Anti-embolism stocking care protocol to prevent associated skin problems: A quasi-experimental study

AimThe aim of this quasi-experimental study was to develop an anti-embolism stocking care protocol and assess its effectiveness in preventing associated skin problems on the legs.Materials and methodsThe study was conducted between 02 March and July 20, 2016 in the surgical clinics of a private university hospital in Ankara, Turkey. The sample consisted of 27 nurses and 162 patients (three different patients were fitted of anti-embolism stockings by each of the 27 nurses; pre-protocol 81 patients and post-protocol 81 patients). Data were collected using data collection forms developed by the researchers. An anti-embolism stocking care protocol was developed and used. Nurses and patients were evaluated using an observational method.ResultsFollowing implementation of the protocol, nurses’ mean knowledge (95.24 ± 5.60) and intervention skill (92.06 ± 10.42) scores were significantly higher than their pre-protocol knowledge (73.54 ± 14.26) and intervention skill (15.30 ± 6.84) scores. Nurses performed almost all steps of the care protocol correctly after the protocol was implemented. The rates of skin problems such as pressure ulcers, neurovascular problems and issues associated with wrinkles or creases in stockings were significantly reduced after implementation of the protocol.ConclusionsThis study demonstrates that nurses’ knowledge and intervention skills are increased when a care protocol is used, together with the prevention of errors and improved patient outcomes. The use of care protocols guides nurses in practice, raises awareness and helps to achieve nursing care objectives by standardizing information.     

Prevention of pressure injuries in critically ill children: A preliminary evaluation

AimsTo evaluate a prevention strategy implemented to reduce incidence and severity of positioning related pressure injuries affecting pediatric patients in a pediatric critical care unit. Secondary objective was to evaluate compliance with preventive recommendations.BackgroundThe skin in infants or children has important physiological and anatomical differences compared with adults. Further, factors such as the immaturity of the skin and limited activity and mobility in pediatric critical care unit, along with the pressure exerted by medical devices, increases the risk of pressure ulcers in infants and children. The most effective preventive measures specific to this intensive care population need to be evaluated.Material and methodsQuasi-experimental before-after study with consecutive sampling. The effectiveness of the care bundle implementation was evaluated based on the latest evidence (intervention group) versus the application of non-standardized care (control group). Pediatric patients up to 14 years old at risk of suffering from pressure injuries and who were admitted more than 48 h in a pediatric intensive care unit (level III) participated. For the collection of data, two computer programs and the hospital clinical records of each participant were consulted. The data collection period was 6 months per group (pre and post intervention).ResultsA sample of 110 patients was obtained (50 control group and 60 intervention group). The cumulative incidence in pediatric patients exposed to the risk of pressure injuries was reduced from 16% to 13.3%; and in the subgroup of patients with prolonged stay (≥28 days), the incidence was reduced from 55.55% to 20%. In the intervention group, category III and IV pressure ulcers were completely reduced. In addition, the total number of pressure injuries decreased by 21.43%. The care bandle recommendations with the highest level of adhesion recorded were: skin inspection, application of hyperoxygenated fatty acids and use of a special support surface. The main risk factor found during the study was the prone position (p < 0.05).ConclusionsThe application of a care bundle for prevention can be an effective solution to reduce the number and severity of LPPs in an intensive care unit. The most vulnerable subgroup of patients may benefit from the application of these resources.     

