Moisturisers, emollients, or barrier preparations for the prevention of pressure injury: a systematic review and meta-analysis

Background Pressure injuries are prevalent, yet preventable global healthcare problem estimated to affect 14% of hospital patients and up to 46% of aged care residents. One common prevention strategy is improving skin integrity through emollient therapy to optimise hydration and avoid skin breakdown. Therefore, this study aims to review the literature and determine effectiveness of inert emollients, moisturisers, and barrier preparations to prevent pressure injury in aged care or hospital settings.

METHODS

Search terms were derived with database searches including ProQuest, CINAHL, Medline, Science Direct, Scopus and the Cochrane library. The Robins1 and Risk of Bias 2 (Rob2) quality appraisal tools were used. A meta-analysis of the effects of interventions was conducted (random effects).

RESULTS

Four studies met the inclusion criteria, with heterogeneous quality. Pooling of non-randomised studies found that the application of emollients, moisturisers or barrier preparations did not significantly reduce incidence of pressure injury compared to standard care (relative risk 0.50 95% CI 0.15-1.63, Z=1.15 p=0.25).

CONCLUSION

This review suggests that the use of inert moisturisers, emollients, or barrier preparations for preventing pressure injuries was not effective to prevent pressure injury in aged care or hospital settings. However, there was a distinct lack of randomised controlled trials, with only one meeting the inclusion criteria. One included study which utilised a combination of neutral body wash and emollient demonstrated a significant reduction in development of stage one and two pressure injuries. This combination of care may further support skin integrity and should be further examined in future trials.

Cost effectiveness of temporary isolation rooms in acute care settings in Singapore

Objectives

To estimate the change to health service costs and health benefits from a decision to adopt temporary isolation rooms that are effective at isolating the patient within a general ward environment. We assess the cost-effectiveness of a decision to adopt an existing temporary isolation room in a Singapore setting.

Method

We performed a model-based cost-effectiveness analysis to evaluate the impact of a decision to adopt temporary isolation rooms for infection prevention. We estimated changes to the costs from implementation, the number of cases of healthcare associated infection, acute care bed days used, they money value of bed days, the number of deaths, and the expected change to life years. We report the probability that adoption was cost-effective by the cost by life year gained, against a relevant threshold. Uncertainty is addressed with probabilistic sensitivity analysis and the findings are tested with plausible scenarios for the effectiveness of the intervention.

Results

We predict 478 fewer cases of HAI per 100,000 occupied bed days from a decision to adopt temporary isolation rooms. This will result in cost savings of $SGD329,432 and there are 1,754 life years gained. When the effectiveness of the intervention is set at 1% of cases of HAI prevented the incremental cost per life year saved is $16,519; below the threshold chosen for cost-effectiveness in Singapore.

Conclusions

We provide some evidence that adoption of a temporary isolation room is cost-effective for Singapore acute care hospitals. It is plausible that adoption is a positive decision for other countries in the region who may demonstrate fewer resources for infection prevention and control.

Effectiveness of meatal cleaning in the prevention of catheter-associated urinary tract infections and bacteriuria: an updated systematic review and meta-analysis

OBJECTIVE

A systematic review on meatal cleaning prior to urinary catheterisation and post catheterisation and reduces the risk catheter-associated urinary tract infections (CAUTIs) and bacteriuria was published in 2017, with further studies undertaken since this time. The objective of this paper is to present an updated systematic review on the effectiveness of antiseptic cleaning of the meatal area for the prevention of CAUTIs and bacteriuria in patients who receive a urinary catheter.

DESIGN

Systematic review.

DATA SOURCES

Electronic databases Cochrane Library, PubMed, Embase, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Academic Search Complete were searched from 1 January 2016 and 29 February 2020.

ELIGIBILITY CRITERIA

Randomised controlled trials (RCTs) and quasi-experimental studies evaluating the use of antiseptic, antibacterial or non-medicated agents for cleaning the meatal, periurethral or perineal areas before indwelling catheter insertion or intermittent catheterisation or during routine meatal care.

