Journal of Wound Ostomy and Continence Nursing最新文献

Purpose: The purpose of this quality improvement project was to develop guidance for safe patient handling and mobility efforts to prevent pressure injuries (PIs) within the Veterans Health Administration (VHA) when slings and other transfer devices are left under patients.

Participants and setting: Health care staff (n = 112) in patient safety and nursing at 77 unique VHA facilities responded to surveys between November and December 2019. Interviews (n = 24) were conducted using purposive sampling with VHA staff at facilities with highest and lowest PI rates (n = 9) between January and March 2021.

Approach: Feedback on practices and perceptions related to leaving slings and other transfer devices were evaluated using online cross-sectional surveys and interviews with VHA staff. Secondary data for VHA inpatient rates of PIs were used to examine associations with staff-reported sling and other transfer device practices.

Outcomes: Leaving slings under patients was associated with higher proportion of patients developing PIs in intensive care units (ICUs, P = .042) and medical-surgical care units (P = .025). In addition, use of sliding boards for seated transfer among short-stay residents in Community Living Centers was associated with higher PI occurrences (P = .017). Qualitative interviews found perceptions and guidance about PI risk related to slings and other transfer devices varied among staff who consider many factors when determining risk.

Implications for pratice: There are perceived benefits and risks of leaving slings and other transfer devices under patients and limited knowledge of PI occurrences associated with this preactice. Clinical decision support can help staff determine safe sling use. More work is needed to test the safety of common sling and transfer device practices and define best practices for communicating PI risk related to sling and transfer device use across the care continuum.

Purpose: the purpose of this study was to evaluate the content, readability, understandability, and suitability of online resources for patient specific ostomy care.

Design: Retrospective cohort study.

Subject and setting: Online websites for ostomy care designed for patients.

Methods: Ostomy care websites designed for patients were identified by querying three online search engines. Content areas were established following assessment of all websites by two reviewers. Readability of each website was determined using the Flesch Reading Ease Test and the Simple Measure of Gobbledygook (SMOG) index. Understandability was measured using the Patient Education Materials Assessment Tool (PEMAT), and suitability was determined using the Suitability Assessment of Materials (SAM). Chi-Square and rank sum tests were used to compare these measures across website type and by number of content areas.

Results: Twenty-three websites met inclusion criteria; 26.1% were for-profit, 13% were government, 26.1% were academic, and 34.8% were non-profit. Nineteen content areas were identified including themes related to pouching, bathing, physical activity, managing output, lifestyle, mental health, and eating. The median number of content areas covered was 8.5 [interquartile range (IQR) 4-13]. The most common content areas were changing/emptying a pouching system (82.6% of websites), preventing/managing peristomal skin irritation (78.3%), eating (60.9%), and odor management (60.9%). Less than 27% of websites had content on irrigation, blockage/constipation, and body image. Readability scores using the Flesch Reading Ease (mean 58, IQR 54.7-69.5) and SMOG Index (mean 9.1, IQR 7.6-9.9) correlated to a high-school or "fairly difficult" reading level. The mean PEMAT measuring understandability was 80 (IQR 78.9-84.0). The mean SAM score checking for suitability (literacy demand, graphics, layout and type, learning stimulation and motivation and cultural appropriateness) was 55% (IQR 48.4%-61.3%), indicating "adequate material." A greater number of content areas on the websites were associated with worse readability (SMOG and Flesch Reading Ease scores) than websites presenting fewer content areas (P = .001 & P < .001, respectively).

Conclusions: We found significant variability in the content, readability, understandability, and suitability of online materials for ostomy care. Websites with more content areas were associated with worse readability.

Purpose: The purpose of this study was to explore the performance of pouching systems with respect to leakage and the development of peristomal skin complications (PSCs) in an acute care setting immediately following ostomy creation.

Design: Non-experimental, retrospective cohort study.

Subjects and setting: The sample comprised 214 patients admitted for stoma-creation surgery at one of the 2 University of Pittsburgh Medical Center Presbyterian-Shadyside campuses located in the Northeastern United States (Pittsburgh, PA). Patients were seen in an in-patient care setting.

Methods: Electronic health records from patients who were in the hospital for ostomy creation surgery were reviewed by wound ostomy continence nurses from each hospital. Demographic and selected clinical data were collected. The main outcome variables used to evaluate pouching system performance were leakage and PSCs. These outcomes were assessed starting at pouch placement in the operating room and at every subsequent pouch change (up to 5) through discharge or 2 weeks following surgery.

Results: Use of an elastic tapeless barrier (ETB) significantly reduced the risk of leakage compared to a ceramide-infused tape-border barrier (CIB) for patients (41% reduced risk of leakage, P = .011). Use of the ETB also reduced leakage risk compared to the CIB for patients who experienced leakage 2 or more times during the observation period (31% reduction in leakage risk, P = .043). Five types of PSCs occurred during the study and statistical analysis indicated no significant differences in the number of PSCs was documented between barrier types.

