1
|
Sanaeifar N, Limam D, Zettl S, Vechter O, Porsch S, Kesselmeier R. Nurses' perspectives and preferences on MoliCare Premium Elastic products for incontinence management. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:1078-1085. [PMID: 38060398 DOI: 10.12968/bjon.2023.32.22.1078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND With the wide range of absorbent incontinence products available, it is crucial to select the most suitable product for individuals with incontinence, ensuring that their expectations are met and their quality of life is not compromised. AIM This study aimed to assess the key features of the newly introduced MoliCare Premium Elastic product by nurses working with residents with incontinence in nursing homes and compare the product characteristics with those of the previous design. METHODS Forty-three nurses from five nursing homes in Germany were asked to complete a questionnaire focusing on key product performance aspects to elicit their views on the use of MoliCare Premium Elastic products. FINDINGS All performance features of the new product design received positive ratings from most nurses: 84% considered the overall acceptance of the new design as 'Good', and 52% preferred the new MoliCare Premium Elastic. CONCLUSIONS The new MoliCare SkinGuard absorbent core technology performed well on each performance characteristic, demonstrating the high quality of the product and its ability to meet the needs of people with incontinence.
Collapse
Affiliation(s)
- Niuosha Sanaeifar
- Manager, Clinical Application Studies, Paul Hartmann AG, Heidenheim, Germany
| | - Deniz Limam
- Global Senior Manager, Product Marketing, Paul Hartmann AG, Heidenheim, Germany
| | - Simone Zettl
- Global Manager, Product Marketing, Paul Hartmann AG, Heidenheim, Germany
| | - Olga Vechter
- Global Senior Manager, Product Development, Paul Hartmann AG, Heidenheim, Germany
| | - Simon Porsch
- Global Manager, Product Development, Paul Hartmann AG, Heidenheim, Germany
| | - Rüdiger Kesselmeier
- Global Vice President, Product and Solution Innovations, Paul Hartmann AG, Heidenheim, Germany
| |
Collapse
|
2
|
Sanaeifar N, Vechter O, Limam D, Kesselmeier R, Maurer T. Usability assessment of the MoliCare absorbent continence products by nursing specialists. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S18-S24. [PMID: 37830861 DOI: 10.12968/bjon.2023.32.18.s18] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Incontinence is a common disorder among older adults with a higher prevalence in nursing home settings than in community dwellings. There is a wide variety of absorbent continence products on the market used to manage continence. AIM The study aimed to investigate the experience of caregivers of residents with incontinence in care home settings using the new MoliCare Premium Form design and to compare some of the product features with the previous design. METHOD A questionnaire focusing on the key performance characteristics of the product was developed and administered to 74 nurses in Germany to obtain their opinions on the use of MoliCare Premium Form products. FINDINGS More than 90% of respondents rated each key performance aspect of the new product design as 'good' and 'OK'. More than 60% of the caregivers found the new product design to be better performing and 93% preferred the new design to the previous version. CONCLUSION The newly redesigned continence pad performed very well on each of the individual performance features, indicating the high quality and optimised design of the product. The new design was found to be suitable and effective for individuals with incontinence.
Collapse
Affiliation(s)
- Niuosha Sanaeifar
- Manager Clinical Application Studies, Paul Hartmann AG, Heidenheim, Germany
| | - Olga Vechter
- Global Senior Manager Product Development, Paul Hartmann AG, Heidenheim, Germany
| | - Deniz Limam
- Global Senior Manager Product Marketing, Paul Hartmann AG, Heidenheim, Germany
| | - Rüdiger Kesselmeier
- Global Vice President Product & Solution Innovations, Paul Hartmann AG, Heidenheim, Germany
| | | |
Collapse
|
3
|
Diadiun T, Baranova I, Musozoda S, Semeniv D, Zaporozhska S. Commodity analysis of medical products used in adult incontinence. PHARMACIA 2021. [DOI: 10.3897/pharmacia.68.e73181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There are problems people don’t want to talk about, and one of them is incontinence in adults. This is a fairly common and delicate problem. It negatively affects human life. This most often applies to people with disabilities and bedridden patients. People have to change their usual way of life, give up their favorite activities, there is a constant need to stay at home. Walking, attending events are difficult. All this has a corresponding effect on the psychological health of a person. In such a situation, it is advisable to use diapers for adults. This is a modern hygienic product that is intended to make life easier for people suffering from various forms of incontinence. Diapers are similar in shape to baby diapers, but they are adapted to the size of an adult. This is a great option for the care of patients who are bedfast or in a wheelchair.