DATA EXTRACTION AND SYNTHESIS

Data were extracted using the Cochrane Collaboration's data collection form for RCTs and non-RCTs. Data were extracted by one researcher and then checked for accuracy by a second researcher.

RESULTS

A total of 18 studies were included. Some potential benefit of using antiseptics, compared with non-antiseptics for meatal cleaning to prevent bacteriuria and or CAUTI was identified (OR 0.84, 95% CI 0.69 to 1.02; p=0.071). Antiseptics (chlorhexidine or povidine-iodine) may be of value for meatal cleaning on the incidence of CAUTI, compared with comparator agents (saline, soap or antimicrobial cloths) (OR=0.65, 95% CI 0.42 to 0.99; p=0.047).

CONCLUSION

There is emerging evidence of the role of some specific antiseptics (chlorhexidine) prior to urinary catheterisation, in reducing CAUTIs, and some potential benefit to the role of antiseptics more generally in reducing bacteriuria.

PROSPERO REGISTRATION NUMBER

CRD42015023741.

Budget impact analysis of routinely using whole-genomic sequencing of six multidrug-resistant bacterial pathogens in Queensland, Australia

OBJECTIVE

To predict the cost and health effects of routine use of whole-genome sequencing (WGS) of bacterial pathogens compared with those of standard of care.

DESIGN

Budget impact analysis was performed over the following 5 years. Data were primarily from sequencing results on clusters of multidrug-resistant organisms across 27 hospitals. Model inputs were derived from hospitalisation and sequencing data, and epidemiological and costing reports, and included multidrug resistance rates and their trends.

SETTING

Queensland, Australia.

PARTICIPANTS

Hospitalised patients.

INTERVENTIONS

WGS surveillance of six common multidrug-resistant organisms (Staphylococcus aureus, Escherichia coli, Enterococcus faecium, Klebsiella pneumoniae, Enterobacter sp and Acinetobacter baumannii) compared with standard of care or routine microbiology testing.

PRIMARY AND SECONDARY OUTCOMES

Expected hospital costs, counts of patient infections and colonisations, and deaths from bloodstream infections.

RESULTS

In 2021, 97 539 patients in Queensland are expected to be infected or colonised with one of six multidrug-resistant organisms with standard of care testing. WGS surveillance strategy and earlier infection control measures could avoid 36 726 infected or colonised patients and avoid 650 deaths. The total cost under standard of care was $A170.8 million in 2021. WGS surveillance costs an additional $A26.8 million but was offset by fewer costs for cleaning, nursing, personal protective equipment, shorter hospital stays and antimicrobials to produce an overall cost savings of $30.9 million in 2021. Sensitivity analyses showed cost savings remained when input values were varied at 95% confidence limits.

CONCLUSIONS

Compared with standard of care, WGS surveillance at a state-wide level could prevent a substantial number of hospital patients infected with multidrug-resistant organisms and related deaths and save healthcare costs. Primary prevention through routine use of WGS is an investment priority for the control of serious hospital-associated infections.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Determination of Total, Saturated, Unsaturated, and Monounsaturated Fats in Cereal Products by Acid Hydrolysis and Capillary Gas Chromatography: Collaborative Study

Fifteen laboratories participated in a collaborative study to determine total, saturated, unsaturated, and monounsaturated fats in cereal products by gas chromatographic (GC) analysis of fatty acid methyl esters (FAMEs). Cereal products, representing a wide range of cereal grains and processes, were hydrolyxed in 8N HCI and extracted with ethyl and petroleum ethers. FAMEs were produced by the reaction of the mixed ether extracts with sodium hydroxide in methanol (NaOH/MeOH) and then with boron trifluoride reagent (14% BF3 in MeOH). They were quantitatively determined by capillary GC. Total fat was calculated as the sum of individual fatty acids expressed as triglyceride equivalents in accordance with nutrition labeling guidelines. Saturated, unsaturated, and monounsaturated fats were calculated as sums of individual fatty acids. The total fat contents of samples ranged from 0.56 to 12.64%. A split design was used to determine performance parameters of results obtained by 15 laboratories on 24 samples. Of the 24 samples, 7 were blind duplicates and 5 were independent materials. Statistical analysis for total fat yielded a relative standard deviation for repeatability (RSDr) range of 1.32 to 13.30% and a relative standard deviation for reproducibility (RSDr) range of 4.42 to 22.82%. The goal of this study was to determine total fat, saturated fat, unsaturated, and monounsaturated fat in cereal-based products by complete extraction, methylation, and quantitation of total fatty acids. The acid hydrolysis-capillary GC method for determining total, saturated, unsaturated, and monosaturated fats in cereal products has been adopted by AOAC INTERNATIONAL.