A quantitative study of hydration level of the skin surface and erythema on conventional and microclimate management capable mattresses and hospital beds

BackgroundIn addition to pressure itself, microclimate factors are gaining more attention in the understanding of the development of pressure ulcers. While there are already various products to reduce pressure on sore-prone areas to prevent pressure ulcers, there are only a few mattresses/hospital beds that actively influence skin microclimate. In this study, we investigated if microclimate management capable mattresses/hospital beds can influence skin hydration and skin redness/erythema.MethodsWe included 25 healthy subjects in our study. Measurements were made using Courage & Khazaka Multi Probe Adapter MPA with Corneometer CM825 and Mexameter MX18 to determine skin hydration of the stratum corneum and skin redness/erythema before and after the subjects were lying in conventional (Viskolastic® Plus, Wulff Med Tec GmbH, Fedderingen, Germany and Duo™ 2 mattress, Hill-Rom GmbH Essen, Germany) or microclimate management capable mattresses/hospital beds (ClinActiv + MCM™ and PEARLS AFT, Hill-Rom GmbH Essen, Germany).ResultsWhile there was no difference in skin redness/erythema on the different mattresses/hospital beds, skin hydration of the stratum corneum decreased significantly in an air fluidized bed compared to baseline values and values measured on standard mattress/Viskolastic® Plus.ConclusionAir-fluidized therapy reduces skin hydration and therefore could contribute to prevent moisture associated ulcers. Changes in skin hydration as one important factor of skin microclimate can be detected after a short time of incubation and even before an erythema appears.     

Validity of skin blot examination for albumin and nerve growth factor β to detect itching of the skin in Indonesian older adults

AimItching, a common skin disorder, impacts the quality of life of individuals. Itchy skin occurs more with increasing age and the prediction of itchy skin prognosis is necessary to provide good skincare. This study validated biomarkers in skin blotting to identify and measure itching sensation as well as conventional methods to measure skin barrier function.Materials and methodsFrom a cross-sectional study conducted in Long-term Care (LTC) facilities in Indonesia itching symptoms were obtained through a questionnaire. Skin conditions were assessed using photographs, stratum corneum (SC) hydration, skin pH, and skin blotting for biomarkers: albumin, interleukin 2 (IL2), nerve growth factor β (NGFβ), and thymic stromal lymphopoietin (TSLP). Association of skin measurements with the presence of skin blotting and trends analysis were conducted.ResultsAltogether, 564 LTC residents (average age, 70 years) participated. The SC hydration, skin pH, albumin, and NGFβ were associated with the presence of itch (p value= <0.001, <0.001, <0.001, and <0.001, respectively). The signal levels of skin blotting biomarkers were higher in itch group than in the non-itch group. Additionally, the higher quantile of SC hydration was significantly associated with a lower intensity level of NGFβ and TSLP (p value = 0.005, 0.003, respectively). The lower quantile of skin pH (better skin condition) was significantly associated with lower albumin, NGFβ, and TSLP (p value = 0.048, 0.035, and <0.001, respectively).ConclusionThe albumin, NGFβ, and TSLP could be a candidate for measurement of itchy skin among older adult with disrupted skin barrier function and local skin inflammation.     

Skin temperature and vascular attributes as early warning signs of pressure injury

ObjectivesThis study aimed to validate the skin temperature on sacral region and vascular attributes as early warning signs of pressure injury.MethodsTotally 415 patients admitted to the adult intensive care unit from August 2018 to April 2019 were prospectively screened. Daily blood pressure and blood glucose affecting vascular attributes and the relative skin temperature of sacral region were measured for 10 consecutive days. Collect the changes of these indicators during the occurrence of pressure injury. The optimal cut-off values of indicators were determined by X-tile analysis. The risk ratios of indicators associated with pressure injury were compared using the Cox proportional hazards regression model.ResultsThere were no obvious interactions among blood pressure, blood glucose and relative skin temperature (P > 0.05). The optimal cutoff value for above indicators was 63.5 mmHg, 9.9 mmol/L and −0.1 °C, respectively. The incidence of pressure injury peaked on the 4th and 5th day after hospitalization when categorizing the patients into low- and high-risk groups according to the cutoff values (P < 0.05). Based on relative skin temperature, patients in the high-risk group were more likely to develop pressure injury (hazard ratio = 6.36, 95% confidence interval = 3.91, 10.36), when compared to the other two indicators of blood pressure and blood glucose.ConclusionStringent skin temperature and vascular attributes measurements were necessary for preventing pressure injury. Nursing measures should be taken according to warning sings to reduce the incidence of pressure injury.     