Conclusion: The use of an ETB significantly reduced the risk of leakage compared to a CIB.

Background: Ms. S was a 50-year-old woman hospitalized with necrotizing fasciitis from a labial abscess. After several surgical interventions wound debridements were performed consecutively for 6 days. She was left with extensive full thickness tissue destruction of her abdomen, bilateral groin areas, and complete displacement of skin over her mons pubis. Wounds related to necrotizing fasciitis can be especially challenging to manage, especially when the perineal region is involved. Due to the location of such wounds, it can be difficult to maintain dressings, including negative pressure wound therapy with instillation devices (NPWTi). Ms. S. also had a history of uncontrolled diabetes mellitus, which can hinder wound healing.

Case: The Wound, Ostomy and Continence (WOC) nurse was consulted on day 6 of Ms. S's admission, for application of NPWTi. Complex NPWTi dressings were completed in the operating room (OR), 2 times weekly for 2 weeks. When Ms. S was transferred from the intensive care unit to the surgical unit, NPWT dressings with instillation were used but later converted to standard NPWT, changed twice weekly by the WOC nurse. Dressings were changed at the bedside until day 29 of her admission.

Conclusion: The management of Ms. S's extensive wounds was successful, and her wounds were closed by plastic surgery on day 29 of her admission. Ms. S was the first patient at our hospital with extensive wounds from necrotizing fasciitis to undergo surgical closure of her wounds during the same hospital admission.

Purpose: The aim of the study was to analyze the characteristics of the biofilm of venous ulcers in terms of location and formation and to relate the presence of the biofilm to ulcer characteristics including duration, injured area, and necrotic tissue.

Design: Descriptive clinical study.

Materials and methods: We obtained 2 biopsy fragments (tissue samples) from 44 patients with venous ulcers treated at a public outpatient clinic in a university hospital in Belo Horizonte, Brazil. Ulcers were photographed and classified according to the duration. In addition, the wound size and proportion of wound surface covered by necrotic tissue were measured. One fragment from each ulcer underwent microbiological analysis, while the other was analyzed using transmission electron microscopy. Data analysis was limited to fragments from patients with bacteria in the microbiological analysis.

Results: Data analysis is based on samples obtained from 21 ulcers in 21 patients who had bacteria in their ulcer based on microbiologic analysis of a tissue sample. Most ulcers were open for 2 to 10 years, 57% (n = 12) were 16 cm2 or smaller, and the proportion of the wound bed covered by necrotic tissue coverage varied widely. Of the 21/44 patients (48%) with bacteria in their ulcers, only 3 patients had bacterial biofilm present in the transmission electron microscopy, corresponding to 7% of the 44 patients. Pseudomonas aeruginosa was the most frequent bacterium, identified in 10 fragments. The biofilm was not present on the surface but in a layer slightly below it. The detection of biofilms was not directly related to the duration of the ulcer. It was not possible to establish a correlation between the size of the lesion and the presence of these microorganisms due to the small sample size.

Conclusions: Our findings indicate that detecting biofilm in venous ulcers is challenging, as it does not uniformly occur throughout the wound bed, can occur at different depths, and is often not present on the wound surface. There is a need to develop studies that can contribute to the detection of biofilm in clinical practice.

Purpose: The purpose of this study was to examine the effects of moisture, as a skin microclimate variable, at the skin-support surface interface on repeated measures of skin erythema, stratum corneum hydration and skin temperature at pressure-prone areas of healthy adults.

Design: Quasi-experimental repeated measures study.

Subjects and setting: Forty-eight healthy adults participated in a single center-controlled study conducted in a simulated hospital setting in an urban setting (Melbourne, Australia). This research project was conducted from November 2021 to June 2022.

Methods: The effects of moisture and intermittent pressure-loading on skin overlying the sacrum, heels, and elbows were investigated. Participants followed a standardized immobilization protocol of 60 minutes, with 10-minute brief pressure off-loading, in the semi-recumbent position on a standard hospital bed/mattress. The intervention comprised laying with the sacrum in contact with an absorbent pad saturated with normal saline; control skin sites (elbows and heels) were not exposed to the moistened absorbent pad. Skin measures were obtained consecutively at each anatomical testing site upon brief off-loading. Linear mixed models (LMMs) were used to compare skin parameters over time and between conditions.

Results: Differences in stratum corneum hydration scores between control and intervention conditions at the sacrum were significant (P = .001). Differences in erythema and skin temperature scores between control and intervention conditions at the sacrum did not significantly differ; however, significant changes in skin temperature (P = .025) at the sacrum were observed at the 10-minute measurement intervals over 1 hour in the sample, suggesting change in skin temperature over time. No participant displayed non-blanching erythema as a subjective indicator of skin injury in any of the testing conditions.