Collapse
|
4
|
A new therapeutic horizon in diaper dermatitis: Novel agents with novel action. Int J Womens Dermatol 2021; 7:466-470. [PMID: 34621960 PMCID: PMC8484940 DOI: 10.1016/j.ijwd.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/20/2021] [Accepted: 02/07/2021] [Indexed: 01/19/2023] Open
Abstract
Objective This review looks at novel combinations of topical agents (i.e., zinc gluconate, zinc oxide, dexpanthenol, and taurine) that target a combination of mechanisms in diaper dermatitis. Methods A literature search of published studies was conducted using the search terms "diaper dermatitis", "treatment of diaper dermatitis in infants", "treatment of diaper dermatitis in adults", "nonsteroidal", "nonantibiotic", "antiinflammatory", "moisturizer", and "treatment for irritation". A total of 207 related articles were screened, and those categorized as clinical trials and reviews were studied and compared. Articles with common themes were categorized, summarized, and presented herein. Results Diaper dermatitis, also referred to as diaper rash, napkin dermatitis, and nappy rash, is the most common skin eruption in infants and toddlers. In the last several years, there have been several technologic advances in diaper design to lessen the severity of diaper dermatitis symptoms. However, due to the unique environment of the diaper area, children and adults continue to have recurring symptoms of diaper dermatitis. Both commercially available products and certain home remedies are considered effective for managing sensitive and delicate skin in the diaper area. These topical agents create a protective barrier over the skin and reduce the impact of external irritants, which cause the reddening and burning sensation often associated with diaper dermatitis. Conclusion A range of therapeutic strategies for preventing and controlling diaper dermatitis are summarized in this manuscript.
Collapse
|
5
|
Conceptual Framework for Incontinence-Associated Dermatitis Based on Scoping Review and Expert Consensus Process. J Wound Ostomy Continence Nurs 2021; 48:239-250. [PMID: 33951713 DOI: 10.1097/won.0000000000000754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Incontinence-associated dermatitis (IAD) has been studied over the last decades, but gaps in the knowledge related to its identification, etiological agents, and risk factors remain. We carried out a scoping review about IAD that included systematic reviews, experimental, and observational studies about IAD and its potential risk factors. We retrieved 24 articles that described 100 potential risk factors and which were synthesized by the authors and proposed to a panel of experts. Panelists used a structured process of consensus development to create a conceptual framework of factors associated with IAD. This framework proposes that liquid fecal material, when combined with exposure to urine and stool, and bacterial contaminated urine are etiological factors for development of IAD. The framework also proposes 2 pathophysiological mechanisms and 8 main risk factors for IAD development. The proposed model could improve the quality of care for patients with or at risk of IAD, assisting healthcare professionals to identify at-risk patients, diagnose the type of lesion, and establish adequate and effective prevention and treatment measures.
Collapse
|
6
|
Mugita Y, Koudounas S, Nakagami G, Weller C, Sanada H. Assessing absorbent products' effectiveness for the prevention and management of incontinence-associated dermatitis caused by urinary, faecal or double adult incontinence: A systematic review. J Tissue Viability 2021; 30:599-607. [PMID: 34376333 DOI: 10.1016/j.jtv.2021.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 06/19/2021] [Accepted: 07/11/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Adults who suffer from incontinence are at substantial risk of developing incontinence-associated dermatitis (IAD). In healthcare settings, several interventions have been implemented to prevent or manage IAD, and several absorbent products have been developed for incontinent patients; however, there is no systematic review that has reported on which absorbent products are effective for the prevention or management of incontinence-associated dermatitis. We conducted a systematic review to investigate the effectiveness of absorbent products in the prevention and management of IAD. METHODS MEDLINE (1946-August 31, 2020), CINAHL (1982-August 31, 2020), and Cochrane Library (August 31, 2020) were searched for relevant articles. RESULTS Eight studies met the eligibility criteria and were included in this review, including two randomized controlled trials that were designed to evaluate the efficacy of absorbent products on the prevention or management of incontinence-associated dermatitis. Quality of evidence was assessed as low or very low. The findings revealed that some outcomes related to IAD prevention or improvement of IAD can be positively affected by the introduction of a new absorbent product or a difference in the frequency of pad changing, which can control the overhydration of the skin. CONCLUSIONS The studies included in this review indicated that the problem of control of overhydration of the skin associated with urine and/or faeces can be controlled by absorbent products and these products may be effective for the prevention or management of incontinence-associated dermatitis. Future research with high-quality studies is required.
Collapse
Affiliation(s)
- Yuko Mugita
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, 113-0033, Tokyo, Japan.
| | - Sofoklis Koudounas
- Global Nursing Research Centre, Graduate School of Medicine, The University of Tokyo, 113-0033, Tokyo, Japan.
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, 113-0033, Tokyo, Japan; Global Nursing Research Centre, Graduate School of Medicine, The University of Tokyo, 113-0033, Tokyo, Japan.
| | - Carolina Weller
- School of Nursing and Midwifery, Monash University, Melbourne, VIC, 3004, Australia.