Determination of the effect of prophylactic dressing on the prevention of skin injuries associated with personal protective equipments in health care workers during COVID-19 pandemic

AimThe present study was carried out as a comparative observational study in order to determine the effect of prophylactic dressing on the prevention of skin injuries due to the use of personal protective equipment (PPE) in health care workers (HCWs) working with COVID-19 patients. In addition, the effect of nasal strip on the prevention of discomfort in breathing with mask was also investigated.Materials and methodsThe present study was carried out with 48 HCWs (Control Group-CG, n = 20; Experimental Group 1-EG1, n = 20; Experimental Group 2-EG2, n = 8) who use PPE on the face region and work with COVID-19 patients. Data was collected with Data Collection Form developed by researchers. In participants in CG, normal procedures of the institution in using PPE were followed. In EG1, prophylactic dressing was used on risky areas on the face. In EG2, nasal strip sticky on one side was used in addition to prophylactic dressing. The evaluation of the facial skin was made once a day by a researcher with expertise in wound management.ResultsGroups were similar in terms of demographic characteristics of participants. Overall rate of skin injuries associated with PPE use was 47.9%. Skin injuries developed in all participants in CG (n = 20), and in two and one participants in EG1 and EG2 respectively, with significant difference between groups. The most common skin injuries were Stage 1 pressure injury (29.2%), blanchable erythema of intact skin (27.1%) and itching (18.8%). No participant in EG2 reported discomfort in breathing (n = 8). Significant difference was found between groups in favor of EG2 in terms of experiencing discomfort in breathing (p < 0.001).ConclusionsIn the present study, it was established that using prophylactic dressing under PPE prevents skin injuries on the facial skin and using nasal strip prevents discomfort in breathing with mask. In view of these results, it was recommended that prophylactic dressing should be used under PPE.     

Anatomical variability of sub-epidermal moisture and its clinical implications

BackgroundTechnologies have been developed to monitor changes in dermal oedema, indicative of the early signs of pressure ulcers. However, there is limited information on the effects of regional differences in tissue morphology on these sub-epidermal moisture (SEM) parameters. This study was designed to investigate the absolute SEM readings across different anatomical sites using a commercial device.MethodsTwenty-four healthy participants were recruited to evaluate basal SEM values at different bony prominences, sampled by an experienced operator.ResultsDistinct differences were observed in unloaded SEM values across different anatomical sites, notably between the upper and lower extremities. A high degree of variability was observed in particular sites, such as the heels. Moreover, SEM values at certain locations revealed significant relationships with age, BMI and gender (p < 0.05).ConclusionThe study revealed a high level of variability between and within anatomical sites in a healthy cohort of participants. Determining the changes in local skin and sub-dermal tissue status using SEM may require consideration of both site specific and individual demographic factors, with further research needed in cohorts at risk of pressure ulcers.     

Evaluation of pain in patients with venous ulcers after skin grafting

AimPain was assessed in patients with venous leg ulcers treated with either split-thickness skin grafts or conventional treatment to evaluate to what extent skin grafting reduces pain in this population.MethodsA controlled prospective clinical trial was conducted from July 2008 to June 2011 in two hospitals in São Paulo, Brazil. Two hundred patients with venous leg ulcers were divided into two treatment groups of 100 patients each: control group (conservative treatment) and surgery group (skin grafting). Patients were assessed at baseline (day 0) and after 30, 90, and 180 days.ResultsThe surgery group reported significantly lower pain intensity (VAS pain scores) at postoperative days 30, 90 and 180 days compared with controls (P = 0.0001). The McGill Pain Questionnaire was used to assess the sensory, affective, evaluative, and miscellaneous dimensions of pain in both groups; there were significant differences between groups at the time points 30, 90 and 180 days (P = 0.0001).ConclusionThe patients with venous leg ulcers treated with split-thickness skin grafts reported significantly lower pain intensity compared with those who received conservative treatment.     

