We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. PubMed, MEDLINE, Scopus, Web of Science, CINAHL, and the Cochrane Database of Systematic Reviews were searched for relevant articles until March 2023.

RESULTS

Based on eligibility criteria, 34 research studies and review articles were included. The prevalence of MASD varies greatly in different medical environments and patient groups. The high-risk factors included prolonged exposure to excessive water, chemical irritation such as urine or feces, mechanical factors such as friction or improper removal of medical adhesives and local bacterial colonization. Prevention measures mainly include avoiding skin exposure to moisture, skin cleansing, moisturizing and the treatment of secondary bacterial infection.

CONCLUSION

A variety of factors have an impact on MASD. Nurses should select suitable tools to screen high-risk patients and take targeted preventive measures according to the related types of skin injury to reduce the incidence of MASD.

Risk factors of incontinence-associated dermatitis in older adults: a protocol for systematic review and meta-analysis

INTRODUCTION

Due to their ageing skin, older adults are more likely to develop incontinence-associated dermatitis (IAD). Although previous attempts to look at the risk factors for IAD in older adults were done, methodological barriers hindered an in-depth understanding. By investigating risk factors for IAD in the ageing population, the development of precise clinical interventions and guidance could be facilitated, which in turn would enhance patient care standards for incontinence management in this target group. To address this knowledge gap, this systematic review with meta-analysis aims to explore the major risk elements linked to IAD among older adults.

METHODS AND ANALYSIS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols are adhered to in this systematic review and meta-analysis. To achieve its objectives, a comprehensive search strategy PubMed, Embase, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Medline, Chinese Scientific Journal Database (VIP database), WanFang Data Knowledge Service Platform, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, along with other relevant sources published until 18 July 2023 in both English and Chinese languages will be performed. The screening of articles, data abstraction and risk of bias evaluation will be done by two impartial reviewers. RevMan V.5.3 software will be used for data synthesis. The quality of the included study will be assessed using the Newcastle-Ottawa Quality Assessment tool and the Agency for Healthcare Research and Quality. The I 2 test will identify the heterogeneity.

ETHICS AND DISSEMINATION

There is no need for ethical approval. Individual patient information or the rights of participants will not be compromised by this protocol. The findings will either be published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42023442585.

Usability assessment of the MoliCare absorbent continence products by nursing specialists

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.

Skin assessments and interventions for maintaining skin integrity in nursing practice: An umbrella review

BACKGROUND

Daily skin care routines are fundamental aspects of clinical nursing practice. Providing skin care, including skin cleansing and application of leave-on products have substantial impact on the prevention and treatment of a number of skin conditions. There are hundreds of individual studies about skin risks, classifications, skin conditions, prevention and treatment.

OBJECTIVE

To summarise the overall evidence regarding 1) risk factors associated with xerosis cutis, incontinence-associated dermatitis/diaper dermatitis, intertrigo, skin tears, 2) the performance of diagnostic tests and/or classifications addressing the severity and/or signs and symptoms of xerosis cutis, incontinence-associated dermatitis/diaper dermatitis, intertrigo, skin tears, 3) the effects of skin cleansing/care interventions for the maintenance and promotion of skin integrity in all age groups, 4) effects of skin cleansing/care interventions for the prevention of xerosis cutis, incontinence-associated dermatitis/diaper dermatitis, intertrigo, skin tears in all age groups.

DESIGN

Umbrella review.

DATA SOURCES

A systematic search in MEDLINE and Embase (via OvidSP), Cochrane and Epistemonikos was conducted. Reference lists and experts were consulted for potentially missed reviews.

REVIEW METHODS

Two reviewers screened titles/abstracts and full-texts independently. After rating the risk of bias only low to high overall confidence (AMSTAR 2) and low risk of bias (ROBIS) reviews were included.

RESULTS

Twelve systematic reviews were included. Due to substantial heterogeneity regarding study designs, methods, and outcomes all authors presented findings in a narrative synthesis. The validity and reliability of the International Skin Tear Advisory Panel classification is supported by moderate quality evidence, and the reliability and criterion validity for Skin Tear Audit Research were rated insufficient. Overall, review results indicate that structured skin care programs are preferable to unstructured skin care with classic soap and water for maintaining skin integrity in general, preventing skin tears, and to prevent and treat xerosis cutis and incontinence-associated dermatitis. All reviews focusing on leave-on products for the prevention and treatment of incontinence-associated dermatitis and diaper dermatitis indicate the effectiveness of barrier films or lipophilic leave-on products in adults, elderly people and paediatric care, but could not establish the superiority of any product.