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, 113-0033, Tokyo, Japan; Global Nursing Research Centre, Graduate School of Medicine, The University of Tokyo, 113-0033, Tokyo, Japan.
| |
Collapse
|
7
|
The Effect of Absorbent Pad Design on Skin Wetness, Skin/Pad Microclimate, and Skin Barrier Function. J Wound Ostomy Continence Nurs 2020; 47:497-506. [DOI: 10.1097/won.0000000000000684] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
Esmail A, Poncet F, Auger C, Rochette A, Dahan-Oliel N, Labbé D, Kehayia E, Billebaud C, de Guise É, Lessard I, Ducharme I, Vermeersch O, Swaine B. The role of clothing on participation of persons with a physical disability: A scoping review. APPLIED ERGONOMICS 2020; 85:103058. [PMID: 32174346 DOI: 10.1016/j.apergo.2020.103058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 01/13/2020] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
Determining ways to facilitate participation of persons with a physical disability is crucial and clothing may play a central role. This review aims to synthesize and examine the role of clothing on participation of persons with a physical disability. Six research databases and grey literature were searched following Arksey & O'Malley's six steps, including multiple expert consultations. English and French articles contributing to how clothing affects participation were included and tabulated based on the International Classification of Functioning, Disability and Health. Fifty-seven articles and 88 websites were included. A variety of stakeholder perspectives, diagnoses, and types of clothing were represented. Clothing mostly influences mobility and self-care, as well as various personal factors. Forty-nine percent of articles reported essential clothing design features to consider. Clothing is an important and complex environmental factor that interacts with all health domains, including participation. Future research should consider intersectoral initiatives.
Collapse
Affiliation(s)
- Alida Esmail
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR-Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM) of the CIUSSS du Centre-Sud-de-l'Île-de-Montréal), Montreal, Quebec, Canada
| | - Frédérique Poncet
- Department of Psychology, Concordia University, Montreal, Quebec, Canada; CRIR-Institut Nazareth et Louis-Braille of the CISSS de la Montérégie-Centre, Longueuil, Quebec, Canada
| | - Claudine Auger
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR-Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM) of the CIUSSS du Centre-Sud-de-l'Île-de-Montréal), Montreal, Quebec, Canada
| | - Annie Rochette
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR-Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM) of the CIUSSS du Centre-Sud-de-l'Île-de-Montréal), Montreal, Quebec, Canada
| | - Noémi Dahan-Oliel
- Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada; School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Delphine Labbé
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eva Kehayia
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR-Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM) of the CIUSSS du Centre-Sud-de-l'Île-de-Montréal), Montreal, Quebec, Canada; School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Christophe Billebaud
- Rhizome Strategies, Montreal, Quebec, Canada; La Piscine, Montreal, Quebec, Canada
| | - Élaine de Guise
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR-Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM) of the CIUSSS du Centre-Sud-de-l'Île-de-Montréal), Montreal, Quebec, Canada; Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | | | | | | | - Bonnie Swaine
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR-Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM) of the CIUSSS du Centre-Sud-de-l'Île-de-Montréal), Montreal, Quebec, Canada.
| |
Collapse
|
9
|
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]
|
10
|
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
|
11
|
The Impact of Microclimate on Skin Health With Absorbent Incontinence Product Use. J Wound Ostomy Continence Nurs 2018; 45:341-348. [DOI: 10.1097/won.0000000000000449] [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]
|
12
|
Goodman C, Norton C, Buswell M, Russell B, Harari D, Harwood R, Roe B, Rycroft-Malone J, Drennan VM, Fader M, Maden M, Cummings K, Bunn F. Managing Faecal INcontinence in people with advanced dementia resident in Care Homes (FINCH) study: a realist synthesis of the evidence. Health Technol Assess 2018; 21:1-220. [PMID: 28805188 DOI: 10.3310/hta21420] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Eighty per cent of care home residents in the UK are living with dementia. The prevalence of faecal incontinence (FI) in care homes is estimated to range from 30% to 50%. There is limited evidence of what is effective in the reduction and management of FI in care homes. OBJECTIVE To provide a theory-driven explanation of the effectiveness of programmes that aim to improve FI in people with advanced dementia in care homes. DESIGN A realist synthesis. This was an iterative approach that involved scoping of the literature and consultation with five stakeholder groups, a systematic search and analysis of published and unpublished evidence, and a validation of programme theories with relevant stakeholders. DATA SOURCES The databases searched included PubMed, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, Scopus, SocAbs, Applied Social Sciences Index and Abstracts, BiblioMap, Sirius, OpenGrey, Social Care Online and the National Research Register. RESULTS The scoping identified six programme theories with related context-mechanism-outcome configurations for testing. These addressed (1) clinician-led support, assessment and review, (2) the contribution of teaching and support for care home staff on how to reduce and manage FI, (3) the causes and prevention of