Efficacy of gel containing organic extra virgin olive oil for peristomal skin hygiene: A pilot randomised controlled trial

AimTo assess the efficacy and safety of the application, during stoma hygiene, of a pH-neutral gel containing organic EVOO (oEVOO) for the maintenance of peristomal skin integrity.MethodPatients with a colostomy or ileostomy were enrolled in a pilot randomized controlled trial and assigned treatment with a pH-neutral gel made from natural products including oEVOO or usual stoma hygiene gel. The primary outcome was three domains of abnormal peristomal skin: Discolouration, Erosion and Tissue overgrowth. Secondary outcomes that were evaluated included skin moisture; oiliness; skin elasticity; water-oil balance; patients’ perceptions; difficulty inserting and removing the pouching system; pain, any other chemical, infectious, mechanical, or immunological complications of concern. The intervention lasted 8 weeks.ResultsTwenty-one patients were recruited for the trial and randomly assigned to either the experimental group (n = 12) or the control group (n = 9). The groups did not differ significantly in terms of patient characteristics. No significant differences between groups were identified either at baseline (p = 0.203) or at the end of the intervention (p = 0.397). In the experimental group, domains of abnormal peristomal skin improved after the intervention. The difference observed before and after the intervention was statistically significant (p = 0.031).ConclusionThe use of a gel containing oEVOO has shown similar levels of efficacy and safety to other gels commonly used for peristomal skin hygiene. It is also relevant to highlight that a significant improvement in skin condition was observed in the experimental group before and after the intervention.     

The Chinese version of the skin tear knowledge assessment instrument (OASES): Cultural adaptation and validation

BackgroundSkin tear knowledge is an important predictor of the decreased incidence and management of skin tears, and the knowledge level among Chinese nurses is unknown so far. A validated instrument for measuring skin tear knowledge is urgent.ObjectiveTo culturally adapt the skin tear knowledge assessment instrument (OASES) into Chinese and verify its validity and reliability in the Chinese context.MethodsThe cultural adaptation process for OASES into Chinese was established on Beaton's translation model. Content validity was determined by the 8-expert group in wound care. A nationwide psychometric validation study was performed on a convenience sample of 3333 nurses from 113 tertiary hospitals, of whom 98 nurses finished the test-retest procedure for reliability analysis. Item validity (item difficulty and discriminating index) and construct validity (known-groups technique) were tested.ResultsThe content validity index was 0.88–1.00. The item validity was as follows: Item difficulty ranged from 0.16 to 0.86, with an average value of 0.52; the discriminating index varied between 0.05 and 0.61. The known-group technique demonstrated excellent construct validity with a significant difference between predefined groups with theoretically expected higher knowledge scores and theoretically expected lower knowledge scores (P < 0.001). For the test-retest reliability, the Intraclass correction coefficient (ICC) during a 14-day interval for the overall tool was 0.79 (95% CI = 0.71–0.86), and Cohen's kappa value for each item varied from 0.17 to 0.62.ConclusionsThe Chinese version of OASES was validated to be suitable for skin tear knowledge assessment with acceptable psychometric properties, through which the knowledge and training priorities of skin tear among Chinese nurses can be quantified.     

