1
|
Qi L, Zhao Q, Guo L, Zhao B, Zhang M. Prevention and care for moisture-associated skin damage: A scoping review. J Tissue Viability 2024:S0965-206X(24)00077-9. [PMID: 38906753 DOI: 10.1016/j.jtv.2024.06.002] [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: 07/21/2023] [Revised: 03/14/2024] [Accepted: 06/05/2024] [Indexed: 06/23/2024]
Abstract
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.
Collapse
Affiliation(s)
- Lin Qi
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China; Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Qingsheng Zhao
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China; Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Lianrong Guo
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China; Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Bingnan Zhao
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, China
| | - Min Zhang
- Qilu Hospital of Shandong University, Jinan, Shandong Province, China.
| |
Collapse
|
2
|
Ayik C, Bişgin T, Cenan D, Manoğlu B, Özden D, Sökmen S. Risk factors for early ostomy complications in emergency and elective colorectal surgery: A single-center retrospective cohort study. Scand J Surg 2024; 113:50-59. [PMID: 38041524 DOI: 10.1177/14574969231190291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
BACKGROUND AND AIMS The clinical significance of early ostomy complications has been emphasized worldwide, and the current evidence concerning the impact of emergency or elective surgery on ostomy complications is limited. This study aimed to investigate the effect of elective and emergency colorectal surgery on early ostomy complications and the risk factors associated with specific complications. METHODS A mandatory colorectal recording system for consecutive ostomy patients between 2012 and 2020 was reviewed retrospectively. Patient socio-demographics, ostomy-related variables, and early period ostomy complications were retrieved from the patient records. The chi-square test, t-test, analysis of variance (ANOVA), and logistic regression were used to analyze the data. RESULTS The study cohort included 872 patients. At least one or more complications developed in 573 (65.7%) patients, 356 (63.6%) in the emergency group, and 217 (69.6%) in the elective group. When comparing emergency surgery to elective surgery, necrosis (7.4% versus 3.4%, p = 0.009), mucocutaneous separation (37.2% versus 27.1%, p = 0.002), and bleeding (6.1% versus 2.1%, p = 0.003) were more prevalent. Peristomal irritant contact dermatitis (PICD) (37.3% versus 26%, p < 0.001) was more common in elective surgery. Risk factors for PICD were comorbidity (p = 0.003), malignant disease (p = 0.047), and loop ostomy (p < 0.001) in elective surgery; female sex (p = 0.025), neo-adjuvant therapy (p = 0.024), and ileostomy (p = 0.006) in emergency surgery. The height of the ostomy (less than 10 mm) was a modifiable risk factor for mucocutaneous separation in both elective surgery (p < 0.001) and emergency surgery (p = 0.045). CONCLUSION Early ostomy complications were more likely to occur after emergency colorectal surgery than in an elective setting. Patient- and ostomy-related risk factors for complications differed between elective and emergency surgeries.
Collapse
Affiliation(s)
- Cahide Ayik
- Assistant Professor, Faculty of Nursing, Dokuz Eylul University, Izmir 35330, Turkey
| | - Tayfun Bişgin
- Department of General Surgery, Dokuz Eylul University, Turkey
| | - Deniz Cenan
- Dokuz Eylul University Hospital, Izmir, Turkey
| | - Berk Manoğlu
- Department of General Surgery, Dokuz Eylul University, Izmir, Turkey
| | - Dilek Özden
- Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey
| | - Selman Sökmen
- Department of General Surgery, Dokuz Eylul University, Izmir, Turkey
| |
Collapse
|
3
|
Rodriguez I, Cruz SA, Kim GH, Chiu M. Peristomal verrucous plaque. JAAD Case Rep 2023; 37:82-84. [PMID: 37342402 PMCID: PMC10277283 DOI: 10.1016/j.jdcr.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Affiliation(s)
- Ivan Rodriguez
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Sebastian A. Cruz
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Gene H. Kim
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Melvin Chiu
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| |
Collapse
|
4
|
Xu X, Zhou Y, Huang Y, Le Q, Lin L, Yu Z. Nursing Management of Abdominal Wound Dehiscence of an Infant With Severe Undernutrition and Peristomal Moisture-Associated Dermatitis After Ileostomy Closure: A Case Study. J Wound Ostomy Continence Nurs 2023; 50:331-336. [PMID: 37467414 DOI: 10.1097/won.0000000000000987] [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: 07/21/2023]
Abstract
BACKGROUND Abdominal wound dehiscence (AWD) is a costly postoperative complication; its management is particularly challenging for WOC nurses when it occurs secondary to an ostomy closure. CASE We present a case of AWD secondary to ileostomy closure in Baby Q, a 9-month 19-day-old female infant. A silver wound contact dressing was used on her dehisced wound followed by negative pressure wound therapy and adhesive tape to pull the wound edge together and promote granulation. We used a combination of enteral nutrition, parenteral nutrition, total parenteral nutrition, and total enteral nutrition adjusting the feeding plan stepwise according to her nutritional status. CONCLUSIONS Malnutrition and severe peristomal skin complications may contribute to the risk of AWD in infants undergoing reversal of a temporary ostomy. Assessing and treating nutritional status and peristomal skin is imperative before performing ostomy closure.
Collapse
Affiliation(s)
- Xiaofeng Xu
- Xiaofeng Xu, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Yiwen Zhou, MSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Ying Huang, MD, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Qian Le, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Lili Lin, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Zhuowen Yu, RN, MSN, WON, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yiwen Zhou
- Xiaofeng Xu, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Yiwen Zhou, MSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Ying Huang, MD, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Qian Le, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Lili Lin, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Zhuowen Yu, RN, MSN, WON, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Ying Huang
- Xiaofeng Xu, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Yiwen Zhou, MSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Ying Huang, MD, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Qian Le, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Lili Lin, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Zhuowen Yu, RN, MSN, WON, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Qian Le
- Xiaofeng Xu, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Yiwen Zhou, MSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Ying Huang, MD, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Qian Le, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Lili Lin, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Zhuowen Yu, RN, MSN, WON, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Lili Lin
- Xiaofeng Xu, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Yiwen Zhou, MSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Ying Huang, MD, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Qian Le, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Lili Lin, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Zhuowen Yu, RN, MSN, WON, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Zhuowen Yu
- Xiaofeng Xu, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Yiwen Zhou, MSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Ying Huang, MD, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Qian Le, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Lili Lin, BSN, RN, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Zhuowen Yu, RN, MSN, WON, Department of Gastroenterology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| |
Collapse
|
5
|
Scientific and Clinical Abstracts From WOCNext® 2023: Las Vegas, Nevada ♦ June 4-7, 2023. J Wound Ostomy Continence Nurs 2023; 50:S1-S78. [PMID: 37632270 DOI: 10.1097/won.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
|
6
|
García-Manzanares ME, Lancharro-Bermúdez M, Fernandez-Lasquetty-Blanc B, Hernández-Martínez A, Rodríguez-Almagro J, Caparros-Sanz MR. Assessment, diagnosis and treatment of peristomal skin lesions by remote imaging: An expert validation study. J Adv Nurs 2023; 79:630-640. [PMID: 36394252 PMCID: PMC10100438 DOI: 10.1111/jan.15497] [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: 05/20/2022] [Revised: 09/25/2022] [Accepted: 10/19/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Prevention and treatment of peristomal skin problems should be a priority for nurses caring for ostomates, even when the assessment of lesions must be done remotely. OBJECTIVE To measure the level of agreement on assessment, diagnosis and care indications for peristomal skin lesions using remote imaging among nurses in Spain. DESIGN Prospective observational multicentre study to assess the diagnostic validity and inter- and intraobserver agreement between nurses in peristomal skin lesions. Data were collected between March and October 2019. SETTINGS AND PARTICIPANTS The research sample consisted of a group of 39 nurses with expertise in the care of ostomates. METHODS A panel of experts established a list of 24 common signs/findings, 15 diagnostic options and 35 treatment approaches for peristomal skin lesions. Three expert stoma therapy nurses compiled the clinical cases, which they described thoroughly and documented with photographs. The 39 participating nurses evaluated the cases in two rounds to measure inter and intraobserver agreement. RESULTS A high or very high level of agreement (κ > 0.61) was observed for the following signs: encrustation, nodules, mucocutaneous separation and varicose veins; for the following diagnoses: mucocutaneous dehiscence, allergic contact dermatitis, encrustation and varicose veins (caput medusae); for the following treatments: recommending a diet rich in vitamin C/blueberries, applying acetic acid dressings, applying cold and topical tacrolimus treatment. CONCLUSIONS The most easily identifiable lesions were those most prevalent and with visible signs. There was a lower level of agreement in identifying lesions for which photographs required additional information (laboratory data, description of signs and symptoms, type of diet and level of self-care). It is important to train nurses caring for ostomates to correctly describe ostomy-related lesions, which is important for nursing records, continuity of care and telehealth care.