constipation, (4) how the cognitive and physical capacity of the resident affect outcomes, (5) how the potential for recovery, reduction and management of FI is understood by those involved and (6) how the care of people living with dementia and FI is integral to the work patterns of the care home and its staff. Data extraction was completed on 62 core papers with iterative searches of linked literature. Dementia was a known risk factor for FI, but its affect on the uptake of different interventions and the dementia-specific continence and toileting skills staff required was not addressed. Most care home residents with FI will be doubly incontinent and, therefore, there is limited value in focusing solely on FI or on single causes of FI such as constipation. Clinical assessment, knowledge of the causes of FI and strategies that recognise the individuals' preferences are necessary contextual factors. Valuing the intimate and personal care work that care home staff provide to people living with dementia and addressing the dementia-related challenges when providing continence care within the daily work routines are key to helping to reduce and manage FI in this population. LIMITATIONS The synthesis was constrained by limited evidence specific to FI and people with dementia in care homes and by the lack of dementia-specific evidence on continence aids. CONCLUSIONS This realist synthesis provides a theory-driven understanding of the conditions under which improvement in care for care home residents living with dementia and FI is likely to be successful. FUTURE WORK Future multicomponent interventions need to take account of how the presence of dementia affects the behaviours and choices of those delivering and receiving continence care within a care home environment. STUDY REGISTRATION This study is registered as PROSPERO CRD42014009902. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
- Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Marina Buswell
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Bridget Russell
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Danielle Harari
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Division of Health and Social Care, King's College London, London, UK
| | - Rowan Harwood
- Health Care of Older People, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - Brenda Roe
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK
| | | | - Vari M Drennan
- Centre for Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston and St George's, London, UK
| | - Mandy Fader
- Health Sciences, University of Southampton, Southampton, UK
| | - Michelle Maden
- School of Health Sciences, University of Liverpool, Liverpool, UK
| | | | - Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| |
Collapse
|
13
|
Van Damme N, Clays E, Verhaeghe S, Van Hecke A, Beeckman D. Independent risk factors for the development of incontinence-associated dermatitis (category 2) in critically ill patients with fecal incontinence: A cross-sectional observational study in 48 ICU units. Int J Nurs Stud 2018; 81:30-39. [PMID: 29428583 DOI: 10.1016/j.ijnurstu.2018.01.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/16/2018] [Accepted: 01/27/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Critically ill patients suffering from fecal incontinence have a major risk of developing incontinence-associated dermatitis (IAD). The presence of moisture and digestive enzymes (lipase, protease) negatively influences skin barrier function. Additional risk factors will make some patients even more vulnerable than others. In order to provide (cost) effective prevention, this specific patient population should be identified timely. OBJECTIVES To identify independent risk factors for the development of IAD category 2 (skin loss) in critically ill patients with fecal incontinence. DESIGN A cross-sectional observational study. SETTING AND PARTICIPANTS The study was performed in 48 ICU wards from 27 Belgian hospitals. Patients of 18 years or older, with fecal incontinence at the moment of data collection, were eligible to participate. Patients with persistent skin redness due to incontinence (IAD category 1) were excluded. METHODS Potential risk factors were carefully determined based on literature and expert consultations. Data were collected over a period of eight months by trained researchers using patient records and observation of skin care practices. At the time a patient was included in the study, all relevant data from the past six days, or since admission at the ICU, were recorded. Simultaneously, direct skin observations were performed and high definition photographs were ratified by an expert IAD researcher. A multiple binary logistic regression model was composed to identify independent risk factors. Variables with P < .25 in single binary logistic regression analyses were added to the multiple model using a forward procedure. A cut-off value of P < .1 was established to retain variables in the final model. Nagelkerke's R2 and Hosmer-Lemeshow statistic were calculated as measures of model fit. RESULTS The sample comprised of 206 patients, of which 95 presented with IAD category 2, and 111 were free of IAD. Seven independent risk factors were identified: liquid stool [odds ratio (OR) 4.69; 95% confidence interval (CI) 2.28-9.62], diabetes (OR 2.89; 95% CI 1.34-6.27), age (OR 1.05; 95% CI 1.02-1.08), smoking (OR 2.67; 95% CI 1.21-5.91), non-use of diapers (OR 2.97; 95% CI 1.39-6.33), fever (OR 2.60; 95% CI 1.23-5.53), and low oxygen saturation (OR 2.15; 95% CI 1.03-4.48). Nagelkerke's R2 was 0.377. The Hosmer-Lemeshow statistic indicated no significant difference between the observed and expected values (p = .301). CONCLUSIONS Liquid stool, diabetes, age, smoking, non-use of diapers, fever, and low oxygen saturation were independently associated with IAD category 2 in critically ill patients with fecal incontinence.