Determination of Vitamin B12 in Fortified Bovine Milk- Based Infant Formula Powder, Fortified Soya-Based Infant Formula Powder, Vitamin Premix, and Dietary Supplements by Surface Plasmon Resonance: Collaborative Study

A collaborative study was conducted on an inhibition-based protein-binding assay using the Biacore Q™ biosensor instrument and the Biacore Qflex™ Kit Vitamin B12 PI. The samples studied included infant formula, cereals, premixes, vitamin tablets, dietary supplements, and baby food. The collaborative study, which involved 11 laboratories, demonstrated that the assay showed an RSDr of 1.59–27.8 and HorRat values for reproducibility of 0.34–1.89 in samples with levels ranging from ppm to ppb. The assay studied is a label-free protein binding-based assay that uses the principle of surface plasmon resonance (SPR) to measure the interaction between vitamin B12 and a specifc binding protein. A Biacore Q biosensor uses this principle to detect binding directly at the surface of a sensor chip with a hydrophilic gold-dextran surface. The instrument passes a mixture of prepared sample extract and binding protein solution across a covalently immobilized vitamin B12 chip surface, and the response is given as free-binding protein as the mixture binds to the immobilized surface. This technique uses the specifcity and robustness of the protein-ligand interaction to allow minimal sample preparation and a wide range of matrixes to be analyzed rapidly. The reagents and accessories needed to perform this assay are provided as the ready-to-use format “Qflex Kit Vitamin B12 PI.” The method is intended for routine use in the quantitative determination of vitamin B12 (as cyanocobalamin) in a wide range of food products, dietary vitamin supplements, and multivitamin premixes.

Community infrastructure to boost social relations: a systematic review

Background

‘Boosting social relations’ in communities has been identified as a priority UK policy-related topic. An earlier scoping review identified evidence gaps in social relations & community infrastructure. We undertook a mixed method systematic review on this topic, which has potential for immediate practical impact.

Methods

A comprehensive search included 11 databases (1997-2017), grey literature and citation checking. Studies of interventions to improve or make alternative use of community or neighbourhood places, reporting outcomes of social relations, community wellbeing & related concepts were included. Established validity checklists. Qualitative data was synthesised thematically and a narrative synthesis was produced. GRADE and CERQual approaches were used to rate the overall strength of evidence for each outcome.

Results

51 included studies, mostly of poor to moderate quality, and mostly qualitative, provided moderate evidence that: Community hubs may promote social cohesion, increase social capital and build trust, widen social networks, increase interaction, and increase knowledge or skills;Changes to neighbourhood design may positively affect sense of belonging and pride in a community;Green and blue space interventions that provide the opportunity to participate in activities or meetings may improve social interactions, increase social networks, bonding and bridging social capital, physical activity and healthy eating, and improve people’s skills and knowledge.

There were also common themes relating to facilitators and barriers to successful interventions.

Conclusions

There is moderate evidence that a range of intervention approaches to community infrastructure can boost social relations and community wellbeing. Future research should prioritise high quality evaluations using repeated measures and validated tools, and robust and credible qualitative evidence.

Key messages

There is moderate evidence that a range of intervention approaches to community infrastructure can boost social relations and community wellbeing. Community hubs may promote social cohesion, increase social capital and build trust, widen social networks, increase interaction, and increase knowledge or skills.