Collapse
Affiliation(s)
- Maria-Elena García-Manzanares
- Department of Nursing, Hospital Universitario 12 de Octubre. Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Faculty of Nursing, University (Complutense of Madrid), Spain
| | | | | | - Antonio Hernández-Martínez
- Department of Nursing, Physiotherapy, and Occupational Therapy, Ciudad Real Faculty of Nursing, University of Castilla-La Mancha, Ciudad Real, Spain
| | - Julián Rodríguez-Almagro
- Department of Nursing, Physiotherapy, and Occupational Therapy, Ciudad Real Faculty of Nursing, University of Castilla-La Mancha, Ciudad Real, Spain
| | | |
Collapse
|
7
|
Indrebø KL, Aasprang A, Olsen TE, Andersen JR. Factors associated with leakage in patients with an ostomy: A cross-sectional study. Nurs Open 2023; 10:3635-3645. [PMID: 36691880 PMCID: PMC10170928 DOI: 10.1002/nop2.1612] [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: 05/01/2022] [Revised: 11/01/2022] [Accepted: 12/16/2022] [Indexed: 01/25/2023] Open
Abstract
AIMS To explore the associations between sociodemographic and clinical data, the patient's knowledge and skills, and relationship to healthcare professionals with leakage from an ostomy. DESIGN Cross-sectional. METHODS This study included 160 patients with a colostomy, ileostomy, or urostomy. Leakage was the dependent variable and was assessed by self-report. Sociodemographic and clinical data and the Ostomy Adjustment Scale subscores, 'knowledge and skills' and 'health care professionals' were independent variables. Spearman's rho and multivariate partial least squares regression analysis were used to estimate possible factors associated with leakage. RESULTS Of the participants, 13.8% had leakage weekly or more often, 16.3% more often than once a month and 37, 5% had leakage more seldom than once a month. The most important risk factors for leakage were (1) having an ostomy placement that does not meet international guidelines, (2) not having an optimal relationship with health professionals, (3) having a diagnosis other than cancer, (4) not having proper knowledge and skills in ostomy care, (5) not having a colostomy, (6) having a convex baseplate, (7) having an oval ostomy, and (8) being dependent on others for ostomy care. The independent variables in the PLS- model explained 31% of the variance in leakage. PATIENT OR PUBLIC CONTRIBUTION We thank the patients in the user panel for their help during the study.
Collapse
Affiliation(s)
- Kirsten Lerum Indrebø
- Department of Surgery, Førde Central Hospital, Førde, Norway.,Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway
| | - Anny Aasprang
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway.,Centre of Health Research, Førde Hospital Trust, Førde, Norway
| | - Torill Elin Olsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Surgery, Haukeland University Hospital, Bergen, Norway
| | - John Roger Andersen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway.,Centre of Health Research, Førde Hospital Trust, Førde, Norway
| |
Collapse
|
8
|
Michalak J, Spitler C, Simman R, Sharp K, Pei M. Stomal and peristomal complications management: a retrospective study. J Wound Care 2023; 32:35-42. [PMID: 36630115 DOI: 10.12968/jowc.2023.32.1.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Correctly identifying and managing stomal and peristomal complications are key to assisting individuals with an ostomy when they are facing challenges with self-care. Providers that are knowledgeable and experienced with stomal and peristomal care are vital when complications arise. Providing care that is consistent with findings in current high evidence-based literature supports the goal of providing optimal patient outcomes in a timely manner. The objective of this study was to explore stomal and peristomal that presented in an outpatient ostomy clinic and compare these interventions with information found in the literature. METHOD This retrospective study used a sample population of convenience that included adult patients aged ≥18 years who presented for stomal or peristomal complications in an outpatient ostomy clinic in northwest Ohio, US. Electronic medical records were reviewed to determine the presenting stomal or peristomal complication(s) of each patient and treatment was provided or prescribed. The interventions were then compared with information found in the literature. Length of treatment and reasons for referral to the surgeon that created the stoma were also reviewed. RESULTS This study showed that interventions for adult individuals with a stomal or peristomal complications that presented to the clinic were consistent with that found in the literature. This study also sought to deliver information to healthcare providers that may not be directly involved in ostomy care, helping to increase their understanding of problems that patients with an ostomy may experience. CONCLUSION This study showed that interventions completed in this setting where the research took place was consistent with information found in literature.
Collapse
Affiliation(s)
- Jill Michalak
- Jobst Vascular Institute/ProMedica Health System, Toledo, Ohio
| | - Carey Spitler
- Jobst Vascular Institute/ProMedica Health System, Toledo, Ohio
| | - Richard Simman
- Jobst Vascular Institute/ProMedica Health System, Toledo, Ohio.,University of Toledo, General Surgery Department, Toledo, Ohio
| | - Kaitlyn Sharp
- Jobst Vascular Institute/ProMedica Health System, Toledo, Ohio
| | - Mitchell Pei
- University of Toledo, College of Medicine & Life Sciences, Toledo, Ohio
| |
Collapse
|
9
|
MORO G, PRONTERA PP, ALOISI A, GROSSI FS, ANGELINI S, GUALANO A, VITALE E. Incidence and evaluation of early complications affecting the stomal complex of ileostomy and their classification using the S.A.C.S instrument: a single-center retrospective analysis. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.21.05335-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
10
|
Gefen A. The influence zone: a critical performance measure for negative pressure wound therapy systems. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S8-S12. [PMID: 35980923 DOI: 10.12968/bjon.2022.31.15.s8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This article provides an introduction to the theory of, what is termed, the 'influence zone' in the context of negative pressure wound therapy (NPWT). It is a quantitative bioengineering performance measure for NPWT systems, to indicate their effectiveness, namely, how far from the wound bed edges a specific system is able to deliver effective mechano-stimulation into the periwound, and at which intensity. The influence zone therefore provides objective and standardised metrics of one of the fundamental modes of action of NPWT systems: the ability to effectively and optimally deform both the wound and periwound macroscopically and microscopically. Most important is the mechanical deformation of the periwound area to activate cells responsible for tissue repair, particularly (myo)fibroblasts. Notably, the influence zone must extend sufficiently into the periwound to stimulate (myo)fibroblasts in order that they migrate and progress the wound healing process, facilitating the formation of scar tissue, without overstretching the periwound tissues so as not cause or escalate further cell and tissue damage. The inclusion of the influence zone theory within research to investigate the efficacy of NPWT systems facilitates systematic comparisons of commercially available and potentially new systems. This approach has the capacity to guide not only research and development work, but also clinical decision-making. Recently published research found that inducing an effective influence zone first and foremost requires continuous delivery of the intended pressure to the wound bed.
Collapse
Affiliation(s)
- Amit Gefen
- Professor of Biomedical Engineering, The Herbert J Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel
| |
Collapse
|
11
|
Rippon MG, Rogers AA, Ousey K, Atkin L, Williams K. The importance of periwound skin in wound healing: an overview of the evidence. J Wound Care 2022; 31:648-659. [PMID: 36001708 DOI: 10.12968/jowc.2022.31.8.648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
DECLARATION OF INTEREST The authors have no conflicts of interest.
Collapse
Affiliation(s)
| | | | - Karen Ousey
- Institute of Skin Integrity and Infection Prevention, Department of Nursing and Midwifery, University of Huddersfield.,Adjunct Professor, School of Nursing, Faculty of Health at the Queensland University of Technology, Australia.,Visiting Professor, RCSI, Dublin, Ireland
| | | | - Kate Williams
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| |
Collapse
|
12
|
Abstract
OBJECTIVE To establish a consensus on terminology used to define stomal, parastomal, and peristomal complications in Australia. METHODS A list of stomal, parastomal, and peristomal complications was generated through group dialogue, which was informed by clinical and academic knowledge of the researchers. An extensive literature review was undertaken to identify any additional terms and to create a database of definitions/descriptions. A library of images related to the identified conditions was generated. An online Delphi process was conducted among a representative, purposive sample of Australia expert wound, ostomy, and continence nurses and colorectal surgeons. Ten terms were presented to the panel with descriptive photographs of each complication. Up to three Delphi rounds and, if necessary, a priority voting round were conducted. RESULTS Seven of the 10 terms reached agreement in the first round. One term ( allergic dermatitis ) was refined ( allergic contact dermatitis ) and reached agreement in the second round. Two terms ( mucocutaneous granuloma and mucosal granuloma ) were considered by the panel to be the same condition in different anatomical locations and were combined as one term ( granuloma ). Two terms ( skin stripping and tension blisters ) were combined as one term ( medical adhesive-related skin injury ) and reached agreement in round 2. CONCLUSIONS A consensus in terminology used to describe stomal or parastomal/peristomal complications will enhance communication among patients and health professionals and advance opportunities for education and benchmarking of stomal, parastomal, and peristomal complications nationally.
Collapse
|
13
|
Orlov A, Gefen A. Effective negative pressure wound therapy for open wounds: The importance of consistent pressure delivery. Int Wound J 2022; 20:328-344. [PMID: 35818745 PMCID: PMC9885467 DOI: 10.1111/iwj.13879] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/14/2022] [Indexed: 02/03/2023] Open
Abstract
Two distinct design concepts exist for single-use negative pressure wound therapy systems: Canister-based versus canisterless. The canister-based technology provides intrinsic stable delivery of the intended negative pressure, because exudate is constantly transferred from the wound into a canister, thereby preventing dressing saturation. In contrast, with a canisterless system, where delivery of the negative pressure depends on continuous evaporation of wound fluids from its dressing, loss of the intended wound-bed pressure may occur due to dressing saturation. To investigate whether these two designs differ in their mechanobiological effect with respect to magnitudes and distributions of tissue strain fields under the absorptive dressing, termed the influence zone, we integrated computational modelling with an animal study. This influence zone must be of biologically influential strain levels and extend sufficiently into the peri-wound for stimulating fibroblasts to migrate and progress the healing. We found that an effective influence zone requires continuous delivery of the intended pressure to the wound-bed. Loss of negative pressure at the wound-bed below 40 mmHg adversely lowered the peri-wound stimulation around a 120 × 70 mm sized wound to less than one-third of the baseline stimulation, and further pressure decreases to 20 mmHg or lower resulted in complete lack of peri-wound mechano-stimulation.