Collapse
Affiliation(s)
- Nele Van Damme
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, UZ Gent, 5K3, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Els Clays
- Epidemiology and Prevention Unit, Department of Public Health, Ghent University, UZ Gent, 5K3, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Sofie Verhaeghe
- University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, UZ Gent, 5K3, Corneel Heymanslaan 10, B-9000 Ghent, Belgium; Department Health Care, VIVES University College, Wilgenstraat 32, B-8800 Roeselare, Belgium
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, UZ Gent, 5K3, Corneel Heymanslaan 10, B-9000 Ghent, Belgium; Nursing Department, Ghent University Hospital, UZ Gent, 11K12, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, UZ Gent, 5K3, Corneel Heymanslaan 10, B-9000 Ghent, Belgium; School of Health Sciences, University of Surrey, Guilford, UK; School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland.
| |
Collapse
|
14
|
Farage MA, Esquerra J, Cheng R, Carpenter S, Bunasky K, Gutshall D, Lawrence A, Messerschmidt A. Specific dermatological benefits associated with quantities of lotion transferred to the skin. J Cosmet Dermatol 2017; 17:900-910. [PMID: 29094461 DOI: 10.1111/jocd.12442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND A growing number of manufacturers are taking advantage of the ability of absorbent consumer products to deliver lotion to the skin. The lotion is included on these products to help protect the skin from adverse skin effects that can occur, including: (1) irritation, (2) over hydration of the stratum corneum, (3) dryness that can occur from extended exposure to highly absorbent consumer products, and (4) changes in pH. OBJECTIVE This manuscript presents results of a quantitative lotion transfer study of adult incontinence products. Resulting lotion transfer is compared to the results of several separate experiments in which specific skin benefits have been correlated to lotion concentrations. METHODS The behind-the-knee (BTK) lotion transfer protocol was used to quantitate lotion transfer from adult incontinence (AI) test products constructed using 2 lotion formulations and 2 configurations of lotion application. A modified arm patch protocol, in which skin sites of a measured dimension were pre-treated with specific volumes of lotion, was used to evaluate protective effects of lotion against exposure to irritants, and over hydration from wetted absorbent products. RESULTS After a 6-hours continuous exposure in the BTK the 5-stripe lotion configuration products transferred (adjusted mean ± SE) 94 ± 11-104 ± 11 μg/cm2 lotion. After 24 hours of wear, transfer had increased to 127 ± 22 and 149 ± 24 μg/cm2 , respectively. The single-block configuration products transferred 289 ± 10-316 ± 10 μg/cm2 (P = .04). Transfer after 24 hours of wear was 328 ± 23 and 472 ± 21 μg/cm2 , respectively (P < .0001). Several protocols were used to evaluate the concentration of lotion required to provide four specific skin benefits. In studies evaluating protection against irritants, skin site pre-treated with lotion were patched with 0.5% sodium lauryl sulfate (SLS). Protective effects were assessed by visual assessment of erythema and trans-epidermal water loss (TEWL). In the first experiment, lotion pre-treatment concentrations as low as 165 μg/cm2 exhibited significantly (P < .05) lower erythema and TEWL compared to the positive irritant control (ie, no lotion pre-treatment and SLS only). In the second experiment, lotion pre-treatment concentrations of 80 μg/cm2 (P = .018) exhibited significantly (P = .018) lower TEWL. In two studies on protection from over hydration, lotion pre-treatment sites were subsequently patched with wetted absorbent consumer products. The change in TEWL was used as a measure of over hydration. Lotion concentrations significantly reduced the increase in TEWL at 80 μg/cm2 (P = .007) and 70 μg/cm2 (P ≤ .05). A BTK study was used to evaluate the ability of lotion to prevent dryness. After 6 hours of wear, test products transferring lotion concentrations of 110 or 133 μg/cm2 produced significantly lower scores for dryness compared to products transferring 48 or 69 μg/cm2 . Using collagen sheets to mimic the stratum corneum, an in vitro study was conducted to measure the ability of lotion to prevent passage of high pH buffer solution. Results demonstrated that the lowest concentration of lotion that was tested (110 μg/cm2 ) interfered with passage of the high pH buffer through the collagen sheet, delaying the rise in pH. CONCLUSIONS We can conclude that pretreatment with 110 μg/cm2 lotion acts as a barrier to high pH fluids such as urine. Using the measurement of lotion transfer from the AI products, together with the results of studies conducted to determine the concentration of lotion required to provide specific skin benefits, we conclude that the five-stripe lotion configuration AI test products transferred enough lotion (ie, ≥80 μg/cm2 ) to provide skin protection with regard to: (1) irritant effects and (2) excess moisture. The single-block AI test products also transferred enough lotion to provide these skin benefits (ie, ≥165 μg/cm2 ), and the additional benefits of skin protection against: (3) dryness, and (4) changes in pH.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Ann Lawrence
- The Procter and Gamble Company, Cincinnati, OH, USA
| | | |
Collapse
|
15
|