Immunogenicity of a Staphylococcus aureus-cholera toxin A2/B vaccine for bovine mastitis

Staphylococcus aureus causes a chronic, contagious disease of the udder, or mastitis, in dairy cows. This infection is often refractory to antibiotic treatment, and has a significant economic impact on milk production worldwide. An effective vaccine to prevent S. aureus mastitis would improve animal health, reduce antibiotic dependence and inform human vaccine approaches. The iron-regulated surface determinant A (IsdA) and clumping factor A (ClfA) are conserved S. aureus extracellular-matrix adhesins and target vaccine antigens. Here we report the results of two bovine immunogenicity trials using purified IsdA and ClfA-cholera toxin A₂/B chimeras (IsdA-CTA₂/B and ClfA-CTA₂/B). Cows were intranasally inoculated with IsdA-CTA₂/B + ClfA-CTA₂/B at dry off and followed for 70 days. Trial 1 utilized three groups with one or two booster doses at a total concentration of 600 or 900 μg. Trial 2 utilized two groups with one booster at a total concentration of 1200 μg. Humoral immune responses in serum and milk were examined by ELISA. Responses in serum were significant between groups and provide evidence of antigen-specific IgG induction after vaccination in both trials. Cellular proliferation was detected by flow cytometry using antigen-stimulated PBMCs from day 60 of Trial 2 and revealed an increase in CD4+ T cells from vaccinated cows. IsdA and ClfA stimulation induced IL-4 expression, but not IFN-γ or IL-17, in PBMCs from day 60 as determined by cytokine expression analysis. Opsonophagocytosis of S. aureus confirmed the functional in vitro activity of anti-IsdA antibodies from Trial 2 serum and milk. The vaccine was well tolerated and safe, and results support the potential of mucosally-delivered CTA₂/B chimeras to protect cows from mastitis caused by S. aureus.

Optimizing the Intensity of Lifestyle Medicine Interventions: Similar Outcomes for Half the Sessions

Lifestyle medicine interventions are typically intensive by design. This study explored the optimal "dosage" of a well-known lifestyle medicine intervention-the Complete Health Improvement Program (CHIP). A total of 2383 individuals (mean age = 61.0 ± 9.2 years; 34% males) participated in either an 8-session (N = 448) or 16-session (N = 1935) version of the CHIP intervention conducted over 4 weeks in community settings throughout North America. Both the 8- and 16-session groups experienced significant improvements in all the chronic disease risk factors measured. There was no difference between the changes experienced by the 8- and 16-session groups in lipid profile, fasting plasma glucose, or systolic blood pressure. The 8-session group experienced a significantly greater reduction in body mass (0.3 percentage points or 0.8 lbs, P < .01), but the 16-session group recorded a significantly greater reduction in diastolic blood pressure (2.8 percentage points or 2.2 mm Hg, P < .01). There was no clear difference between the outcomes achieved in 4 weeks by the 8- and 16-session versions of the CHIP lifestyle medicine intervention. This study suggests that the short-term outcomes achieved by a 16-session CHIP intervention can be achieved in half the number of sessions, which has implications from a resourcing and cost-effectiveness perspective.

The role of obesity in the onset of type 2 diabetes mellitus

The onset of type 2 diabetes mellitus is associated with various modifiable and non-modifiable risk factors, including lifestyle factors. Obesity is the principal lifestyle factor associated with an increased risk of developing type 2 diabetes. It is essential for nurses to have an understanding of the pathophysiology associated with factors that contribute to an increased risk of type 2 diabetes, particularly those associated with obesity. Nurses who have an understanding of the interaction between obesity and the onset of type 2 diabetes are better equipped to discuss the importance of weight loss and other necessary lifestyle adjustments in the prevention and management of obesity and diabetes associated with obesity, to implement evidence-based practice and to support patients to manage their health effectively.

Medication adherence 1 month after hospital discharge in medical inpatients

BACKGROUND

The rate of medication non-adherence has been consistently reported to be between 20 and 50%. The majority of available data comes from international studies, and we hypothesised that a similar rate of adherence may be observed in Australian patients.