Collapse
Affiliation(s)
- Aleksei Orlov
- Department of Biomedical Engineering, Faculty of EngineeringTel Aviv UniversityTel AvivIsrael
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of EngineeringTel Aviv UniversityTel AvivIsrael
| |
Collapse
|
14
|
Tuca AC, Bernardelli de Mattos I, Funk M, Winter R, Palackic A, Groeber-Becker F, Kruse D, Kukla F, Lemarchand T, Kamolz LP. Orchestrating the Dermal/Epidermal Tissue Ratio during Wound Healing by Controlling the Moisture Content. Biomedicines 2022; 10:biomedicines10061286. [PMID: 35740308 PMCID: PMC9219632 DOI: 10.3390/biomedicines10061286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 01/13/2023] Open
Abstract
A balanced and moist wound environment and surface increases the effect of various growth factors, cytokines, and chemokines, stimulating cell growth and wound healing. Considering this fact, we tested in vitro and in vivo water evaporation rates from the cellulose dressing epicitehydro when combined with different secondary dressings as well as the resulting wound healing efficacy in a porcine donor site model. The aim of this study was to evaluate how the different rates of water evaporation affected wound healing efficacy. To this end, epicitehydro primary dressing, in combination with different secondary dressing materials (cotton gauze, JELONET◊, AQUACEL® Extra ™, and OPSITE◊ Flexifix), was placed on 3 × 3 cm-sized dermatome wounds with a depth of 1.2 mm on the flanks of domestic pigs. The healing process was analyzed histologically and quantified by morphometry. High water evaporation rates by using the correct secondary dressing, such as cotton gauze, favored a better re-epithelialization in comparison with the low water evaporation resulting from an occlusive secondary dressing, which favored the formation of a new and intact dermal tissue that nearly fully replaced all the dermis that was removed during wounding. This newly available evidence may be of great benefit to clinical wound management.
Collapse
Affiliation(s)
- Alexandru-Cristian Tuca
- Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, 8036 Graz, Austria; (R.W.); (A.P.); (L.-P.K.)
- Correspondence: ; Tel.: +43-316-385-30742
| | - Ives Bernardelli de Mattos
- Department Tissue Engineering & Regenerative Medicine (TERM), University Hospital Würzburg, 97080 Würzburg, Germany; (I.B.d.M.); (F.G.-B.); (D.K.)
| | | | - Raimund Winter
- Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, 8036 Graz, Austria; (R.W.); (A.P.); (L.-P.K.)
| | - Alen Palackic
- Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, 8036 Graz, Austria; (R.W.); (A.P.); (L.-P.K.)
| | - Florian Groeber-Becker
- Department Tissue Engineering & Regenerative Medicine (TERM), University Hospital Würzburg, 97080 Würzburg, Germany; (I.B.d.M.); (F.G.-B.); (D.K.)
- Translational Center Regenerative Therapies, Fraunhofer Institute for Silicate Research ISC, 97080 Würzburg, Germany
| | - Daniel Kruse
- Department Tissue Engineering & Regenerative Medicine (TERM), University Hospital Würzburg, 97080 Würzburg, Germany; (I.B.d.M.); (F.G.-B.); (D.K.)
| | - Fabian Kukla
- TPL Path Labs GmbH, 79111 Freiburg, Germany; (F.K.); (T.L.)
| | | | - Lars-Peter Kamolz
- Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, 8036 Graz, Austria; (R.W.); (A.P.); (L.-P.K.)
- Joanneum Research Forschungsgesellschaft mbH, COREMED, 8036 Graz, Austria
| |
Collapse
|
15
|
McNichol L, Bliss DZ, Gray M. Moisture-Associated Skin Damage: Expanding Practice Based on the Newest ICD-10-CM Codes for Irritant Contact Dermatitis Associated With Digestive Secretions and Fecal or Urinary Effluent From an Abdominal Stoma or Enterocutaneous Fistula. J Wound Ostomy Continence Nurs 2022; 49:235-239. [PMID: 35523238 PMCID: PMC9093722 DOI: 10.1097/won.0000000000000873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Moisture-associated skin damage (MASD) occurs when skin is repeatedly exposed to various sources of bodily secretions or effluents, often leading to irritant contact dermatitis, characterized by inflammation with or without denudation of affected skin. In 2020, the Wound, Ostomy and Continence Nurses Society commissioned an initiative that led to the addition of multiple International Classification of Diseases, Tenth Revision, Clinical Modification codes (ICD-10-CM) for irritant contact dermatitis caused by various forms of MASD for use in the United States. In a recent issue of the Journal of Wound, Ostomy and Continence Nursing, a clinical practice alert identifying the various new codes was published that summarized each of the new codes and provided highlights of the descriptions for each of these codes. This is the second in a series of 2 follow-up articles providing a more detailed description of the MASD conditions to which the newest irritant contact dermatitis ICD-10-CM codes apply. Specifically, this article reviews the clinical manifestations and assessment, pathophysiology, epidemiology, prevention, and management of irritant contact dermatitis associated with digestive secretions from a stoma or fistula, and fecal or urinary effluent from an abdominal stoma or enterocutaneous fistula.
Collapse
Affiliation(s)
- Laurie McNichol
- Correspondence: Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, FAAN, 11 Bluff Ridge Court, Greensboro, NC 27455 ()
| | - Donna Z. Bliss
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, FAAN, WOC Nurse, Cone Health, Greensboro, North Carolina
- Donna Z. Bliss, PhD, RN, FGSA, FAAN, University of Minnesota School of Nursing, Minneapolis
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, Charlottesville
| | - Mikel Gray
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, FAAN, WOC Nurse, Cone Health, Greensboro, North Carolina
- Donna Z. Bliss, PhD, RN, FGSA, FAAN, University of Minnesota School of Nursing, Minneapolis
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, Charlottesville
| |
Collapse
|
16
|
Gray M, Bliss DZ, McNichol L. Moisture-Associated Skin Damage: Expanding and Updating Practice Based on the Newest ICD-10-CM Codes. J Wound Ostomy Continence Nurs 2022; 49:143-151. [PMID: 35255065 DOI: 10.1097/won.0000000000000865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Moisture-associated skin damage (MASD) occurs when skin is repeatedly exposed to various sources of bodily secretions or effluents, often leading to irritant contact dermatitis with inflammation, with or without denudation of affected skin. In 2020, the Wound, Ostomy and Continence Nurses Society took an initiative that led to the addition of multiple International Classification for Diseases codes for irritant contract dermatitis caused by various forms of MASD for use in the United States (ICD-10-CM). In the last issue of the Journal of Wound, Ostomy and Continence Nursing, a clinical practice alert identifying the various new codes was published that summarized each of the new codes and provided highlights of the descriptions of each of the these codes. This is the first in a series of 2 articles providing a more detailed description of the newest irritant contact dermatitis codes linked to MASD. Specifically, this article reviews the clinical manifestations and assessment, pathophysiology, epidemiology, prevention, and management of irritant contact dermatitis due to saliva, respiratory secretions, and fecal or urinary incontinence.
Collapse
Affiliation(s)
- Mikel Gray
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, Charlottesville
- Donna Z. Bliss, PhD, RN, FGSA, FAAN, University of Minnesota School of Nursing, Minneapolis
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, FAAN, WOC Nurse, Cone Health, Greensboro, North Carolina
| | - Donna Z Bliss
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, Charlottesville
- Donna Z. Bliss, PhD, RN, FGSA, FAAN, University of Minnesota School of Nursing, Minneapolis
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, FAAN, WOC Nurse, Cone Health, Greensboro, North Carolina
| | - Laurie McNichol
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, Charlottesville
- Donna Z. Bliss, PhD, RN, FGSA, FAAN, University of Minnesota School of Nursing, Minneapolis
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, FAAN, WOC Nurse, Cone Health, Greensboro, North Carolina
| |
Collapse
|
17
|
Brogna L. Prevention and Management of Pseudoverrucous Lesions: A Review and Case Scenarios. Adv Skin Wound Care 2021; 34:461-471. [PMID: 34415250 DOI: 10.1097/01.asw.0000758620.93518.39] [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: 11/25/2022]
Abstract
GENERAL PURPOSE To present the associated risk factors, prevention measures, and assessment and management of pseudoverrucous lesions specific to a surgically created ileal conduit, as well as three clinical scenarios illustrating this condition. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Define pseudoverrucous lesions.2. Identify the risk factors for stoma complications such as pseudoverrucous lesions.3. Select the appropriate routine care procedures to teach patients following stoma creation to help prevent pseudoverrucous lesions.4. Choose the recommended treatment options for patients who develop pseudoverrucous lesions.
