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Liu H, Du A, Tian Y, Gao M, Ji S, Mi J, Shao X, Huang D, Cao X. The ability of critical care nurses to identify pressure injury and incontinence-associated dermatitis: A multicentre cross-sectional survey. Nurs Open 2022; 10:1556-1564. [PMID: 36266743 PMCID: PMC9912419 DOI: 10.1002/nop2.1406] [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: 10/12/2021] [Revised: 04/22/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022] Open
Abstract
AIM To investigate the ability of critical care nurses to identify pressure injury and incontinence-associated dermatitis and analyse the possible influencing factors. DESIGN Cross-sectional survey. METHODS This study was conducted at 24 hospitals across 12 provinces in China. A self-made electronic questionnaire was used. Nurses identified and judged injuries according to the information provided. RESULTS The average identification score for pressure injury and incontinence-associated dermatitis was 9.00 ± 3.51 points, and only 2.16% of nurses scored ≥16 points. The average correct identification rate for pressure injury and incontinence-associated dermatitis was 45%. The correct identification rate for stage 1 pressure injury was the highest, while those for stage 3, stage 4, deep tissue pressure injury and unstageable pressure injury were all lower than 50%; incontinence-associated dermatitis was also easily misjudged. Nurses' educational backgrounds, professional titles, job positions, hospital levels and learning frequency were the factors that affected their ability to identify pressure injury and incontinence-associated dermatitis.
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Affiliation(s)
- Huan Liu
- Department of Critical Care MedicineWest China Hospital of Sichuan UniversityChengduChina
| | - Aiping Du
- Department of Critical Care MedicineWest China Hospital of Sichuan UniversityChengduChina
| | - Yongming Tian
- Department of Critical Care MedicineWest China Hospital of Sichuan UniversityChengduChina
| | - Mingrong Gao
- Department of Critical Care MedicineThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Shuming Ji
- Office of Program Design and StatisticsWest China Hospital of Sichuan UniversityChengduChina
| | - Jie Mi
- Department of Critical Care MedicineThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Xiaoping Shao
- Department of Critical Care MedicineShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Debin Huang
- Department of Critical Care MedicineThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Xiaoyi Cao
- Department of NursingWest China Hospital of Sichuan UniversityChengduChina
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Abstract
This article discusses the effects of ageing on the skin, particularly the main structural and functional changes that occur in the epidermis and dermis that make the skin more vulnerable to damage. Specific alterations that occur with ageing include slower epidermal turnover, flattening of the epidermal-dermal junction, loss of moisture and hydration as well as reduced immunity placing the skin at increased risk of damage. The discussion will also examine common periwound complications associated with ageing including; maceration, excoriation, dry skin, hyperkeratosis, callus, contact dermatitis and eczema. Strategies to manage these problems and interventions to reduce the risk of these complications include moisturising the skin to make it more resilient, debriding keratinised and callus tissue in the periwound area, appropriate choice of dressings to manage excessive exudate, careful removal of dressings as well as treating inflammatory conditions of the periwound skin.
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Affiliation(s)
- Samantha Holloway
- Reader, Centre for Medical Education, School of Medicine, Cardiff University, Wales
| | - Kirsty Mahoney
- Senior Tissue Viability Nurse and Clinical Operational programme improvement Lead, Welsh Wound Innovation Centre
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Glass GF, Goh CCK, Cheong RQ, Ong ZL, Khong PCB, Chan EY. Effectiveness of skin cleanser and protectant regimen on incontinence-associated dermatitis outcomes in acute care patients: A cluster randomised trial. Int Wound J 2021; 18:862-873. [PMID: 33960676 PMCID: PMC8613386 DOI: 10.1111/iwj.13588] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/04/2021] [Accepted: 03/09/2021] [Indexed: 01/13/2023] Open
Abstract
Skin cleansers and protectants protect skin from incontinent matter to reduce the risk of incontinence-associated dermatitis (IAD), but their effectiveness treating established IAD in the tropics is unknown. We conducted an open-label cluster randomised trial to compare the effectiveness of a combined regimen of (1) specialised skin cleansers with disposable body wipes and (2) either an acrylic terpolymer (T1) or zinc oxide (T2) skin protectant against disposable body wipes and zinc oxide protectant (control) in promoting IAD healing and reducing the risk of deterioration. Eighty-four patients were recruited in a tertiary hospital in Singapore between April 2019 and January 2020 (T1: n = 23; T2: n = 37; Control: n = 24). Although not statistically significant, patients treated with T1 and T2 were 1.5 times as likely to experience IAD healing within seven days compared with the control (P = .66). Healing was more pronounced in participants with skin loss treated with T1 or T2. No treatment was superior in preventing IAD deterioration, the prevalence of which remained small (8%-14%). While skin cleaning and protectants reduced the overall risk of skin deterioration, the addition of skin cleansers enhanced IAD healing within a short period, an important consideration for future research examining IAD treatment in acute care.