Seated buttocks anatomy and its impact on biomechanical risk

AimThe objective of this study was to describe the amount, types, and shapes of tissue present in the buttocks during sitting (i.e., seated buttocks soft tissue anatomy), and the impact of seated buttocks soft tissue anatomy on biomechanical risk.Materials and methodsThe buttocks of 35 people, including 29 full-time wheelchair users with and without a history of pelvic pressure ulcers were scanned sitting upright on 3” of flat HR45 foam in a FONAR Upright MRI. Multi-planar scans were analyzed to calculate bulk tissue thickness, tissue composition, gluteus maximus coverage at the ischium, the contour of the skin, and pelvic tilt.ResultsBulk tissue thickness varied from 5.6 to 32.1 mm, was composed mostly of adipose tissue, and was greatest in the able-bodied cohort. Skin contours varied significantly across status group, with wheelchair users with a history of pressure ulcers having tissue with a peaked contour with a radius of curvature of 65.9 mm that wrapped more closely to the ischium (thickness at the apex = 8.2 mm) as compared to wheelchair users with no pressure ulcer history (radius of curvature = 91.5 mm and apex thickness = 14.5 mm). Finally, the majority of participants presented with little to no gluteus coverage over their ischial tuberosity, regardless of status group.ConclusionsThis study provides quantitative evidence that Biomechanical Risk, or the intrinsic characteristic of an individual's soft tissues to deform in response to extrinsic applied forces, is greater in individuals at greater risk for pressure ulcers.     

A decade of research on Incontinence-Associated Dermatitis (IAD): Evidence,knowledge gaps and next steps

Background

Incontinence-Associated Dermatitis (IAD) is one of the clinical manifestations of Moisture- Associated Skin Damage (MASD). IAD is a common problem in aged patients with fecal and/or urinary incontinence.

Differences in the skin surface pH and bacterial microflora due to the long-term application of synthetic detergent preparations of pH 5.5 and pH 7.0. Results of a crossover trial in healthy volunteers

Skin cleansing preparations consisting of identical synthetic detergents but differing in pH-value (pH 5.5 and 7.0) were applied twice daily on the forehead and forearm of healthy volunteers in a randomized crossover trial. The skin surface pH was found to be significantly higher when the neutral preparation had been used, as was the propionibacterial count (p less than 0.05). The number of propionibacteria was significantly linked to the skin pH. Hence even minor differences in the pH of skin cleansing preparations seem to be of importance for the integrity of the skin surface. This should be taken into account when planning the formulation of optimal skin care products.     

The effect of a pressure ulcer prevention care bundle on nursing workload costs

AimThis study investigated the effect of care under the guidance of a pressure ulcer prevention care bundle on pressure ulcer incidence rates and on nursing workload costs.Design, setting, and participantsThis prospective pre-post interventional study was conducted in an anesthesia and reanimation intensive care unit. The sample consisted of 16 nurses and 84 patients.MethodsThe study was conducted in two periods: (1) nursing workload of pre-care bundle period and (2) nursing workload of post-care bundle period. In the collection of data, 6 forms (the demographic data forms, the Braden scale, nurse information form, the care bundle follow-up form and nursing workload follow-up form) were administered. The main outcomes of the study; Pressure ulcer incidence rate was evaluated with Form V, and nursing workload costs were evaluated with Form VI. These forms were evaluated daily by the nurses. In the first period (15.09.2018–30.11.2018), pressure ulcer incidence rates and nursing workload costs were evaluated before training. Then, the researcher trained nurses on how to prevent pressure ulcers and use the care bundle. The care bundles components were risk assessment, skincare, activity, in-service training, nutrition, wetness/incontinence and support surface management, and keeping records. In the second period (01.12.2018–15.02.2019), pressure ulcer incidence rates and nursing workload costs were evaluated after the training. The outcomes of the two periods regarding the incidence of pressure ulcers and nursing workload costs were compared.ResultsThe pressure ulcer incidence rates before and after the care bundle were 22.1 and 13.0 per 100 patient-day, respectively. There was a decrease in pressure ulcer incidence rates after the care bundle, but it wasn't significant (p = 0.138). The total workload cost of pressure ulcer prevention was significantly lower after the care bundle than before (p = 0.001).ConclusionThe pressure ulcer incidence rates were lower after the care bundle than before, albeit insignificantly. The total pressure ulcer prevention workload costs were significantly lower after the care bundle than before. The reduction in pressure ulcer incidence and workload cost indicates that the use of care bundle is effective. Healthcare professionals in intensive care units should use a pressure ulcer prevention care bundle more often.     