Collapse
Affiliation(s)
- Luanne Brogna
- Certified Wound Ostomy Continence Nurse, Hackensack University Medical Center, Hackensack, New Jersey
| |
Collapse
|
18
|
Abstract
The Wound, Ostomy, and Continence Nurses (WOCN) Society identified the need to define and promote peristomal skin health. A task force was appointed to complete a scoping literature review, to develop evidence-based statements to guide peristomal skin health best practices. Based on the findings of the scoping review, the Society convened a panel of experts to develop evidence- and consensus-based statements to guide care in promoting peristomal skin health. These consensus statements also underwent content validation using a different panel of clinicians having expertise in peristomal skin health. This article reports on the scoping review and subsequent 6 evidenced-based statements, along with the generation and validation of 19 consensus-based statements, to assist clinical decision-making related to promoting peristomal skin health in adults.
Collapse
|
19
|
Dissemond J, Assenheimer B, Gerber V, Hintner M, Puntigam MJ, Kolbig N, Koller S, Kurz P, Läuchli S, Probst S, Protz K, Steiniger A, Strohal R, Traber J, Kottner J. Flüssigkeits‐assoziierte Hautschäden (FAH): Eine
Best Practice
Empfehlung von Wund‐D.A.CH. J Dtsch Dermatol Ges 2021; 19:815-827. [PMID: 34139095 DOI: 10.1111/ddg.14388_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/01/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Joachim Dissemond
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum, Essen, Deutschland
| | - Bernd Assenheimer
- Schule für Pflegeberufe, Universitätsklinikum, Tübingen, Deutschland
| | - Veronika Gerber
- Schulung und Beratung im Wundmanagement, Spelle, Deutschland
| | | | | | - Norbert Kolbig
- Stabstelle Wundmanagement, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | | | - Peter Kurz
- WPM Wund Pflege Management, Bad Pirawarth, Österreich
| | | | | | - Kerstin Protz
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, CWC - Comprehensive Wound Center, Universitätsklinikum Hamburg, Hamburg, Deutschland
| | | | - Robert Strohal
- Abteilung für Dermatologie und Venerologie, Landeskrankenhaus Feldkirch, Feldkirch, Österreich
| | - Jürg Traber
- Chirurgie/Gefässchirurgie FEBVS, Phlebologie SGP, Venenklinik Bellevue, Kreuzlingen, Schweiz
| | - Jan Kottner
- CharitéCentrum 1 für Human- und Gesundheitswissenschaften, Charité -Universitätsmedizin Berlin, Berlin, Deutschland
| |
Collapse
|
20
|
Quigley M, Hannigan A, Dowling C, Stuart A, McGovern S, Untoy L, Joyce M, Larkin J, Kavanagh D. Evaluation of a Novel Ostomy Barrier Ring with Assisted Flow for Individuals with an Ileostomy. Adv Skin Wound Care 2021; 34:1-5. [PMID: 33660660 DOI: 10.1097/01.asw.0000734368.48756.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the performance and user experience of a novel ostomy barrier ring over a 4-week period. METHODS This single-arm investigation conducted across three clinical sites included 25 adult participants with an ileostomy for 3 months or longer. The participants used their standard ostomy pouching appliance along with a novel barrier ring for a period of 4 weeks. Skin condition was assessed using the Ostomy Skin Tool. Change in skin condition over the study period was recorded for each participant. The participants' experience in using the novel barrier ring was measured using a five-point Likert-type scale. RESULTS Twenty of the 25 participants (80%) completed the trial. Of those participants, the median Ostomy Skin Tool score at both the beginning (range, 0-8) and end was 0 (range, 0-6). In terms of skin condition, 7 participants experienced an improvement in skin condition, 11 experienced no change, and 2 got worse. A median score of 5 out of 5 was recorded for all questions relating to user experience. CONCLUSIONS Although not statistically significant, there was a clear trend toward improvements in peristomal skin condition using the novel barrier ring, even for participants who were already using a barrier ring. User feedback was positive with respect to comfort, device handling, and the perception of the device's ability to protect the skin. Further, most participants who already used a barrier ring indicated that the novel barrier ring would result in a longer wear time.
Collapse
Affiliation(s)
- Mary Quigley
- Mary Quigley, CNS, is Stoma Nurse, Stoma Department, University Hospital, Galway, Ireland. Ailish Hannigan, PhD, BSc, is Professor of Biomedical Statistics, Graduate Entry Medical School, University of Limerick. At St James Hospital, Dublin, Catherine Dowling, CNS; AnneMarie Stuart, CNS; and Siobhan McGovern, CNS, are Stoma Nurses. Larry Untoy, CNS, is Stoma Nurse, Stoma Department, Tallaght University Hospital, Dublin. Myles Joyce, MD, MMedSci, FRCS (Gen), is Colorectal Surgeon, Department of Colorectal Surgery, University Hospital, Galway. John Larkin, PhD, FRCSI, is Colorectal Surgeon, Department of Surgery, St James Hospital. Dara Kavanagh, MCh, FRCSI, is Colorectal Surgeon, Department of Surgery, Tallaght University Hospital. The authors have disclosed no financial relationships related to this article. Submitted February 22, 2020; accepted in revised form April 7, 2020
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Dissemond J, Assenheimer B, Gerber V, Hintner M, Puntigam MJ, Kolbig N, Koller S, Kurz P, Läuchli S, Probst S, Protz K, Steiniger A, Strohal R, Traber J, Kottner J. Moisture-associated skin damage (MASD): A best practice recommendation from Wund-D.A.CH. J Dtsch Dermatol Ges 2021; 19:815-825. [PMID: 33942514 DOI: 10.1111/ddg.14388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
Wund-D.A.CH., as the umbrella organization of German-speaking wound treatment societies, has currently developed a best practice recommendation for skin damage caused by body fluids, which is known as moisture-associated skin damage (MASD) in English-speaking countries. In this expert consensus, the diseases incontinence-associated dermatitis (IAD), intertriginous dermatitis, including intertrigo, gram-negative bacterial toe web infection and toxic contact dermatitis, including periwound and peristomal dermatitis are presented in a differentiated manner. A common feature of these clinical diseases is a deterioration of skin integrity due to prolonged exposure to body fluids such as urine, stool, sweat or wound exudate with associated physical-irritative and/or chemical irritation. In addition, other comorbidities and cofactors play an important role. The diagnosis of these interdisciplinary and interprofessionally relevant MASD is difficult in everyday clinical practice because there are currently no uniform definitions and many relevant differential diagnoses. Effective strategies for the prevention and therapy of these skin diseases are, for example, continence management, use of efficient, absorbent aids with good retention as well as consistent skin protection and adequate skin care. Another important aspect is the education of patients and relatives about the origin, treatment and prevention of MASD.
Collapse
Affiliation(s)
- Joachim Dissemond
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Germany
| | | | - Veronika Gerber
- Training and Consulting for Wound Management, Spelle, Germany
| | | | | | - Norbert Kolbig
- Office for Wound Management, University Hospital Düsseldorf, Germany
| | | | - Peter Kurz
- WPM Wound Care Management, Bad Pirawarth, Austria
| | - Severin Läuchli
- Dermatology Department, University Hospital, Zurich, Switzerland
| | | | - Kerstin Protz
- Institute for Health Services Research in Dermatology and Nursing, CWC - Comprehensive Wound Center, University Hospital Hamburg, Germany
| | | | - Robert Strohal
- Department of Dermatology and Venereology, State Hospital Feldkirch, Austria
| | - Jürg Traber
- Surgery/Vascular Surgery FEBVS, Phlebology SGP, Vein Hospital Bellevue, Kreuzlingen, Switzerland
| | - Jan Kottner
- Charité Centrum 1 for Human and Health Sciences, Charité -University Hospital Berlin, Germany
| |
Collapse
|
22
|
Roveron G, Barbierato M, Rizzo G, Parini D, Bondurri A, Veltri M, Pata F, Cattaneo F, Tafuri A, Forni C, Ferrara F. Italian Guidelines for the Nursing Management of Enteral and Urinary Stomas in Adults: An Executive Summary. J Wound Ostomy Continence Nurs 2021; 48:137-147. [PMID: 33690248 DOI: 10.1097/won.0000000000000745] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This article is an executive summary of Italian guidelines for nursing management of enteral and urinary ostomies in adults. METHODS Scoping review and generation of evidence and consensus-based clinical guidelines. SEARCH STRATEGY The Multidisciplinary Italian Study group for STOmas (MISSTO) was founded in 2018. This group created guidelines for management of enteral and urinary ostomies in adults based on a scoping review of the literature. The research included previous guidelines, systematic reviews, meta-analyses, randomized clinical trials, cohort studies, and case reports. Five main topics were identified: "stoma preparation," "stoma creation," "stoma complications," "stoma care," and "stoma reversal" (for enteral stomas)." All the studies were evaluated according to the GRADE system and AGREE II tool. Recommendations were elaborated in the form of statements, with an established grade of recommendation for each statement. For low levels of scientific evidence statements, a consensus conference composed of expert members of the major Italian scientific societies in the field of stoma management and care discussed, corrected, validated, or eliminated the statements. A final version of the guidelines with definitive recommendations was elaborated and prepared for publication. FINDINGS/CONCLUSIONS This document represents the first Italian guidelines on enteral and urinary stoma management to assist nurses caring for persons with an enteral or urinary ostomy.
