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Reuvekamp H, Hekman E, van der Heide E, Matthews D. Strategies in surface engineering for the regulation of microclimates in skin-medical product interactions. Heliyon 2024; 10:e25395. [PMID: 38370189 PMCID: PMC10869805 DOI: 10.1016/j.heliyon.2024.e25395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/17/2023] [Accepted: 01/25/2024] [Indexed: 02/20/2024] Open
Abstract
There is a growing number of personal healthcare devices that are in prolonged contact with the skin. The functionality of these products is linked to the interface formed by the contact between the medical apparatus and the skin. The interface can be characterised by its topology, compliance, and moisture and thermal regulating capabilities. Many devices are, however, described to have suboptimal and occlusive contacts, resulting in physiological unfavourable microclimates at the interface. The resulting poor management of moisture and temperature can impact the functionality and utility of the device and, in severe cases, lead to physical harm to the user. Being able to control the microclimate is therefore expected to limit medical-device related injuries and prevent associated skin complications. Surface engineering can modify and potentially enhance the regulation of the microclimate factors surrounding the interface between a product's surface and the skin. This review provides an overview of potential engineering solutions considering the needs for, and influences on, regulation of temperature and moisture by considering the skin-medical device interface as a system. These findings serve as a platform for the anticipated progress in the role of surface engineering for skin-device microclimate regulation.
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Affiliation(s)
- H. Reuvekamp
- Laboratory for Surface Technology and Tribology, Department of Mechanics of Solids, Surfaces and Systems (MS3), Faculty of Engineering Technology, University of Twente, Postbox 217, 7500 AE Enschede, the Netherlands
| | - E.E.G. Hekman
- Biomedical Device Design and Production Lab, Department of Biomechanical Engineering (BE), Faculty of Engineering Technology, University of Twente, Postbox 217, 7500 AE Enschede, the Netherlands
| | - E. van der Heide
- Laboratory for Surface Technology and Tribology, Department of Mechanics of Solids, Surfaces and Systems (MS3), Faculty of Engineering Technology, University of Twente, Postbox 217, 7500 AE Enschede, the Netherlands
| | - D.T.A. Matthews
- Laboratory for Surface Technology and Tribology, Department of Mechanics of Solids, Surfaces and Systems (MS3), Faculty of Engineering Technology, University of Twente, Postbox 217, 7500 AE Enschede, the Netherlands
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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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Abiakam NS, Jayabal H, Filingeri D, Bader DL, Worsley PR. Spatial and temporal changes in biophysical skin parameters over a category I pressure ulcer. Int Wound J 2023; 20:3164-3176. [PMID: 37060199 PMCID: PMC10502241 DOI: 10.1111/iwj.14194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/16/2023] Open
Abstract
In acute care facilities, the detection of pressure ulcers (PUs) relies on visual and manual examination of the patient's skin, which has been reported to be inconsistent and may lead to misdiagnosis. In skin and wound research, various biophysical parameters have been extensively employed to monitor changes in skin health. Nonetheless, the transition of these measures into care settings as part of a routine clinical assessment has been limited. This study was designed to examine the spatial and temporal changes in skin biophysical parameters over the site of a category I PU, in a cohort of hospitalised patients. Thirty patients, each presenting with a category I PU, were enrolled in the study. Skin integrity was assessed at the PU-compromised site and two adjacent areas (5 and 10 cm away). Data was collected over three sessions to examine both temporal differences and longitudinal changes. Skin integrity was assessed using two biophysical parameters, namely, transepidermal water loss (TEWL) and stratum corneum (SC) hydration. In addition, the influence of intrinsic factors, namely, incontinence and mobility status, on the parameters was evaluated. TEWL values at the sites compromised by PU were statistically significantly greater (P < .001) than corresponding values at the adjacent control sites at 5 and 10 cm, which were consistent with a normative range (<20 g/h/m2 ). By contrast, SC hydration values did not reveal clear distinctions between the three sites, with high inter-patient variation detected at the sites. Nevertheless, individual profiles were consistent across the three sessions, and the PU site was observed to be either abnormally dry or overhydrated in different individuals. No consistent temporal trend in either parameter was evident. However, intrinsic factors were shown to influence the parameters, with females, bedridden and incontinent patients presenting significantly higher TEWL and SC hydration values (P < .05). TEWL was able to identify differences in skin responses at skin sites compromised with a category I PU when compared to healthy adjacent skin sites. Accordingly, this parameter could be included in the clinical assessment for the identification of PU risk. Further studies are required to elucidate the role of hydration and skin barrier function in the development of PUs and their ability to monitor temporal changes in skin integrity.
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Affiliation(s)
- Nkemjika S. Abiakam
- Faculty of Environmental and Life Sciences, School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Hemalatha Jayabal
- Faculty of Environmental and Life Sciences, School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Davide Filingeri
- Faculty of Environmental and Life Sciences, School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Dan L. Bader
- Faculty of Environmental and Life Sciences, School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Peter R. Worsley
- Faculty of Environmental and Life Sciences, School of Health SciencesUniversity of SouthamptonSouthamptonUK
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Mugita Y, Koudounas S, Nakagami G, Weller C, Sanada H. Assessing absorbent products' effectiveness for the prevention and management of incontinence-associated dermatitis caused by urinary, faecal or double adult incontinence: A systematic review. J Tissue Viability 2021; 30:599-607. [PMID: 34376333 DOI: 10.1016/j.jtv.2021.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 06/19/2021] [Accepted: 07/11/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Adults who suffer from incontinence are at substantial risk of developing incontinence-associated dermatitis (IAD). In healthcare settings, several interventions have been implemented to prevent or manage IAD, and several absorbent products have been developed for incontinent patients; however, there is no systematic review that has reported on which absorbent products are effective for the prevention or management of incontinence-associated dermatitis. We conducted a systematic review to investigate the effectiveness of absorbent products in the prevention and management of IAD. METHODS MEDLINE (1946-August 31, 2020), CINAHL (1982-August 31, 2020), and Cochrane Library (August 31, 2020) were searched for relevant articles. RESULTS Eight studies met the eligibility criteria and were included in this review, including two randomized controlled trials that were designed to evaluate the efficacy of absorbent products on the prevention or management of incontinence-associated dermatitis. Quality of evidence was assessed as low or very low. The findings revealed that some outcomes related to IAD prevention or improvement of IAD can be positively affected by the introduction of a new absorbent product or a difference in the frequency of pad changing, which can control the overhydration of the skin. CONCLUSIONS The studies included in this review indicated that the problem of control of overhydration of the skin associated with urine and/or faeces can be controlled by absorbent products and these products may be effective for the prevention or management of incontinence-associated dermatitis. Future research with high-quality studies is required.
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Affiliation(s)
- Yuko Mugita
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, 113-0033, Tokyo, Japan.
| | - Sofoklis Koudounas
- Global Nursing Research Centre, Graduate School of Medicine, The University of Tokyo, 113-0033, Tokyo, Japan.
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, 113-0033, Tokyo, Japan; Global Nursing Research Centre, Graduate School of Medicine, The University of Tokyo, 113-0033, Tokyo, Japan.
| | - Carolina Weller
- School of Nursing and Midwifery, Monash University, Melbourne, VIC, 3004, Australia.
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, 113-0033, Tokyo, Japan; Global Nursing Research Centre, Graduate School of Medicine, The University of Tokyo, 113-0033, Tokyo, Japan.
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