Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan; Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan.
Nursing Department, Yoichi Kyokai Hospital, Yoichi, Japan.
J Tissue Viability. 2024 Aug;33(3):504-510. doi: 10.1016/j.jtv.2024.05.008. Epub 2024 May 18.
Wiping pressure (WP [mmHg]) during bed baths is essential to maintain skin integrity and care quality for older adults. However, effects of different wiping pressures on skin barrier recovery over multiple days remain unclear. This study evaluated and compared the effects of consecutive bed bathing with weak pressure and that with ordinary pressure on skin barrier recovery of hospitalised older adults.
This within-person, randomised, controlled trial involved 254 forearms (127 patients) and was conducted at a general hospital. Forearms were blinded and randomly assigned a site and sequence of two bed bathing sessions: wiping three times with weak (10≤WP<20) and ordinary pressure (20≤WP<30) once per day for 2 consecutive days. The skin barrier was assessed daily based on transepidermal water loss (TEWL) and stratum corneum hydration (SCH) before and 15 min after the interventions. Dry skin was assessed using the overall dry skin score.
A linear mixed model showed that the time courses of TEWL and SCH differed significantly between groups. Impaired skin barrier function caused by ordinary pressure on the first day did not recover to baseline values the next day, whereas weak pressure did not cause significant changes. During subgroup analyses, TEWL of patients with dry skin was more likely to increase with ordinary pressure.
Despite decreased skin barrier recovery experienced by older adults, our findings suggest the safety of weak pressure and highlight the importance of WP during bed baths. Weak pressure is particularly desirable for patients with dry skin.
UMIN000048838.
擦浴压力（WP[mmHg]）对于维持老年人的皮肤完整性和护理质量至关重要。然而，不同擦浴压力对皮肤屏障恢复的影响在多天内仍不清楚。本研究评估并比较了连续弱压和普通压床上擦浴对住院老年人皮肤屏障恢复的影响。
这是一项在一家综合医院进行的个体内、随机、对照试验，共涉及 254 只前臂（127 名患者）。前臂被遮盖并随机分配到两个床上擦浴方案的部位和顺序：每天用弱压（10≤WP<20）和普通压（20≤WP<30）各擦拭 3 次，连续 2 天。在干预前和干预后 15 分钟，根据经表皮水分流失（TEWL）和角质层水分（SCH）评估皮肤屏障，每天评估。使用整体干燥皮肤评分评估干燥皮肤。
线性混合模型显示，两组之间 TEWL 和 SCH 的时间进程差异显著。第一天普通压力导致的皮肤屏障功能受损第二天未恢复到基线值，而弱压力未引起显著变化。在亚组分析中，干燥皮肤患者的 TEWL 更有可能随着普通压力而增加。
尽管老年人的皮肤屏障恢复受到影响，但我们的研究结果表明弱压是安全的，并强调了床上擦浴时 WP 的重要性。弱压对于干燥皮肤的患者尤其可取。
UMIN000048838。