Collapse
Affiliation(s)
- Gabriele Roveron
- Gabriele Roveron, RN, Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy
- Maria Barbierato, RN, Ostomy Centre, Azienda Ospedaliera di Padova, Padova, Italy
- Gianluca Rizzo, MD, Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dario Parini, MD, General Surgery Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
- Andrea Bondurri, MD , Department of General Surgery, Luigi Sacco University Hospital, ASST FBF-Sacco, Milan, Italy
- Marco Veltri, MD, General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
- Francesco Pata, MD, General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- Francesco Cattaneo, MD, Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Italy
- Alessandro Tafuri, MD , Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona Italy
- Cristiana Forni, RN , Nursing and Allied Profession Research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Francesco Ferrara, MD, Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Maria Barbierato
- Gabriele Roveron, RN, Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy
- Maria Barbierato, RN, Ostomy Centre, Azienda Ospedaliera di Padova, Padova, Italy
- Gianluca Rizzo, MD, Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dario Parini, MD, General Surgery Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
- Andrea Bondurri, MD , Department of General Surgery, Luigi Sacco University Hospital, ASST FBF-Sacco, Milan, Italy
- Marco Veltri, MD, General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
- Francesco Pata, MD, General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- Francesco Cattaneo, MD, Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Italy
- Alessandro Tafuri, MD , Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona Italy
- Cristiana Forni, RN , Nursing and Allied Profession Research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Francesco Ferrara, MD, Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Gianluca Rizzo
- Gabriele Roveron, RN, Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy
- Maria Barbierato, RN, Ostomy Centre, Azienda Ospedaliera di Padova, Padova, Italy
- Gianluca Rizzo, MD, Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dario Parini, MD, General Surgery Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
- Andrea Bondurri, MD , Department of General Surgery, Luigi Sacco University Hospital, ASST FBF-Sacco, Milan, Italy
- Marco Veltri, MD, General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
- Francesco Pata, MD, General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- Francesco Cattaneo, MD, Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Italy
- Alessandro Tafuri, MD , Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona Italy
- Cristiana Forni, RN , Nursing and Allied Profession Research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Francesco Ferrara, MD, Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Dario Parini
- Gabriele Roveron, RN, Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy
- Maria Barbierato, RN, Ostomy Centre, Azienda Ospedaliera di Padova, Padova, Italy
- Gianluca Rizzo, MD, Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dario Parini, MD, General Surgery Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
- Andrea Bondurri, MD , Department of General Surgery, Luigi Sacco University Hospital, ASST FBF-Sacco, Milan, Italy
- Marco Veltri, MD, General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
- Francesco Pata, MD, General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- Francesco Cattaneo, MD, Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Italy
- Alessandro Tafuri, MD , Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona Italy
- Cristiana Forni, RN , Nursing and Allied Profession Research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Francesco Ferrara, MD, Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Andrea Bondurri
- Gabriele Roveron, RN, Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy
- Maria Barbierato, RN, Ostomy Centre, Azienda Ospedaliera di Padova, Padova, Italy
- Gianluca Rizzo, MD, Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dario Parini, MD, General Surgery Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
- Andrea Bondurri, MD , Department of General Surgery, Luigi Sacco University Hospital, ASST FBF-Sacco, Milan, Italy
- Marco Veltri, MD, General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
- Francesco Pata, MD, General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- Francesco Cattaneo, MD, Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Italy
- Alessandro Tafuri, MD , Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona Italy
- Cristiana Forni, RN , Nursing and Allied Profession Research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Francesco Ferrara, MD, Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Marco Veltri
- Gabriele Roveron, RN, Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy
- Maria Barbierato, RN, Ostomy Centre, Azienda Ospedaliera di Padova, Padova, Italy
- Gianluca Rizzo, MD, Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dario Parini, MD, General Surgery Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
- Andrea Bondurri, MD , Department of General Surgery, Luigi Sacco University Hospital, ASST FBF-Sacco, Milan, Italy
- Marco Veltri, MD, General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
- Francesco Pata, MD, General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- Francesco Cattaneo, MD, Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Italy
- Alessandro Tafuri, MD , Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona Italy
- Cristiana Forni, RN , Nursing and Allied Profession Research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Francesco Ferrara, MD, Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Francesco Pata
- Gabriele Roveron, RN, Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy
- Maria Barbierato, RN, Ostomy Centre, Azienda Ospedaliera di Padova, Padova, Italy
- Gianluca Rizzo, MD, Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dario Parini, MD, General Surgery Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
- Andrea Bondurri, MD , Department of General Surgery, Luigi Sacco University Hospital, ASST FBF-Sacco, Milan, Italy
- Marco Veltri, MD, General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
- Francesco Pata, MD, General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- Francesco Cattaneo, MD, Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Italy
- Alessandro Tafuri, MD , Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona Italy
- Cristiana Forni, RN , Nursing and Allied Profession Research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Francesco Ferrara, MD, Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Francesco Cattaneo
- Gabriele Roveron, RN, Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy
- Maria Barbierato, RN, Ostomy Centre, Azienda Ospedaliera di Padova, Padova, Italy
- Gianluca Rizzo, MD, Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dario Parini, MD, General Surgery Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
- Andrea Bondurri, MD , Department of General Surgery, Luigi Sacco University Hospital, ASST FBF-Sacco, Milan, Italy
- Marco Veltri, MD, General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
- Francesco Pata, MD, General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- Francesco Cattaneo, MD, Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Italy
- Alessandro Tafuri, MD , Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona Italy
- Cristiana Forni, RN , Nursing and Allied Profession Research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Francesco Ferrara, MD, Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Alessandro Tafuri
- Gabriele Roveron, RN, Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy
- Maria Barbierato, RN, Ostomy Centre, Azienda Ospedaliera di Padova, Padova, Italy
- Gianluca Rizzo, MD, Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dario Parini, MD, General Surgery Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
- Andrea Bondurri, MD , Department of General Surgery, Luigi Sacco University Hospital, ASST FBF-Sacco, Milan, Italy
- Marco Veltri, MD, General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
- Francesco Pata, MD, General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- Francesco Cattaneo, MD, Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Italy
- Alessandro Tafuri, MD , Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona Italy
- Cristiana Forni, RN , Nursing and Allied Profession Research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Francesco Ferrara, MD, Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Cristiana Forni
- Gabriele Roveron, RN, Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy
- Maria Barbierato, RN, Ostomy Centre, Azienda Ospedaliera di Padova, Padova, Italy
- Gianluca Rizzo, MD, Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dario Parini, MD, General Surgery Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
- Andrea Bondurri, MD , Department of General Surgery, Luigi Sacco University Hospital, ASST FBF-Sacco, Milan, Italy
- Marco Veltri, MD, General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
- Francesco Pata, MD, General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- Francesco Cattaneo, MD, Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Italy
- Alessandro Tafuri, MD , Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona Italy
- Cristiana Forni, RN , Nursing and Allied Profession Research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Francesco Ferrara, MD, Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Francesco Ferrara
- Gabriele Roveron, RN, Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy
- Maria Barbierato, RN, Ostomy Centre, Azienda Ospedaliera di Padova, Padova, Italy
- Gianluca Rizzo, MD, Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dario Parini, MD, General Surgery Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
- Andrea Bondurri, MD , Department of General Surgery, Luigi Sacco University Hospital, ASST FBF-Sacco, Milan, Italy
- Marco Veltri, MD, General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
- Francesco Pata, MD, General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- Francesco Cattaneo, MD, Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Italy
- Alessandro Tafuri, MD , Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona Italy
- Cristiana Forni, RN , Nursing and Allied Profession Research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Francesco Ferrara, MD, Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| |
Collapse
|
23
|
Mitchell A, Hill B. Moisture-associated skin damage: an overview of its diagnosis and management. Br J Community Nurs 2020; 25:S12-S18. [PMID: 32160066 DOI: 10.12968/bjcn.2020.25.sup3.s12] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This educational article introduces an explores moisture-associated skin damage (MASD) and the four forms it manifests as, namely, incontinence-associated dermatitis; intertriginous dermatitis; peristomal moisture-associated dermatitis; and peri-wound moisture-associated dermatitis. The aetiology and predisposing factors of each form are critically discussed, in addition to the treatments and interventions that can be used by nurses to support patient recovery. Nurses and other health professionals working with patients who are at risk of skin damage or who already require wound care, must be knowledgeable about all aspects of MASD. Fortunately, a plethora of evidence-based literature exists to support health professionals in their practice, although validated assessment and recording tools for incontinence-associated dermatitis are limited.
Collapse
Affiliation(s)
| | - Barry Hill
- Director of Employability, Nursing, Midwifery and Health; Programme Leader, Adult Nursing, Northumbria University
| |
Collapse
|
24
|
Cornell G, Hardy MK, Wilson J. Persistent venous leg ulcers complicated by linear morphea: a case report. J Wound Care 2020; 29:S14-S20. [DOI: 10.12968/jowc.2020.29.sup9.s14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Soft tissue ulceration resulting from chronic venous insufficiency is a common condition that requires standardised long-term therapy, which has been thoroughly established. We report a patient with a five-year history of persistent venous stasis ulcers despite treatment consistent with traditional wound care. Resolution of the ulcers began only upon deviation from conventional therapy. This report considers non-standard treatments in patients with venous ulcers that do not progress.