Bliss DZ, Bland P, Wiltzen K, Gannon A, Wilhems A, Mathiason MA, Turnbaugh R. Incontinence Briefs Containing Spiral-Shaped Fiber Acidify Skin pH of Older Nursing Home Residents at Risk for Incontinence-Associated Dermatitis. J Wound Ostomy Continence Nurs 2017; 44:475-480. [PMID: 28877114 DOI: 10.1097/won.0000000000000362] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The study's purpose was to assess the pH of the skin of older (aged ≥75 years) incontinent nursing home residents after exposure to an incontinence brief containing spiral-shaped fiber wet with an alkaline solution mimicking urine or fecal pH and compared to skin pH after exposure to an industry standard brief wet with the same solution and various controls. DESIGN The design was experimental, as conditions were applied to skin and skin pH was measured in random order, and subjects served as their own controls. SETTING AND SUBJECTS The setting was a Midwestern nonprofit nursing home. The sample was 26 nursing home residents; their mean age was 87 years (SD = 6 years); 77% were female. Most (69%) had urinary incontinence alone, and 31% had dual urinary and fecal incontinence. METHODS Skin pH was measured in duplicate on 6 areas of the inner thighs and 6 areas of the volar surface of the forearms. Each area was exposed to 1 of 6 conditions applied in random order: an incontinence brief containing spiral-shaped fiber wet with an alkaline solution and one that was dry; a standard incontinence brief (without spiral-shaped fiber) wet with the same alkaline solution and one that was dry; the alkaline solution alone; and normal skin. RESULTS On both the thighs and the forearms, skin pH was significantly lower (more acidic) after exposure to the incontinence brief containing spiral-shaped fiber wet with an alkaline solution compared to the wet standard brief and all other control conditions (P < .001). On thighs, the mean skin pH was 5.7 (SD = 0.5) after exposure to the wet brief with spiral-shaped fiber versus 6.4 (SD = 0.5) after exposure to the wet standard brief. On forearms, the mean skin pH was 5.3 (SD = 0.4) after exposure to the wet brief with spiral-shaped fiber versus 6.0 (SD = 0.4) after exposure to the wet standard brief. CONCLUSIONS Incontinence briefs containing a spiral-shaped fiber significantly acidify the pH of the skin exposed to an alkaline solution, while industry standard briefs do not. Since alkaline skin pH is a risk factor for incontinence-associated dermatitis (IAD), results suggest that briefs with spiral-shaped fiber may help prevent IAD. Findings encourage further research.
Collapse
Affiliation(s)
- Donna Z Bliss
- Donna Z. Bliss, PhD, RN, FAAN, FGSA, University of Minnesota School of Nursing, Minneapolis. Peggy Bland, HSD, RN, Presbyterian Manor of Mid-America Nursing Home, Farmington, Missouri. Kjerstie Wiltzen, BA, BSN, RN, CWCN, University of Minnesota School of Nursing, Minneapolis. Alexandra Gannon, BSN, RN, University of Minnesota School of Nursing, Minneapolis. Anna Wilhems, BSN, RN, University of Minnesota School of Nursing, Minneapolis. Michelle A. Mathiason, MS, University of Minnesota School of Nursing, Minneapolis. Robert Turnbaugh, RN, Presbyterian Manor of Mid-America Nursing Home, Farmington, Missouri
| | | | | | | | | | | | | |
Collapse
|
16
|
Buswell M, Goodman C, Roe B, Russell B, Norton C, Harwood R, Fader M, Harari D, Drennan VM, Malone JR, Madden M, Bunn F. What Works to Improve and Manage Fecal Incontinence in Care Home Residents Living With Dementia? A Realist Synthesis of the Evidence. J Am Med Dir Assoc 2017; 18:752-760.e1. [DOI: 10.1016/j.jamda.2017.05.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 05/26/2017] [Indexed: 01/06/2023]
|
17
|
Best practice nursing care for ICU patients with incontinence-associated dermatitis and skin complications resulting from faecal incontinence and diarrhoea. INT J EVID-BASED HEA 2016; 14:15-23. [PMID: 26735567 DOI: 10.1097/xeb.0000000000000067] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIMS Incontinence-associated dermatitis (IAD), resulting from diarrhoea and/or faecal incontinence, is a common problem in intensive care, occurring in 7-50% of the patients, with an estimated 10 million dollars spent annually on continence skin care. This project aimed to evaluate and improve the staff knowledge on IAD and also improve practice in the identification, prevention and treatment of IAD in the ICU. METHODS A pre/post-audit framework was used to implement the best practice recommendations between August 2013 and March 2014. Nursing staff were surveyed and a chart review was conducted to audit baselines of knowledge and nursing practice regarding IAD. Education and product standardization were used to implement the best practice recommendations and a post-audit was conducted to evaluate changes in knowledge and practice. RESULTS Thirty-one (pre-implementation) and 27 (post-implementation) nurses were surveyed to evaluate knowledge on IAD identification, care and documentation practices. No IAD policy or IAD-specific skin assessment tool for use existed in the ICU. After implementation, there was a 40% increase in the ability of the staff to distinguish between IAD and pressure injuries, an increase from 87% to 100% in the use of skin-protectant and an improvement from 25 to 66% in the correct application of skin-protectants. An encouraging 70% of the nurses were using a single standard skin-protectant after implementation as opposed to audit 1, where 100% of the nurses were using multiple products before implementation. There was a 16% increase in the staff surveyed post-audit who said they reported on the perineal skin in patients with IAD. However, IAD documentation in both audit 1 and audit 2, as evidenced by chart review, remained poor. CONCLUSION The project had created an awareness of IAD in the ICU. There was clear knowledge improvement and nursing staff were able to differentiate IAD from pressure injuries. The skin cleansing and protection regime is now more clear and consistent, and a single standardized product is being used to prevent and treat IAD. There was a small improvement in consistently documenting the condition of the perineal skin of patients with IAD; however, it was beyond the scope of this project to develop a policy and implement an IAD-specific skin assessment tool in the ICU, as this would have improved documentation of IAD in the ICU.