AIMS

To determine the rate of adherence to medications after discharge from acute general hospital admission and identify factors that may be associated with non-adherence.

METHODS

A prospective cohort study of 68 patients, comparing admission and discharge medication regimens to self-reported regimens 30-40 days after discharge from hospital. Patients were followed up via telephone call and univariate and multivariate binary logistic regression used to determine patient factors associated with non-adherence.

RESULTS

In all, 27 of 68 patients (39.7%) were non-adherent to one or more regular medications at follow up. Intentional and unintentional non-adherence contributed equally to non-adherence. Using multivariate analysis, presence of a carer responsible for medications was associated with significantly lower non-adherence (odds ratio (OR) 0.20 (0.05-0.83), P = 0.027) when adjusted for age, co-morbidities, chemist blister pack and total number of discharge medications.

CONCLUSIONS

Non-adherence to prescription medications is suboptimal and consistent with previous overseas studies. Having a carer responsible for medications is associated with significantly lower rates of non-adherence. Understanding patients' preferences and involving them in their healthcare may reduce intentional non-adherence.

Utilization of native oxygen in Eu(RE)-doped GaN for enabling device compatibility in optoelectronic applications

The detrimental influence of oxygen on the performance and reliability of V/III nitride based devices is well known. However, the influence of oxygen on the nature of the incorporation of other co-dopants, such as rare earth ions, has been largely overlooked in GaN. Here, we report the first comprehensive study of the critical role that oxygen has on Eu in GaN, as well as atomic scale observation of diffusion and local concentration of both atoms in the crystal lattice. We find that oxygen plays an integral role in the location, stability, and local defect structure around the Eu ions that were doped into the GaN host. Although the availability of oxygen is essential for these properties, it renders the material incompatible with GaN-based devices. However, the utilization of the normally occurring oxygen in GaN is promoted through structural manipulation, reducing its concentration by 2 orders of magnitude, while maintaining both the material quality and the favorable optical properties of the Eu ions. These findings open the way for full integration of RE dopants for optoelectronic functionalities in the existing GaN platform.

Homelessness and housing crises among individuals accessing services within a Canadian emergency department

ACCESSIBLE SUMMARY

Studies have indicated that individuals who are homeless access hospital emergency departments more frequently and may have different needs than individuals who are housed. Successful interventions have been developed and tested to reduce discharge to homelessness for psychiatric inpatients but have not been similarly tested for discharge from emergency departments. This study was developed to provide baseline data on this issue to inform future emergency department interventions. Findings from the current study suggest that discharge from emergency departments to homelessness happens frequently in London, Canada. Participants are unlikely to spontaneously disclose their housing/homelessness issue when first entering the emergency department, which may result in services that do not adequately meet their complex needs. Screening for housing issues is necessary within emergency departments and psychiatric crisis teams as housing issues may be a reason for accessing care or contribute to the presenting condition. Nurses are in an ideal position to evaluate housing needs among emergency department patients. Services outside of the emergency department are also needed to address housing issues, particularly outside of regular office hours.

ABSTRACT

Individuals who have mental health issues and are homeless or in housing crisis have been found to access emergency departments more frequently than individuals with stable housing. While emergency departments primarily focus on medical issues, homeless individuals may require psychosocial support as well. This study examined issues around housing crises and emergency department use for individuals with mental illness in Canada. Collecting baseline data about these issues is important to inform subsequent interventions. Administrative data from a hospital emergency department and psychiatric crisis service were collected, and five individuals accessing the emergency department for psychiatric reasons were interviewed. Results indicated that individuals with an identified housing crisis accessed the emergency department 930 times in 6 months. None of the interview participants identified housing as the primary reason for accessing the emergency department, but all noted that housing was a contributing stressor. Future research is needed to examine ways in which discharge to homelessness from emergency departments can be avoided and identify alternative services to address housing concerns, particularly for individuals with mental illness. Crisis service and emergency department staff, especially nurses, can play an important role in screening for housing issues and connecting individuals to outside services.