Collapse
Affiliation(s)
- Georgeanne Cornell
- Department of Internal Medicine, The University of Missouri-Kansas City, Kansas City, MO, US
| | | | - Jonathon Wilson
- Midwest Aortic and Vascular Institute, North Kansas City, MO, US
| |
Collapse
|
25
|
Voegeli D. Prevention and management of moisture-associated skin damage. Nurs Stand 2020; 34:77-82. [PMID: 31468844 DOI: 10.7748/ns.2019.e11314] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2018] [Indexed: 02/06/2023]
Abstract
The harmful effects of excessive moisture on a patient's skin are well known. While traditionally considered an issue only encountered in continence care and older people, it is now recognised that the harmful effects of excessive moisture can occur across the lifespan and in various patient groups. The term 'moisture-associated skin damage' describes the spectrum of inflammatory damage that occurs in response to the prolonged exposure of a patient's skin to perspiration, urine, faeces or wound exudate. It is generally accepted that moisture-associated skin damage consists of four conditions: incontinence-associated dermatitis, intertrigo, peristomal moisture-associated dermatitis, and periwound moisture-associated dermatitis. This article describes the aetiologies of each of the different types of moisture-associated skin damage, and outlines the nursing interventions required for their prevention and management.
Collapse
|
26
|
Jiang Q, Song S, Zhou J, Liu Y, Chen A, Bai Y, Wang J, Jiang Z, Zhang Y, Liu H, Hua J, Guo J, Han Q, Tang Y, Xue J. The Prevalence, Characteristics, and Prevention Status of Skin Injury Caused by Personal Protective Equipment Among Medical Staff in Fighting COVID-19: A Multicenter, Cross-Sectional Study. Adv Wound Care (New Rochelle) 2020; 9:357-364. [PMID: 32320359 PMCID: PMC7307701 DOI: 10.1089/wound.2020.1212] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 04/15/2020] [Indexed: 01/08/2023] Open
Abstract
Objective: To investigate the prevalence, characteristics, and preventive status of skin injuries caused by personal protective equipment (PPE) in medical staff. Approach: A cross-sectional survey was conducted online for understanding skin injuries among medical staff fighting COVID-19 in February 8-22, 2020. Participants voluntarily answered and submitted the questionnaire with cell phone. The questionnaire items included demographic data, grade of PPE and daily wearing time, skin injury types, anatomical sites, and preventive measures. Univariable analyses and logistic regression analyses were used to explore the risk factors associated with skin injuries. Results: A total of 4,308 respondents were collected from 161 hospitals and 4,306 respondents were valid. The overall prevalence of skin injuries was 42.8% (95% confidence interval [CI] 41.30-44.30) with three types of device-related pressure injuries, moist-associated skin damage, and skin tear. Co-skin injuries and multiple location injuries were 27.4% and 76.8%, respectively. The logistic regression analysis indicated that sweating (95% CI for odds ratio [OR] 87.52-163.11), daily wearing time (95% CI for OR 1.61-3.21), male (95% CI for OR 1.11-2.13), and grade 3 PPE (95% CI for OR 1.08-2.01) were associated with skin injuries. Only 17.7% of respondents took prevention and 45.0% of skin injuries were treated. Innovation: This is the first cross-sectional survey to understand skin injuries in medical staff caused by PPE, which is expected to be a benchmark. Conclusion: The skin injuries among medical staff are serious, with insufficient prevention and treatment. A comprehensive program should be taken in the future.
Collapse
Affiliation(s)
- Qixia Jiang
- Department of Burns and Plastic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Siping Song
- Wound Care Center of Outpatient Department, Medical School of Nanjing University, Nanjing, China
| | - Jihong Zhou
- Department of Burns and Plastic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yuxiu Liu
- Department of Medical Statistics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Aihua Chen
- Department of Anorectal Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yuxuan Bai
- Clinical Academic Department, Zhejiang Top-Medical Dressing Co., Ltd., Wenzhou, China
| | - Jing Wang
- Nursing Department, Yangpu District Central Hospital Shanghai, Shanghai, China
| | - Zhixia Jiang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yanhong Zhang
- Nursing Department, Dalang Hospital of Dongguan, Dongguan, China
| | - Haiying Liu
- Nursing Department, The Second People's Hospital of Wuxi, Wuxi, China
| | - Jiao Hua
- Nursing Department, Affiliated Hospital of Jiangnan University (The Third People's Hospital of Wuxi), Wuxi, China
| | - Jinli Guo
- Nursing Department, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Qiuying Han
- Nursing Department, Zhongshan Hospital Xiamen University, Xiamen, China
| | - Yongli Tang
- Orthopedics Department, The First Affiliated Hospital of ChongQing Medical University, ChongQing, China
| | - Jiayu Xue
- Wound Care Center of Outpatient Department, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| |
Collapse
|
27
|
Parnham A, Copson D, Loban T. Moisture-associated skin damage: causes and an overview of assessment, classification and management. ACTA ACUST UNITED AC 2020; 29:S30-S37. [DOI: 10.12968/bjon.2020.29.12.s30] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Moisture-associated skin damage (MASD) can result when the skin has prolonged or continuous exposure to excessive moisture. If the skin experiences too much moisture, it becomes overhydrated and is prone to maceration. This makes it easier for irritants and microorganisms to penetrate the skin, reduce its integrity to mechanical forces and disrupt its protective acid mantle. The condition can greatly affect patient wellbeing. MASD is a collective definition and it has four main causes: incontinence-associated dermatitis, periwound skin damage, intertriginous dermatitis and peristomal moisture-associated dermatitis. Practitioners can use tools such as the Skin Moisture Alert Reporting Tool (S.M.A.R.T.) to identify its aetiology, which informs its management. Management of MASD involves assessment, addressing the underlying cause, and implementing a structured skin care regimen to treat it and prevent its recurrence. Case studies illustrate the use of a structured treatment strategy using Medi Derma barrier products and the principles of Total Barrier Protection to provide a cost-effective solution for the prevention and management of skin compromised by MASD.
Collapse
Affiliation(s)
- Alison Parnham
- Teaching Associate/Clinical Nurse Specialist–Tissue Viability, University of Nottingham and Nottingham City Care
| | - Dale Copson
- National Clinical Services Manager UK, Medicareplus International, London
| | - Tanya Loban
- Clinical Nurse Advisor, Medicareplus International, London
| |
Collapse
|
28
|
Abstract
The skin's main function is to act as a physical barrier against harmful substances. Medical adhesive-related skin injury (MARSI) is a prevalent and under-reported condition that compromises the skin's integrity. Repeated applications and removal of appliances can increase the likelihood of MARSI occurring. Prevention and treatment are key to ensure appropriate skin preparation, product appliance and removal. The use of structured approaches is imperative and there is a need to increase the awareness of MARSI among patients and health professionals to ensure that informed decisions are made.
Collapse
Affiliation(s)
| | - Luxmi Mohamud
- Tissue Viability Nurse, Central and North West London NHS Foundation Trust
| | - Dale Copson
- Clinical Sevices Manager, Medicareplus International
| |
Collapse
|
29
|
Affiliation(s)
- Jennie Burch
- Registered Nurse Enhanced Recovery, St Mark's Hospital, London North West Healthcare NHS Trust
| |
Collapse
|
30
|
Abstract
PURPOSE The purpose of this study was to examine the incidence and economic burden of peristomal skin complications (PSCs) following ostomy surgery. DESIGN Retrospective cohort study based on electronic health records and administrative data stores at a large US integrated healthcare system. SUBJECTS AND SETTINGS The sample comprised 168 patients who underwent colostomy (ICD-9-CM 46.1X) (n = 108), ileostomy (46.2X) (n = 40), cutaneous ureteroileostomy (56.5X), or other external urinary diversion (56.6X) (n = 20) between January 1, 2012, and December 31, 2014. The study setting was an integrated health services organization that serves more than 2 million persons in the northeastern United States. METHODS We scanned electronic health records of all study subjects to identify those with evidence of PSCs within 90 days of ostomy surgery and then examined healthcare utilization and costs over 120 days, beginning with date of surgery, among patients with and without evidence of PSCs. Testing for differences in continuous measures between the 3 ostomy groups was based on one-way analysis of variance; testing for differences in such measures between the PSC and non-PSC groups was based on a t statistic, and the χ statistic was used to test for differences in categorical measures. RESULTS Sixty-one subjects (36.3%) had evidence of PSCs within 90 days of ostomy surgery (ileostomy, 47.5%; colostomy, 36.1%; urinary diversion, 15.0%; P < .05 for differences between groups). Among patients with evidence of PSCs, the mean (SD) time from surgery to first notation of this complication was 26.4 (19.0) days; it was 24.1 (13.2) days for ileostomy, 27.2 (21.1) days for colostomy, and 31.7 (25.7) days for urinary diversion (P = .752). Patients with PSCs were more likely to be readmitted to hospital by day 120 (55.7% vs 35.5% for those without PSCs; P = .011). The mean length of stay for patients readmitted to hospital was 11.0 days for those with PSCs and 6.8 days for those without PSCs (P = .111). The mean total healthcare cost over 120 days was $58,329 for patients with evidence of PSCs and $50,298 for those without evidence of PSCs (P = .251). CONCLUSIONS Approximately one-third of ostomy patients developed PSCs within 90 days of their surgery. Peristomal skin complications are associated with a greater likelihood of hospital readmission. Our findings corroborate results of earlier studies.