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Affiliation(s)
| | | | - Run Qi Cheong
- Nursing Research Unit, Tan Tock Seng Hospital, Singapore, Singapore
| | - Zhi Lei Ong
- Nursing Research Unit, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Ee-Yuee Chan
- Nursing Research Unit, Tan Tock Seng Hospital, Singapore, Singapore.,Alice Lee Centre of Nursing Studies, National University of Singapore, Singapore
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Raepsaet C, Fourie A, Van Hecke A, Verhaeghe S, Beeckman D. Management of incontinence-associated dermatitis: A systematic review of monetary data. Int Wound J 2020; 18:79-94. [PMID: 33236846 PMCID: PMC7948709 DOI: 10.1111/iwj.13496] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/13/2022] Open
Abstract
The objective was to systematically review monetary data related to management of incontinence‐associated dermatitis (IAD) in an adult population. Six electronic databases were searched: MEDLINE, CINAHL, Web of Science, EMBASE, The Cochrane Library and EconLit. The search string combined index terms and text words related to IAD and monetary data. The quality of the articles was assessed using the consensus on Health Economic Criteria. Results were synthesised narratively because of methodological heterogeneity. Nine studies were included. Only direct medical costs were reported. The product cost per application for prevention ranged between $0.05 and $0.52, and for treatment between $0.20 and $0.35. The product cost per patient/day for prevention ranged between $0.23 and $20.17. The product cost of IAD prevention and treatment per patient/day ranged between $0.57 and $1.08. The cost to treat IAD did not consider the treatment of secondary infection. The calculation of labour cost and total cost differed considerably between studies. Summarising monetary data is a challenge because of heterogeneity in currencies, settings, samples, time horizons, health‐ and cost outcome valuation, IAD definition and measurements, and included costs. Procedures for health economic evaluations are to be clarified to guarantee valid interpretation and comparison with other studies.
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Affiliation(s)
- Charlotte Raepsaet
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Anika Fourie
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Ann Van Hecke
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sofie Verhaeghe
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,School of Health Sciences, Örebro University, Örebro, Sweden.,School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, Vejle, Denmark.,School of Nursing and Midwifery, Monash University, Melbourne, Australia
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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.
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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
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Acton C, Ivins N, Bainbridge P, Browning P. Management of incontinence-associated dermatitis patients using a skin protectant in acute care: a case series. J Wound Care 2020; 29:18-26. [DOI: 10.12968/jowc.2020.29.1.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: Incontinence-associated dermatitis (IAD) is a common type of irritant contact dermatitis. It is categorised by persistent erythema and can be associated with denudation and/or colonisation and infection. IAD is challenging to treat and affects 3.4–50% of patients. This case series evaluates a novel, elastomeric, advanced skin protectant (3M Cavilon Advanced Skin Protectant) in a UK acute health-care setting, for the management of IAD in patients suffering from moisture-associated skin damage (MASD) in the sacral/genital area. Method: The patient's skin was assessed by clinicians using the GLOBIAD classification tool at the point of recruitment and to monitor progress throughout the study period. The product was applied as a single layer in accordance with the instructions for use. Patients, when able, were asked to assess their own pain level using the Wong-Baker FACES pain scale. Photographs were taken as part of the ongoing assessment. Results: The skin protectant was used on average every 2.28 days. Of the 18 IAD patients recruited, 79% (n=11) were classified as IAD-free, based on the GLOBIAD categorisation tool, by the end of the evaluation period. Skin deterioration during the evaluation period was seen in one patient (6%), and of the patients able to complete pain assessments, 55% (n=6) reported a reduction in pain. Conclusion: These results suggest that the elastomeric skin protectant, applied every three days, plays a role in the improvement of IAD. The skin protectant adheres to wet and weeping partial-thickness wounds and may aid IAD management. Reducing application to every third day supports a change in practice which may offer benefits to patients and caregivers.
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Affiliation(s)
| | - Nicola Ivins
- Clinical Research Director, Welsh Wounds Innovation Initiative, UK
| | | | - Paul Browning
- Strategic Medical Writer, 3M Company, Medical & Clinical Affairs, St. Paul, US
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