Conclusions: Skin moisture/wetness, over a period of 1 hour, does not appear to impact erythema and skin temperature at the sacrum. In contrast, the introduction of moisture at the sacrum significantly increases sacral stratum corneum hydration. Study findings suggest that more frequent monitoring cycles of wet sacral skin may be required to identify moisture-associated skin changes.

Purpose: This study assessed the efficiency of urine collection using external urine collection devices over two voids in a group of morbidly obese and non-obese men.

Design: Prospective single-blind comparative crossover study.

Materials and method: We assessed the comparative urine capture efficiency of two commercially available male external urine management systems. Continent consenting men were randomized to use each device for a single void. The proportion of urine captured by each device expressed as a percentage of the total volume voided in grams was calculated and compared. Results were compared between morbidly obese (BMI ≥ 40 kg/m2) and non-morbidity (BMI ≤ 40 kg/m2) men.

Results: Fifty-nine men completed the study; their mean (standard deviation, SD) age was 40.8 (SD 12.4) years. For void 1, the mean proportion of urine capture for Device A was 97.8% (SD 10.0); for Device B it was 90.7% (SD 20.7). For void 2, the mean proportion of urine capture for Device A was 91.1% (SD 25.8); for Device B it was 85.2% (SD 21.7). The mean difference between devices was 6.6% (95% CI 0.18, 13.0), P = .044. Stratified by weight, in the morbidly obese men, Device A captured 99.7% (SD 0.88) of the first void versus 83.5% (SD 32.2) for Device B. Analysis of the second voids found that Device A captured 80.8% (SD 36.9) versus 79.3% (SD 23.3) for Device B.

Conclusion: Device A (the investigational device) performed significantly better than Device B in capture rates when compared based on voided volume, order of void, or BMI category. Device A male external catheter system is an effective option for urine management in both obese and non-obese men.

Malignant cutaneous wounds pose unique challenges in patient care, requiring specialized attention to alleviate local symptoms and enhance health-related quality of life. As the prevalence of these wounds continues to rise with improving cancer survival rates, it is essential to establish comprehensive best practice recommendations for their topical management. To address this need, a task force was assembled from across Canada, consisting of members from Nurses Specialized in Wound, Ostomy, and Continence Canada and the Canadian Palliative Care Nursing Association. The purpose of these recommendations is to provide a framework for the topical management of malignant cutaneous wounds for health care professionals, emphasizing the substantial role of their support persons. Recognizing the impact of cultural humility and the need to deliver care that respects individual beliefs and practices is crucial in providing effective and equitable care. The 23 presented recommendations aim to guide nurses, the interdisciplinary team, and the health system to enhance the overall quality of malignant cutaneous wound care management.

Purpose: The purpose of this study was to examine characteristics of diaper dermatitis (DD) in critically ill patients aged 0 to 24 months following surgery for congenital heart disease (CHD), the effects of a diaper dermatitis care bundle (DDCB), and factors associated with the development of DD in this population.

Design: Nonrandomized comparison cohort study with a historical comparison group.

Subjects and setting: Convenience sampling was used to identify children aged 0 to 24 months undergoing CHD and cared for in a pediatric intensive care unit in central Taiwan (Taichung). The sample comprised 54 participants; 24 were in the historical comparison group and 30 received the DDCB.

Methods: The rate of DD from the historical comparison group was compared to that in an intervention group managed with a bundle of interventions used to prevent and manage DD, which includes the routine use of a topical skin protectant. The participants in the historical comparison group received usual care to prevent and manage DD including routine cleansing with a moistened, disposable cloth every 3 hours and following defecation or urination. The DDCB comprised diaper changes at least every 3 hours and as needed after soiling, along with the routine application of a dimethicone and sodium hyaluronate-based skin protectant before diaper changes. Both groups were evaluated for use of an antifungal cream when candidiasis was present.

Results: Participants managed with the DDCB have a significantly lower rate of DD than the historical comparison group who received routine care (41.65% vs 6.67%, P = .002). Univariate logistic regression showed an odds ratio of 0.10 (95% confidence interval of 0.019-0.520, P = .006), suggesting that the DDCB acted as a protective factor against the development of DD. Multivariate analysis of the historical comparison group indicated that non-cyanotic heart disease was associated with a lower likelihood of postoperative DD compared to those with cyanotic heart disease (odds ratio = 0.01, 95% confidence interval of 0.000-0.946, P = .047).

Conclusions: Managing critically ill patients with a DDCB recovering from cardiac surgery significantly decreased the incidence of DD. We recommend routine use of this type of care bundle for preventing DD in this vulnerable population in all children with CHD, with particular attention being paid to this with cyanotic CHD.