Collapse
|
31
|
Woodward S. Moisture-associated skin damage: use of a skin protectant containing manuka honey. ACTA ACUST UNITED AC 2019; 28:329-335. [DOI: 10.12968/bjon.2019.28.6.329] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sue Woodward
- Senior Lecturer, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London
| |
Collapse
|
32
|
|
33
|
McNichol LL, Ayello EA, Phearman LA, Pezzella PA, Culver EA. Incontinence-Associated Dermatitis: State of the Science and Knowledge Translation. Adv Skin Wound Care 2018; 31:502-513. [DOI: 10.1097/01.asw.0000546234.12260.61] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
34
|
Abstract
BACKGROUND: Protecting the skin against moisture-associated damage is an important component of comprehensive skin and wound care. Based on a review of literature, the authors propose key interventions to protect and prevent damage in the skin folds, perineum, and areas surrounding a wound or stoma. OBJECTIVE: The aim of this scoping review is to identify and provide a narrative integration of the existing evidence related to the management and prevention of moisture-associated skin damage (MASD). METHODS: Study authors searched several databases for a broad spectrum of published and unpublished studies in English, published between 2000 and July 2015. Selected study information was collated in several different formats; ultimately, key findings were aggregated into a thematic description of the evidence to help generate a set of summative statements or recommendations. RESULTS: Based on inclusion criteria, 37 articles were considered appropriate for this review. Findings included functional definitions and prevalence rates of the 4 types of MASD, assessment scales for each, and 7 evidence-based strategies for the management of MASD. CONCLUSIONS: Based on this scoping review of literature, the authors propose key interventions to protect and prevent MASD including the use of barrier ointments, liquid polymers, and cyanoacrylates to create a protective layer that simultaneously maintains hydration levels while blocking external moisture and irritants.
Collapse
|
35
|
Changes in Peristomal Skin Condition and User Experience of a Novel Ostomy Barrier Ring With Assisted Flow. J Wound Ostomy Continence Nurs 2018; 45:444-448. [DOI: 10.1097/won.0000000000000463] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
36
|
Abstract
Quality patient education of how to care for their stoma improves patient outcomes and enhances quality of care and efficacy. There is a need for home visits to assist ostomates with rehabilitation of their stoma formation, as they often feel stigmatised and are likely to withdraw from social activities. It has previously been highlighted that community care is often the weakest link in rehabilitation, highlighting the need for effective teamwork and collaboration between stoma nurse specialists and community nurses. This article will focus on some of the more common complications of stomas which will be seen in the community setting, how to treat these conditions and when patients should be referred to the specialist stoma care nurse.
Collapse
|
37
|
Scientific and Clinical Abstracts From the WOCN® Society's 50th Annual Conference. J Wound Ostomy Continence Nurs 2018. [DOI: 10.1097/won.0000000000000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
38
|
Abstract
PURPOSE To provide information from a literature review about the prevention, recognition, and treatment for contact dermatitis. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES After participating in this educational activity, the participant should be better able to:1. Identify signs and symptoms of and diagnostic measures for contact dermatitis.2. Identify causes and risks for contact dermatitis.3. Select appropriate treatment for contact dermatitis and its prevention. ABSTRACT Contact dermatitis to wound care products is a common, often neglected problem. A review was conducted to identify articles relevant to contact dermatitis.A PubMed English-language literature review was conducted for appropriate articles published between January 2000 and December 2015.Contact dermatitis is both irritant (80% of cases) or allergic (20% of cases). Frequent use of potential contact allergens and impaired barrier function of the skin can lead to rising sensitization in patients with chronic wounds. Common known allergens to avoid in wound care patients include fragrances, colophony, lanolin, and topical antibiotics.Clinicians should be cognizant of the allergens in wound care products and the potential for sensitization. All medical devices, including wound dressings, adhesives, and bandages, should be labeled with their complete ingredients, and manufacturers should be encouraged to remove common allergens from wound care products, including topical creams, ointments, and dressings.
Collapse
|
39
|
|
40
|
Clinical and Economic Burden of Peristomal Skin Complications in Patients With Recent Ostomies. J Wound Ostomy Continence Nurs 2017; 44:350-357. [PMID: 28574928 PMCID: PMC5507819 DOI: 10.1097/won.0000000000000339] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE: The purpose of this study was to estimate the risk and economic burden of peristomal skin complications (PSCs) in a large integrated healthcare system in the Midwestern United States. DESIGN: Retrospective cohort study. SUBJECTS AND SETTING: The sample comprised 128 patients; 40% (n = 51) underwent colostomy, 50% (n = 64) underwent ileostomy, and 10% (n = 13) underwent urostomy. Their average age was 60.6 ± 15.6 years at the time of ostomy surgery. METHODS: Using administrative data, we retrospectively identified all patients who underwent colostomy, ileostomy, or urostomy between January 1, 2008, and November 30, 2012. Trained medical abstractors then reviewed the clinical records of these persons to identify those with evidence of PSC within 90 days of ostomy surgery. We then examined levels of healthcare utilization and costs over a 120-day period, beginning with date of surgery, for patients with and without PSC, respectively. Our analyses were principally descriptive in nature. RESULTS: The study cohort comprised 128 patients who underwent ostomy surgery (colostomy, n = 51 [40%]; ileostomy, n = 64 [50%]; urostomy, n = 13 [10%]). Approximately one-third (36.7%) had evidence of a PSC in the 90-day period following surgery (urinary diversion, 7.7%; colostomy, 35.3%; ileostomy, 43.8%). The average time from surgery to PSC was 23.7 ± 20.5 days (mean ± SD). Patients with PSC had index admissions that averaged 21.5 days versus 13.9 days for those without these complications. Corresponding rates of hospital readmission within the 120-day period following surgery were 47% versus 33%, respectively. Total healthcare costs over 120 days were almost $80,000 higher for patients with PSCs. CONCLUSIONS: Approximately one-third of ostomy patients over a 5-year study period had evidence of PSCs within 90 days of surgery. Costs of care were substantially higher for patients with these complications.
Collapse
|
41
|
Abstract
PURPOSE The objective of this study was to examine the attitudes of baccalaureate nursing students toward their role in pressure injury prevention (PIP) and describe how clinical experiences influence their attitudes. Understanding students' attitudes and experiences related to PIP may facilitate development of evidence-based interventions for PIP by nurses. DESIGN Qualitative exploratory descriptive design. SETTING AND SUBJECTS Participants were 16 senior nursing students enrolled in a prelicensure baccalaureate nursing program in an accredited school of nursing. Half of the participants had completed their first 2 years of the nursing major in the baccalaureate program. The remaining participants completed their first 2 years in a community college associate degree nursing program. METHOD Semistructured, in-depth, open-ended interviews were conducted. Interviews were digitally recorded and transcribed verbatim; data were analyzed for key themes using content analysis. RESULTS Four categories of attitudes about PIP were identified: (1) ambivalence, (2) emerging awareness, (3) committed, and (4) passionate. Diverse clinical experiences in pediatrics, the operating room, trauma units, and long-term care facilities enhanced nursing students' learning related to PIP. Experiences observing WOC nurses and other staff role models engaged in PIP were associated with student commitment and passion for PIP. CONCLUSIONS Findings from this study can be used to guide interventions to enhance attitudes of commitment to PIP. WOC nurses, clinical preceptors, and clinical staff can involve nursing students in intentional PIP learning activities to improve clinical practice and patient outcomes. Intentionally incorporating key learning activities about PIP in the nursing curriculum is recommended.
Collapse
|
42
|
CMS MDS 3.0 Section M Skin Conditions in Long-term Care: Pressure Ulcers, Skin Tears, and Moisture-Associated Skin Damage Data Update. Adv Skin Wound Care 2017; 30:415-429. [DOI: 10.1097/01.asw.0000521920.60656.03] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
43
|
Hoeflok J, Salvadalena G, Pridham S, Droste W, McNichol L, Gray M. Use of Convexity in Ostomy Care: Results of an International Consensus Meeting. J Wound Ostomy Continence Nurs 2017; 44:55-62. [PMID: 28002174 PMCID: PMC5266410 DOI: 10.1097/won.0000000000000291] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ostomy skin barriers that incorporate a convexity feature have been available in the marketplace for decades, but limited resources are available to guide clinicians in selection and use of convex products. Given the widespread use of convexity, and the need to provide practical guidelines for appropriate use of pouching systems with convex features, an international consensus panel was convened to provide consensus-based guidance for this aspect of ostomy practice. Panelists were provided with a summary of relevant literature in advance of the meeting; these articles were used to generate and reach consensus on 26 statements during a 1-day meeting. Consensus was achieved when 80% of panelists agreed on a statement using an anonymous electronic response system. The 26 statements provide guidance for convex product characteristics, patient assessment, convexity use, and outcomes.