CONCLUSIONS

The majority of systematic reviews in the field of skin care is at high risk of bias and should not be used for evidence-based practice. Overall, evidence indicates, that structured skin care programs containing low-irritating cleansers and application of leave-on products are beneficial to maintain skin integrity and prevent skin damage across a wide range of different skin conditions across the life span.

Functionalization Routes for Keratin from Poultry Industry Side-Streams-Towards Bio-Based Absorbent Polymers

Keratin is a largely available protein that can be obtained from the ca. 3 million tons of feathers that the European poultry industry produces as a side-stream. Here, the functionalization of keratin from poultry feathers was evaluated using a one- versus two-stage process using two functionalization agents (succinic anhydride-SA and ethylene dianhydride-EDTAD). The functionalization resulted in the keratin having improved liquid swelling capacities, reaching up to 400%, 300%, and 85% increase in water, saline, and blood, respectively, compared to non-functionalized keratin. The highest swelling was obtained for samples functionalized with EDTAD (one-stage process), while the highest saline uptake was noted for samples processed with 25 wt% SA (two-stage process). Swelling kinetics modeling indicated that the water uptake by the functionalized samples takes place in two steps, and the EDTAD samples showed the highest diffusivity. It is demonstrated that the one-stage functionalization of keratin utilizing EDTAD results in better performance than two-stages, which allows for resource-saving and, thereby, protecting the environment. The results show some potential for the keratin to be utilized as liquid absorbent materials in water, saline, and blood uptake applications. Using keratin from side-streams is an advantage from a sustainability perspective over biomacromolecules that need to be extracted from virgin biomass.

A Human Defecation Prediction Method Based on Multi-Domain Features and Improved Support Vector Machine

The difficulty of defecation seriously affects the quality of life of the bedridden elderly. To solve the problem that it is difficult to know the defecation time of the bedridden elderly, this paper proposed a human pre-defecation prediction method based on multi-domain features and improved support vector machine (SVM) using bowel sound as the original signal. The method includes three stages: multi-domain features extraction, feature optimization, and defecation prediction. In the stage of multi-domain features extraction, statistical analysis, fast Fourier transform (FFT), and wavelet packet transform are used to extract feature information in the time domain, frequency domain, and time-frequency domain. The symmetry of the bowel sound signal in the time domain, frequency domain, and time-frequency domain will change when the human has the urge to defecate. In the feature optimization stage, the Fisher Score (FS) algorithm is introduced to select meaningful and sensitive features according to the importance of each feature, aiming to remove redundant information and improve computational efficiency. In the stage of defecation prediction, SVM is optimized by the gray wolf optimization (GWO) algorithm to realize human defecation prediction. Finally, experimental analysis of the bowel sound data collected during the study is carried out. The experimental result shows that the proposed method could achieve an accuracy of 92.86% in defecation prediction, which proves the effectiveness of the proposed method.

Bacterial invasion into the epidermis of rats with sodium lauryl sulphate-irritated skin increases damage and induces incontinence-associated dermatitis

Incontinence-associated dermatitis (IAD) is caused by prolonged exposure to urine/liquid stool. It is a common and often painful skin condition in older incontinent adults because of poor prevention. Patients with urinary infections are at risk of developing IAD, and to guide the development of novel prevention strategies, we aimed to develop an animal model of IAD by urine and bacteria. First, contralateral sites on the dorsal skin of Sprague-Dawley rats were compromised by sodium lauryl sulphate (SLS), simulating frequent cleansing with soap/water. Filter discs were then placed inside ring-shaped chambers on foam dressings, inoculated with or without Pseudomonas aeruginosa, covered with agarose gels immersed in cultured filtrated urine, and secured in place with an occlusive dressing for 3 days. Untreated and SLS-compromised sites served as controls. The IAD was developed at bacteria-inoculated sites, characterised by severe IAD-like redness that persisted for up to 3 days post-exposure and higher disruption of the skin barrier function compared with non-inoculated sites. Pathological changes included epidermal thickening, partial skin loss, inflammatory cell infiltration, accumulation of red blood cells, and invasion of bacteria into the epidermis. This novel, clinically relevant IAD rat model can serve for future prevention developments.