Wound irrigation versus swabbing technique for cleansing noninfected chronic wounds: A systematic review of differences in bleeding,pain, infection,exudate, and necrotic tissue

PurposeTo systematically summarize and review the existing literature to determine the difference between wound cleansing techniques, irrigation and swabbing, in relation to bleeding, pain, infection, necrotic tissue and exudate in non-infected chronic wounds including pressure injuries, venous and arterial leg ulcers and diabetic foot ulcers.MethodsA systematic search of the electronic databases Ovid Medline, Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and EMBASE was performed to identify all relevant literature in English. The search also included systematic reviews as a method to obtain additional potential citations by manually searching the reference lists. Included studies were assessed for methodological quality using the Cochrane Risk of Bias Tool.ResultsOne study met eligibility criteria. Two hundred fifty six patients with wounds healing via secondary intention (n = 256) were included. Wound cleansing via swabbing technique was associated with increased perception of pain and increased rates of infection when compared to the irrigation group (93.4% versus 84.2% p = 0.02 and 5.2% versus 3.3% p = 0.44, respectively). Only a small proportion of this sample met the inclusion criteria, so the results are not considered externally valid.ConclusionWound cleansing remains a controversial topic. Despite calls for further research, there continues to remain a large gap in evidence to guide practice. Irrigation continues to replace swabbing in the management of chronic wounds, although evidence of improved outcomes is virtually nonexistent. Although the one study identified was of sound methodological quality, chronic wounds accounted for only a small percentage of the sample. Therefore, results are not generalizable to those with chronic wounds. Further research is needed to determine the effectiveness of basic wound cleansing techniques before considering more costly products.     

A pilot randomised controlled trial comparing reactive air and active alternating pressure mattresses in the prevention and treatment of pressure ulcers among medical ICU patients

BackgroundData on the prevention and treatment of pressure ulcers (PU's) among ICU patients is sparse.ObjectiveTo compare PU outcomes in medial ICU patients nursed on either a reactive mattress overlay (ROHO^®, ROHO Inc, Belleville, IL, USA) or an active alternating pressure mattress (NIMBUS^®3, ArjoHuntleigh, Luton Bedfordshire, UK).DesignPilot prospective single blind randomised controlled clinical trial.InterventionTwo types of pressure redistributing mattress.PatientsTwo groups of eight patients.MethodsPatients included in the study were those at high risk (Norton scale <8) or with a PU on admission.ResultsThe two groups had similar patient characteristics. However, the NIMBUS 3 group presented with more ulcers per patient on admission (62.5%) and more severe ulcers (20% category 3) while four patients (50%) presented with a single superficial ulcer in the ROHO group.HealingThe progress of the ulcers showed significant decreases in PU surface area (p = 0.05), total PUSH tool score (p = 0.01) in the NIMBUS 3 group compared to the ROHO group. In the NIMBUS 3 group 82% of the ulcers improved versus none in the ROHO group (p = 0.002) and 18% remained stable versus 33%. None of the ulcers deteriorated in the NIMBUS 3 group versus 67% in the ROHO group (p = 0.006). Full thickness wounds (Category 3) were present in 22% of the NIMBUS 3 group versus 0% of the ROHO group on admission and in 0% versus 66.7% (p = 0.008) respectively at the end of the pilot study.PreventionNon-blanching erythema occurred equally in both arms at baseline; skin remained intact for the NIMBUS 3 group while 50% in the ROHO group worsened with superficial tissue loss.ConclusionThis small pilot study suggests that ‘active’ alternating therapy is a useful adjunct in the care of highly vulnerable patients, while the outcomes may be less favourable when using ‘reactive’, constant low pressure devices.     