Collapse
Affiliation(s)
- Jo Hoeflok
- Correspondence: Jo Hoeflok, MA, BSN, RN, CETN(C), CGN(C), St Michael's Hospital, 30 Bond St, Room 16-078CN, Toronto, ON M5B-1W8, Canada ()
| | - Ginger Salvadalena
- Jo Hoeflok, MA, BSN, RN, CETN(C), CGN(C), Gastroenterology & General Surgery, St. Michael's Hospital, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Ginger Salvadalena, PhD, RN, CWOCN, Clinical Affairs, Hollister Incorporated, Libertyville, Illinois
- Sue Pridham, BA, Diploma Nursing (Adult), Manchester Royal Infirmary, Manchester, United Kingdom
- Werner Droste, ET Nurse, private practice, Selm, Germany
- Laurie McNichol, MSN, RN, GNP, CWOCN, CWON-AP, CNS/WOC Nurse, Cone Health, Greensboro, North Carolina
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, School of Medicine (Department of Urology) and School of Nursing (Department of Acute and Specialty Practice), University of Virginia, Charlottesville
| | - Sue Pridham
- Jo Hoeflok, MA, BSN, RN, CETN(C), CGN(C), Gastroenterology & General Surgery, St. Michael's Hospital, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Ginger Salvadalena, PhD, RN, CWOCN, Clinical Affairs, Hollister Incorporated, Libertyville, Illinois
- Sue Pridham, BA, Diploma Nursing (Adult), Manchester Royal Infirmary, Manchester, United Kingdom
- Werner Droste, ET Nurse, private practice, Selm, Germany
- Laurie McNichol, MSN, RN, GNP, CWOCN, CWON-AP, CNS/WOC Nurse, Cone Health, Greensboro, North Carolina
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, School of Medicine (Department of Urology) and School of Nursing (Department of Acute and Specialty Practice), University of Virginia, Charlottesville
| | - Werner Droste
- Jo Hoeflok, MA, BSN, RN, CETN(C), CGN(C), Gastroenterology & General Surgery, St. Michael's Hospital, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Ginger Salvadalena, PhD, RN, CWOCN, Clinical Affairs, Hollister Incorporated, Libertyville, Illinois
- Sue Pridham, BA, Diploma Nursing (Adult), Manchester Royal Infirmary, Manchester, United Kingdom
- Werner Droste, ET Nurse, private practice, Selm, Germany
- Laurie McNichol, MSN, RN, GNP, CWOCN, CWON-AP, CNS/WOC Nurse, Cone Health, Greensboro, North Carolina
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, School of Medicine (Department of Urology) and School of Nursing (Department of Acute and Specialty Practice), University of Virginia, Charlottesville
| | - Laurie McNichol
- Jo Hoeflok, MA, BSN, RN, CETN(C), CGN(C), Gastroenterology & General Surgery, St. Michael's Hospital, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Ginger Salvadalena, PhD, RN, CWOCN, Clinical Affairs, Hollister Incorporated, Libertyville, Illinois
- Sue Pridham, BA, Diploma Nursing (Adult), Manchester Royal Infirmary, Manchester, United Kingdom
- Werner Droste, ET Nurse, private practice, Selm, Germany
- Laurie McNichol, MSN, RN, GNP, CWOCN, CWON-AP, CNS/WOC Nurse, Cone Health, Greensboro, North Carolina
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, School of Medicine (Department of Urology) and School of Nursing (Department of Acute and Specialty Practice), University of Virginia, Charlottesville
| | - Mikel Gray
- Jo Hoeflok, MA, BSN, RN, CETN(C), CGN(C), Gastroenterology & General Surgery, St. Michael's Hospital, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Ginger Salvadalena, PhD, RN, CWOCN, Clinical Affairs, Hollister Incorporated, Libertyville, Illinois
- Sue Pridham, BA, Diploma Nursing (Adult), Manchester Royal Infirmary, Manchester, United Kingdom
- Werner Droste, ET Nurse, private practice, Selm, Germany
- Laurie McNichol, MSN, RN, GNP, CWOCN, CWON-AP, CNS/WOC Nurse, Cone Health, Greensboro, North Carolina
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, School of Medicine (Department of Urology) and School of Nursing (Department of Acute and Specialty Practice), University of Virginia, Charlottesville
| |
Collapse
|
44
|
|
45
|
EXPLORING PATENT ACTIVITY AND ITS POTENTIAL ASSOCIATION WITH HEALTHCARE OUTCOMES: A CASE STUDY OF OSTOMY PRODUCTS IN SWEDEN. Int J Technol Assess Health Care 2017; 33:168-175. [PMID: 28655367 DOI: 10.1017/s0266462317000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate whether ostomy industry patent activity (PA) is associated with patient outcomes and healthcare costs. METHODS Two groups of ostomy pouch users based on manufacturer PA (low or high) were compared in terms of ostomy-related wear patterns, adverse events, and healthcare expenditure. Using Swedish registry data, all patients with newly formed stomas were divided between each group and were followed during a 2-year period (2011-12). Propensity score matching and parametric duration analysis were used to compare outcomes between patients of similar characteristics such as sex, age, and ostomy surgery type. RESULTS In both one- and two-piece systems, the high PA group had significantly lower monthly ostomy-related expenditure than the low PA group (one-piece: 197.47 EUR versus 233.34 EUR; two-piece: 164.00 EUR versus 278.98 EUR). Fewer pouch and skin wafer purchases per month were an important driver of cost differences. Both groups had similar likelihood of purchasing dermatological products for skin complications over time. CONCLUSIONS PA in the ostomy care industry was associated with reduced healthcare costs, but not necessarily with fewer skin complications. It suggests that there is a health economic benefit from products made by patent intensive companies which may differentiate them from generic comparators, but more research is needed to understand the impact of activities conducive to medical innovation on health outcomes.
Collapse
|
46
|
Rippon M, Perrin A, Darwood R, Ousey K. The potential benefits of using aloe vera in stoma patient skin care. ACTA ACUST UNITED AC 2017; 26:S12-S19. [PMID: 28328276 DOI: 10.12968/bjon.2017.26.5.s12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Individuals living with an ostomy may suffer from a variety of peri-stomal skin complications related to the use of their stoma appliance or accessories. These conditions can be serious enough to significantly impact on a patient's quality of life and may result in severe clinical complications (such as infection). This article is a review of the literature with the objective of investigating and presenting evidence for the well-documented use of aloe vera in the prevention of skin conditions similar to those seen in peri-stomal skin complications. An exploration for the potential use of aloe vera directly or indirectly (as an adjunct to medical devices such as wafers) in stoma patients is presented with the view that this use may be beneficial in the prevention of such peri-stomal skin complications.
Collapse
Affiliation(s)
- Mark Rippon
- Visiting Clinical Research Fellow, School of Human and Health Sciences, University of Huddersfield
| | - Angie Perrin
- Clinical Lead, Research & Development, Salts Healthcare Ltd, Aston, Birmingham B7 4AA
| | | | - Karen Ousey
- Professor and Director for the Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, University of Huddersfield
| |
Collapse
|
47
|
|
48
|
|
49
|
Borzdynski CJ, McGuiness W, Miller C. Comparing visual and objective skin assessment with pressure injury risk. Int Wound J 2016; 13:512-8. [PMID: 26179873 PMCID: PMC7949774 DOI: 10.1111/iwj.12468] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 05/03/2015] [Accepted: 05/05/2015] [Indexed: 01/28/2023] Open
Abstract
Contemporary approaches to pressure injury (PI) risk identification rely on the use of risk assessment tools and visual skin assessment. Objective biophysical measures that assess skin hydration, melanin, erythema and lipids have not been traditionally used in PI risk; however, these may prove useful as a risk assessment tool. The relationship between subjective visual assessments of skin condition, biophysical measures and PI risk warrants investigation. This study used a descriptive correlational design to examine the relationship between measures of skin hydration, colour (melanin and erythema) and lipids at PI-prone areas amongst geriatric persons (n = 38), obtained using biophysical skin measures and visual skin assessment. Twice daily measures of epidermal hydration, colour and lipids were assessed using the SD202 Skin Diagnostic (Courage + Khazaka GmBH, Cologne, Germany) over pressure-prone areas of the body of study participants over seven consecutive days. Concurrent visual assessment of skin hydration and colour was performed. Results obtained using the SD202 Skin Diagnostic were compared with results gathered from visual assessment and examined for their association with participants' PI risk based on scores of the Norton Risk Assessment Scale. While epidermal hydration and skin colour reading scores did not vary significantly over the data collection period, lipid readings could not be registered on any occasion. With the exception of skin dryness, skin parameters via both objective and subjective means had significant, positive correlations. Statistically significant correlations emerged between visual assessment of skin wetness at the sacrum (r = -0·441, P < 0·01) and ischia (r = -0·468, P < 0·01) and Norton Risk Assessment Scale scores. It was found that the objective assessment of epidermal hydration (skin wetness) was also significantly associated with PI risk at the sacrum (r = -0·528, P < 0·01), as well as the right ischia (r = -0·410, P < 0·05) and left ischia (r = -0·407, P < 0·05). Erythema, when assessed objectively, was significantly correlated with PI risk at the sacrum (r = -0·322, P < 0·05). Such findings indicating that the finer measures afforded by the SD202 Skin Diagnostic in the assessment of the subtle red hues displayed in erythematous skin may provide an additional advantage over traditional, clinician assessment.
Collapse
Affiliation(s)
- Caroline J Borzdynski
- La Trobe University, Melbourne VIC Australia, Eltham Retirement Centre, Eltham VIC, Australia
| | - William McGuiness
- Deputy Head, Division of Nursing and Midwifery, La Trobe University, Melbourne VIC, Australia
| | - Charne Miller
- La Trobe University, Melbourne VIC Australia, Alfred Health Clinical School, The Alfred Centre, Pahran VIC, Australia
| |
Collapse
|
50
|
|