Canning Jennifer, Barford Brian, Sullivan David, Wickett Randy, Visscher Marty
The Skin Sciences Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Skin Res Technol. 2009 Feb;15(1):24-34. doi: 10.1111/j.1600-0846.2008.00333.x.
BACKGROUND/AIMS: Nosocomial infections affect up to 26% of ICU patients. Compliance with the required hand hygiene procedures remains low, rarely exceeding 50%, with skin irritation as one of the main reasons for lack of conformity. The aim was to quantify the epidermal barrier effects, particularly erythema, from repetitive exposure to hand hygiene procedures among health care workers (HCWs) using an objective, reliable clinical method that could evaluate the entire hand surface.
The hand skin of HCWs was evaluated before the initial scrub and at the end of multiple 2-3 days work cycles during spring (n=54) and winter (n=60) trials. The skin condition was measured with live visual skin evaluation (LSG), digital image analysis (DIA) of high-resolution digital images, and visual perception evaluation (VPS) of image pairs.
The HCWs had significantly higher values of erythema than the non-HCW control group with all methods. Knuckle erythema increased over the cycle in both seasons. It decreased during recovery in spring and continued to increase during recovery in winter. For the DIA area of excess redness, the quantitative measure of erythema, the decrease over the cycle in spring was significantly different than the increase over the cycle in winter. Minimal changes in area of excess redness occurred during recovery in both seasons. With the VPS, both judges found a decrease in erythema during recovery in spring and an increase during recovery in winter, indicating significant differences for spring vs. winter (P<0.05). No differences in VPS erythema were seen for either product set over the work cycle during spring. Correlations were observed for (1) results for the VPS vs. the LSG method and (2) between excess erythema (mu+sigma) from DIA and the VPS erythema scores. Relatively low correlations were found between the DIA and VPS methods, i.e., knuckle mu+sigma and VPS erythema.
Significant work cycle effects for spring vs. winter were observed with DIA, while significant effects were found during the recovery period with VPS. DIA produced an objective quantitative measure of erythema that was not limited or influenced by other aspects of skin irritation (e.g., dryness, scaling) or texture encountered in the visual methods of LSG and VPS. The DIA method minimizes the difficulty in differentiating erythema severity. Standardization of image capture and processing allows assessment of skin condition across clinical locations. The VPS is a more reliable way to compare skin condition at different times, i.e. beginning vs. the end of a treatment cycle, because images are viewed simultaneously and can be carefully examined for differences.
背景/目的：医院感染影响多达26%的重症监护病房患者。对手卫生程序的依从性仍然很低，很少超过50%，皮肤刺激是不符合规定的主要原因之一。目的是使用一种客观、可靠的临床方法，量化医护人员因反复接触手卫生程序而产生的表皮屏障效应，特别是红斑，该方法可以评估整个手部表面。
在春季（n=54）和冬季（n=60）试验中，在初次擦洗前以及多个2-3天工作周期结束时，对医护人员的手部皮肤进行评估。使用实时视觉皮肤评估（LSG）、高分辨率数字图像的数字图像分析（DIA）以及图像对的视觉感知评估（VPS）来测量皮肤状况。
使用所有方法，医护人员的红斑值均显著高于非医护人员对照组。在两个季节中，指关节红斑在整个周期内均增加。在春季恢复期间红斑减少，而在冬季恢复期间继续增加。对于红斑的定量测量指标——DIA法测得的过度发红面积，春季整个周期内的减少与冬季整个周期内的增加有显著差异。在两个季节的恢复期间，过度发红面积的变化最小。使用VPS时，两位评判者均发现春季恢复期间红斑减少，冬季恢复期间红斑增加，表明春季与冬季存在显著差异（P<0.05）。在春季，两种产品在整个工作周期内的VPS红斑均无差异。观察到（1）VPS与LSG方法的结果之间以及（2）DIA法测得的过度红斑（均值+标准差）与VPS红斑评分之间存在相关性。DIA法与VPS法之间的相关性相对较低，即指关节均值+标准差与VPS红斑之间的相关性较低。
DIA法观察到春季与冬季在工作周期上有显著差异，而VPS法在恢复期间有显著差异。DIA法提供了一种客观的红斑定量测量方法，不受皮肤刺激的其他方面（如干燥、脱屑）或LSG和VPS视觉方法中遇到的纹理的限制或影响。DIA法最大限度地减少了区分红斑严重程度的难度。图像采集和处理的标准化允许在不同临床地点评估皮肤状况。VPS是比较不同时间（即治疗周期开始与结束时）皮肤状况的更可靠方法，因为图像是同时查看的，可以仔细检查差异。