Pressure levels in the trochanter area according to repositioning at different degrees of inclination in healthy subjects

ObjectivesPatient repositioning is a recommended intervention to prevent or treat pressure ulcers (PUs). One option under consideration is the tailored repositioning according to patient characteristics, but more knowledge is needed on how different repositioning patterns influence on skin pressure. To determine what degree of inclination of the body in bed generates more pressure in the trochanteric region. Additionally, to analyze the influence of factors such as gender, age and anthropometric characteristics in the variations of this pressure.MethodsAnalytical cross-sectional study. Body Mass Index (BMI), lean mass and fat mass were measured in healthy volunteers subject to different inclinations (90°, 60° and 30°) in right lateral decubitus. Pressure was measured with a capacitive surface.ResultsIn total, 146 subjects were included, of which 45 were men and 101 women. The results showed pressure differences due to the inclination according to gender and anthropometric values, being statistically significant in men at 90° and 60°, and in women at 30°. (hombres 90° p = 0,026, 60° p = 0,049; mujeres 30° p = 0,036) según prueba Brown-Forsythe.ConclusionsThere are differences in the pressures of the trochanteric zone depending on anthropometric factors and by gender, in different body positions. Obese people exerted a higher pressure in the trochanter area at 30° of body inclination than overweight, normal weight and underweight people, respectively. From the clinical point of view, these findings invite to consider a possible differentiation in the repositioning interventions of the patients, according to gender and BMI, as a preventive strategy for PUs.     

Effect of Diaper Cream and Wet Wipes on Skin Barrier Properties in Infants: A Prospective Randomized Controlled Trial

The effect of different diaper care procedures on skin barrier function in infants has been minimally investigated and may be assessed using objective methods. In a single‐center, prospective trial, 89 healthy 9‐month‐old infants (±8 wks) were randomly assigned to three diaper care regimens: group I used water‐moistened washcloths at diaper changes (n = 30), group II additionally applied diaper cream twice daily (n = 28), and group III used wet wipes and diaper cream twice daily (n = 31). Transepidermal water loss (TEWL), skin hydration (SCH), skin pH, interleukin 1α (IL‐1α) levels, and microbiologic colonization were measured in diapered skin (upper outer quadrant of the buttocks), nondiapered skin (upper leg), and if diaper dermatitis (DD) occurred, using the most affected skin area at day 1 and weeks 4 and 8. Skin condition was assessed utilizing a neonatal skin condition score and diaper rash grade. On diapered skin, SCH decreased in groups II and III, whereas TEWL values were reduced in group II only. Skin pH increased in groups II and III. In general, SCH, skin pH, and IL‐1α levels were higher in healthy diapered skin than in nondiapered skin. The incidence and course of DD was comparable in all groups. Areas with DD had greater TEWL and skin pH than unaffected skin areas. Infants who received diaper cream had lower SCH and TEWL and higher pH levels in the diapered area than on nondiapered skin. No correlation with the occurrence of DD was found.     

Tissue temperature,flux and oxygen of sacral and trochanteric area under pressure of healthy subjects: A quasi-experimental study

AimTo evaluate the changes that take place in the perfusion, oxygenation and local temperature of the skin of the sacrum and trochanter when subjected to direct pressure for 2 h.MethodsQuasi-experimental study in the preclinical phase with healthy subjects acting as their own controls (intrasubject control). The outcome variables were measured with a laser Doppler system (local temperature and oxygenation) and by near-infrared spectroscopy (perfusion). The pressure exerted was measured with a capacitive pressure sensor. No more than one week elapsed between the sacrum and trochanter measurements.ResultsThe study sample consisted of 18 persons. The comparative analysis of the fluctuations in the parameters measured on the skin of the trochanters and sacrum, according to the time elapsed, revealed a statistically significant increase in temperature and in the pressure exerted. On the other hand, the changes in capillary blood flow and in SaO2 were not statistically significant.ConclusionOur study results show that changes found in terms of temperature and pressure should be taking into account when planning personalised repositioning to patients according to biomechanical and biological situations that vary between anatomical areas. In future research, the changes reported could be evaluated in patients with risk factors for the development of pressure ulcers, thus facilitating the introduction of more personalised planning in the care and prevention of these injuries.