Collapse
|
18
|
Rippon M, Colegrave M, Ousey K. Incontinence-associated dermatitis: reducing adverse events. ACTA ACUST UNITED AC 2016; 25:1016-1021. [PMID: 27734729 DOI: 10.12968/bjon.2016.25.18.1016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Incontinence-associated dermatitis (IAD) is a common problem in patients with faecal and/or urinary incontinence. Urine alters the normal skin flora and increases permeability of the stratum corneum and faecal enzymes on the skin contribute to skin damage. Faecal bacteria can then penetrate the skin, increasing the risk of secondary infection. However, IAD can be prevented and healed with timely and appropriate skin cleansing and skin protection. This includes appropriate use of containment devices. This article also looks at HARTMANN incontinence pads that have been developed to absorb the fluids that cause IAD and maintain the skin's acidic pH. The acidic pH of the skin contributes to its barrier function and defence against infection. Therefore, maintaining an acidic pH will help protect the skin from damage.
Collapse
Affiliation(s)
- Mark Rippon
- Visiting Clinical Research Fellow, School of Human and Health Sciences, Institute of Skin Integrity and Infection Prevention, University of Huddersfield
| | | | - Karen Ousey
- Professor and Director for the Institute of Skin Integrity and Infection Prevention, University of Huddersfield
| |
Collapse
|
19
|
Bonifaz A, Rojas R, Tirado-Sánchez A, Chávez-López D, Mena C, Calderón L, María POR. Superficial Mycoses Associated with Diaper Dermatitis. Mycopathologia 2016; 181:671-9. [PMID: 27193417 PMCID: PMC5014885 DOI: 10.1007/s11046-016-0020-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 05/11/2016] [Indexed: 11/24/2022]
Abstract
Diapers create particular conditions of moisture and friction, and with urine and feces come increased pH and irritating enzymes (lipases and proteases). Fungi can take advantage of all these factors. Candida yeasts, especially C. albicans, are responsible for the most frequent secondary infections and are isolated in more than 80 % of cases. Correct diagnosis is important for ensuring the correct prescription of topical antimycotics. Nystatin, imidazoles and ciclopirox are effective. It is important to realize there are resistant strains. Dermatophytes can infect the diaper area, with the most common agent being Epidermophyton floccosum. The clinical characteristics of dermatophytosis are different from those of candidiasis, and it can be diagnosed and treated simply. Malassezia yeasts can aggravate conditions affecting the diaper area, such as seborrheic dermatitis, atopic dermatitis, and inverse psoriasis. Additional treatment is recommended in this case, because they usually involve complement activation and increased specific IgE levels. Erythrasma is a pseudomycosis that is indistinguishable from candidiasis and may also occur in large skin folds. It is treated with topical antibacterial products and some antimycotics.
Collapse
Affiliation(s)
- Alexandro Bonifaz
- Department of Mycology and Dermatology Service, Hospital General de México, "Dr. Eduardo Liceaga", Dr. Balmis 148, Col Doctores, CP 06720, Mexico, DF, Mexico.
