Clarke-OʼNeill Sinead, Farbrot Anne, Lagerstedt Marie-Louise, Cottenden Alan, Fader Mandy
Sinead Clarke-O'Neill, MSc, RN, Research Fellow Continence and Skin Technology Group, Department of Medical Physics and Bioengineering, University College London, London, England. Anne Farbrot, PhD, Standardization Development, SCA Hygiene Products AB, Sweden. Marie-Louise Lagerstedt, Eidrup, Skin Health & Comfort, SCA Hygiene Products AB, Sweden. Alan Cottenden PhD, Continence Technology, Continence and Skin Technology Group, Department of Medical Physics and Bioengineering, University College London, London, England. Mandy Fader PhD, Continence Technology, Continence Technology and Skin Health Group, Faculty of Health Sciences, University of Southampton, Southampton, Hants, United Kingdom.
J Wound Ostomy Continence Nurs. 2015 Nov-Dec;42(6):621-31; quiz E1-2. doi: 10.1097/WON.0000000000000177.
The primary aim of this study was to determine whether the severity of incontinence-associated dermatitis (IAD) among nursing home-based incontinence pad users varies between pad designs. A second aim was to examine the utility of a simple method for reporting skin health problems in which healthcare assistants were asked to record basic observational data at each pad change.
Randomized, multiple crossover, observational, exploratory.
Twenty-one men and 57 women using absorbent continence products to contain urinary and/or fecal incontinence were recruited from 10 nursing homes in London and the south of England.
A day-time variant and a night-time variant of each of the 4 main disposable pad designs on the market for moderate/heavy incontinence were tested: (1) insert pads with stretch pants; (2) 1-piece all-in-one diapers; (3) pull-up pants; and (4) belted/T-shape diapers. All pad variants for day-time use had an absorption capacity of 1900 mL ± 20% (measured using ISO 11948-1 International Standards Organization) while the capacity of night-time variants was 2400 mL ± 20%. Each resident used each of the 4 pad designs (day-time and night-time variants) for 2 weeks and the order of testing was randomized by nursing home. Skin health data were collected using 2 methods in parallel. Method 1 comprised visual observation by researchers (1 observation per pad design; 4 observations in total over 8 weeks). In method 2, healthcare assistants logged observational data on skin health at every pad change for the 8 weeks. The primary outcome variable was severity of the most severe skin problem noted by the researcher for each resident, and for each pad design (method 1). Descriptive data on skin care methods used in the nursing homes were also collected using short questionnaires and researcher observation.
No significant differences in the severity or incidence of skin problems were found between observations using the 4 pad designs. However, a wide range of skin conditions was recorded that made classification difficult; the skin was often marked with creases from absorbent products, temporary marks, and pink/purple discoloration. We observed few cases of the severe erythema, rashes, and vesicles that are commonly used descriptors in previous skin tools. Nevertheless, the collected data reflect an abundance of skin problems that were difficult to categorize neatly. Researcher observations (method 1) showed that nearly all the residents (96%) had at least 1 IAD skin problem recorded over the 8-week period and 64% of residents had at least 1 problem that was rated as maximum severity. Healthcare assistants logged skin problems on 6.1% of pad changes. The discrepancy between researcher and healthcare assistant data appears to be largely due to healthcare assistants sometimes discounting low-grade IAD as normal for that population.
Incontinence-associated dermatitis is common among nursing home residents who use incontinence pads, and it is often severe. No evidence was found that any design of pad was more likely than any others to be associated with skin problems. The method devised to enable healthcare assistants to record basic observational data on skin health in the diaper area at each pad change (Method 2) proved simple to use but still resulted in substantial underreporting of IAD, suggesting that further work is needed to develop a tool that more successfully encourages them to log and treat IAD problems.
本研究的主要目的是确定在使用失禁护理垫的养老院居民中，失禁相关性皮炎（IAD）的严重程度在不同护理垫设计之间是否存在差异。第二个目的是检验一种报告皮肤健康问题的简单方法的实用性，该方法要求医护助理在每次更换护理垫时记录基本的观察数据。
随机、多次交叉、观察性、探索性研究。
从伦敦和英格兰南部的10家养老院招募了21名男性和57名女性，他们使用吸收性失禁产品来控制尿失禁和/或大便失禁。
对市场上用于中度/重度失禁的4种主要一次性护理垫设计的日间款和夜间款进行测试：（1）带弹力裤的插入式护理垫；（2）一体式纸尿裤；（3）拉拉裤；（4）束腰/T型纸尿裤。所有日间使用的护理垫变体的吸收能力为1900 mL±20%（按照国际标准化组织ISO 11948-1进行测量），而夜间款的吸收能力为2400 mL±20%。每位居民使用这4种护理垫设计（日间款和夜间款）各2周，测试顺序由养老院随机安排。使用两种方法并行收集皮肤健康数据。方法1包括研究人员的目视观察（每种护理垫设计观察1次；8周内共观察4次）。在方法2中，医护助理在8周内每次更换护理垫时记录皮肤健康的观察数据。主要结局变量是研究人员针对每位居民以及每种护理垫设计（方法1）所记录的最严重皮肤问题的严重程度。还通过简短问卷和研究人员观察收集了养老院使用的皮肤护理方法的描述性数据。
使用这4种护理垫设计进行观察时，未发现皮肤问题的严重程度或发生率存在显著差异。然而，记录到的皮肤状况范围很广，难以进行分类；皮肤经常有吸收性产品造成的褶皱、暂时性痕迹以及粉红/紫色变色。我们观察到很少有严重红斑、皮疹和水疱的病例，而这些是以往皮肤评估工具中常用的描述指标。尽管如此，收集到的数据反映出大量难以精确分类的皮肤问题。研究人员的观察（方法1）显示，在8周期间，几乎所有居民（96%）至少有1次IAD皮肤问题记录，64%的居民至少有1个问题被评为最严重程度。医护助理在6.1%的护理垫更换时记录了皮肤问题。研究人员和医护助理数据之间的差异似乎主要是因为医护助理有时将轻度IAD视为该人群的正常情况而不予记录。
在使用失禁护理垫的养老院居民中，失禁相关性皮炎很常见，而且往往很严重。没有证据表明任何一种护理垫设计比其他设计更易引发皮肤问题。为使医护助理在每次更换护理垫时能够记录尿布区域皮肤健康的基本观察数据而设计的方法（方法2）证明使用简单，但IAD的报告率仍然严重偏低，这表明需要进一步开展工作来开发一种工具，以更成功地促使他们记录和处理IAD问题。