| | - Rubí Rojas
- Dermatology Service, Hospital Infantil de México, "Dr. Federico Gómez", Mexico, Mexico
| | - Andrés Tirado-Sánchez
- Department of Mycology and Dermatology Service, Hospital General de México, "Dr. Eduardo Liceaga", Dr. Balmis 148, Col Doctores, CP 06720, Mexico, DF, Mexico
| | - Dinora Chávez-López
- Dermatology Service, Hospital Infantil de México, "Dr. Federico Gómez", Mexico, Mexico
| | - Carlos Mena
- Dermatology Service, Hospital Infantil de México, "Dr. Federico Gómez", Mexico, Mexico
| | - Luz Calderón
- Department of Mycology and Dermatology Service, Hospital General de México, "Dr. Eduardo Liceaga", Dr. Balmis 148, Col Doctores, CP 06720, Mexico, DF, Mexico
| | - Ponce-Olivera Rosa María
- Department of Mycology and Dermatology Service, Hospital General de México, "Dr. Eduardo Liceaga", Dr. Balmis 148, Col Doctores, CP 06720, Mexico, DF, Mexico
| |
Collapse
|
20
|
Fujimura T, Makino M, Takagi M, Maki K, Murakami E, Tasaka Y, Sato N, Akiba S, Hotta M, Kitahara T, Ando K. The influence of incontinence on the characteristic properties of the skin in bedridden elderly subjects. Int J Dermatol 2015; 55:e234-40. [DOI: 10.1111/ijd.13170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 06/20/2015] [Accepted: 08/03/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Tsutomu Fujimura
- Biological Science Research; Kao Corporation; Haga Tochigi Japan
| | - Mayumi Makino
- Department of Nursing; Medical Corporation; Saijyo Central Hospital; Saijyo Ehime Japan
| | - Miyuki Takagi
- Department of Nursing; Medical Corporation; Saijyo Central Hospital; Saijyo Ehime Japan
| | - Kumiko Maki
- Department of Nursing; Medical Corporation; Saijyo Central Hospital; Saijyo Ehime Japan
| | - Emiko Murakami
- Department of Nursing; Medical Corporation; Saijyo Central Hospital; Saijyo Ehime Japan
| | - Yoshiko Tasaka
- Department of Nursing; Medical Corporation; Saijyo Central Hospital; Saijyo Ehime Japan
| | - Noriko Sato
- Biological Science Research; Kao Corporation; Haga Tochigi Japan
| | - Shunichi Akiba
- Biological Science Research; Kao Corporation; Haga Tochigi Japan
| | - Mitsuyuki Hotta
- Biological Science Research; Kao Corporation; Haga Tochigi Japan
| | - Takashi Kitahara
- Biological Science Research; Kao Corporation; Haga Tochigi Japan
| | - Kikue Ando
- Department of Nursing; Medical Corporation; Saijyo Central Hospital; Saijyo Ehime Japan
| |
Collapse
|
21
|
Lowry N, McLister A, McCreadie K, Davis J. An electronic approach to minimising moisture-associated skin damage in ostomy patients. Med Hypotheses 2015; 85:192-6. [PMID: 25981876 DOI: 10.1016/j.mehy.2015.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/25/2015] [Indexed: 12/01/2022]
Abstract
Marked developments in the design of ostomy appliances in recent years have revolutionised stoma care and management but the prevalence of peristomal skin complications continues to be problematic with incidence rates ranging from 10% to 70%. Despite requisite pre and post-operative education for new patients, complications continue to arise - even under the close supervision of specialist nurses. Prolonged exposure of the skin to high pH stoma effluent is widely accepted as a key contributor to the onset of moisture-associated skin disease and it is our hypothesis that a "smart wafer", employing electrochemical manipulation of local pH, could mitigate some of the issues currently plaguing ostomy management. Current electrochemical research strategies translatable to stoma care are presented and their possible implementations critically appraised.
Collapse
Affiliation(s)
- Naomi Lowry
- School of Engineering, University of Ulster, Jordanstown, Northern Ireland BT37 0QB, UK
| | - Anna McLister
- School of Engineering, University of Ulster, Jordanstown, Northern Ireland BT37 0QB, UK
| | - Karl McCreadie
- School of Engineering, University of Ulster, Jordanstown, Northern Ireland BT37 0QB, UK
| | - James Davis
- School of Engineering, University of Ulster, Jordanstown, Northern Ireland BT37 0QB, UK.
| |
Collapse
|
22
|
|
23
|
Sugama J, Sanada H, Shigeta Y, Nakagami G, Konya C. Efficacy of an improved absorbent pad on incontinence-associated dermatitis in older women: cluster randomized controlled trial. BMC Geriatr 2012; 12:22. [PMID: 22642800 PMCID: PMC3426468 DOI: 10.1186/1471-2318-12-22] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 05/29/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most older adults with urinary incontinence use absorbent pads. Because of exposure to moisture and chemical irritating substances in urine, the perineal skin region is always at risk for development of incontinence-associated dermatitis (IAD). The aim of this study was to examine the efficacy of an improved absorbent pad against IAD. METHODS A cluster randomized controlled design was used to compare the efficacy of two absorbent pads. Female inpatients aged ≥65 years who had IAD and used an absorbent pad or diaper all day were enrolled. Healing rate of IAD and variables of skin barrier function such as skin pH and skin moisture were compared between the usual absorbent pad group (n = 30) and the test absorbent pad group (n = 30). RESULTS Thirteen patients (43.3%) from the test absorbent pad group and 4 patients (13.3%) from the usual absorbent pad group recovered completely from IAD. Moreover, the test absorbent pad group healed significantly faster than the usual absorbent pad group (p = 0.009). On the other hand, there were no significant differences between the two groups in skin barrier function. CONCLUSION The test absorbent pad for older adults with urinary incontinence might be more efficacious against IAD than usual absorbent pad. TRIAL REGISTRATION UMIN-CTR: UMIN000006188.
Collapse
Affiliation(s)
- Junko Sugama
- Department of Clinical Nursing, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan.
| | | | | | | | | |
Collapse
|
24
|
|