Chizuko Konya

Comparison of two pressure ulcer preventive dressings for reducing shear force on the heel.

OBJECTIVE We compared the shear forces exerted over the heel between a pressure ulcer preventive dressing and a thin-film dressing in a clinical setting. Interface pressures were measured as well. DESIGN Quasi-experimental clinical trial. SETTING AND SUBJECTS Participants were 30 elderly patients (5 men, 25 women; mean age, 86.4 ± 8.0 years) hospitalized in a geriatrics hospital in Japan; all had a Braden score of less than 14 (mean, 10.1 ± 1.1). Informed consent was obtained from all the patients. A shear force and pressure sensor including a strain gauge, and an oval airbag-type pressure sensor were used. METHODS The sensor was attached to one heel using double-sided tape; then the target dressing was applied over the sensor and on the opposite heel to avoid the influence of the opposite heel on the shear force measurement. Interface pressures were measured with the patient in a stationary supine position; shear force was then measured at 0.2-second intervals, while the sheet was manually pulled at a velocity of around 5 cm/second. Shear force was determined by averaging the stable shear force lasting for 10 measurement points. RESULTS The mean interface pressures with the PPD and the film dressings were 70.7 ± 16.5 and 70.2 ± 15.2 mmHg, respectively; this difference was not statistically significant. The shear force produced during the pulling of the sheet was 2.2 ± 1.4 and 11.7 ± 5.8 N, respectively (P < .001, Wilcoxon signed-rank test). CONCLUSIONS The results of this study suggest that a dressing with a low-friction external surface (such as the pressure ulcer preventive dressing) can significantly reduce shear force. However, results also suggest that external dressings do not significantly reduce interface pressures and cannot be used as a substitute for heel elevation in an immobile patient.

Skin injuries caused by medical adhesive tape in older people and associated factors.

AIM AND OBJECTIVES This study was designed to investigate the status of skin injuries in older individuals caused by adhesive tape and the associated factors for skin injury. BACKGROUND Older individuals are susceptible to skin injuries caused by medical adhesive tape. However, the current status of such skin injuries and the associated factors involved has not been clearly elucidated. DESIGN Prospective cohort design, using comparative and descriptive statistical tests. METHODS The subjects were 155 patients aged 65 or older who were admitted to a long-term care facility and required the use of medical adhesive tape. Patients who showed no skin injuries were selected and the incidence rate and status of skin injuries that occurred during the eight-week study period were investigated. The skin injuries observed were classified by a dermatologist. The associated factors were examined statistically. Informed consent was obtained from all patients. RESULTS Skin injuries developed at 34 sites in 24 subjects. The cumulative incidence rate was 15.5%, and the incidence density was 38.0/1000 person-days. Many of the skin injuries occurred around pressure ulcers and intravenous hyperalimentation sites. Other prevalent areas included the buttocks and back, where tape is commonly used. The skin injuries were classified as contact dermatitis (70.6%), trauma (20.6%) and infection (8.8%). The ratio of skin contamination and skin mobility in patients with contact dermatitis was significantly higher than in patients without skin injury. CONCLUSION The highest incidence rate was observed in the buttock area of patients with pressure ulcers. The incidence rate of contact dermatitis was the highest. RELEVANCE TO CLINICAL PRACTICE Skin care to minimise contamination and more effective ways of applying medical adhesive tape may be needed to prevent contact dermatitis.

Prognosis of stage I pressure ulcers and related factors

The prognosis of stage I pressure ulcers cannot be predicted; therefore, nursing interventions for preventing their deterioration have not been clearly established. This study describes the clinical course of stage I pressure ulcers and prospectively investigates the factors related to their deterioration. Thirty‐one stage I pressure ulcers in 30 patients in a long‐term care facility were studied, and morphological changes were assessed every day until the ulcers healed or deteriorated. The physiological changes were assessed by ultrasonography and thermography. Twenty ulcers healed, and 11 deteriorated. The characteristics of deterioration were as follows: (1) double erythema; (2) non blanchable erythema across the whole area determined by glass plate compression; (3) erythema away from the tip of the bony prominence; and (4) expanding erythema on the following day. We analysed the sensitivity, specificity, positive predictive value, negative predictive value and positive likelihood ratio for the diagnostic utility of the indicators of deterioration double erythema and distance from the tip of bony prominence, which can be instantly assessed without the use of any special device. The values were 36·4%, 95·0%, 80·0%, 73·1% and 7·28, respectively. These results suggest that clinicians can predict the prognosis of stage I pressure ulcers by initial assessment and provide appropriate care based on the assessment.

Quantitative evaluation of elderly skin based on digital image analysis

Background: The evaluation of the skin state when it is healthy at the time of examination, but predisposed to disease, is based solely on the subjective assessment of clinicians. This assessment may vary from moment to moment and from rater to rater.

Exploring the relationship between skin property and absorbent pad environment

AIM The aim of this study is to identify the related factors of skin lesions found in the surrounding environment of absorbent pads by clinical investigation. BACKGROUND Most older patients with incontinence use absorbent products, therefore causing many patients to have skin lesion in the absorbent pad area. To prevent these skin lesions from occurring, it is necessary to examine the absorbent pad environment of clinical patients since there are many contributing factors that complicate the pathophysiology in this area. DESIGN A cross-sectional design was used. METHODS One hundred older Japanese patients with faecal and/or urinary incontinence using diapers and absorbent pads participated. Excluding blanchable erythema, the presence of skin lesions in the absorbent pad area was confirmed. Skin pH, hydration level and bacterial cultures were used to assess the skin property. Absorbent pad environment and patient demographics were also investigated. RESULTS The overall prevalence of skin lesions was 36%. Forty percent of the skin lesions were contact dermatitis. Multivariate logistic regression analysis revealed that only the presence of diarrhoea independently affected contact dermatitis. CONCLUSION There was a significant relationship between contact dermatitis and the use of absorbent pads when the patient had diarrhoea. Although the factors related to skin lesions in the absorbent pad area are complexly intertwined, this study was the first to be able to determine diarrhoea as one specific factor in clinical setting. RELEVANCE TO CLINICAL PRACTICE This finding suggests that the presence of diarrhoea is significantly related with contact dermatitis. Therefore, when a patient has diarrhoea, health-care professionals should immediately implement a preventative care program which includes careful skin observation and improved skin care. It is also necessary to develop a more effective absorbent pad to protect the skin of incontinent patients who suffer from the irritating effects of liquid stool.

Do nutritional markers in wound fluid reflect pressure ulcer status

Evaluation of wound fluid characteristics for pressure ulcer (PU) assessment in clinical settings remains subjective, requiring considerable expertise. This cross‐sectional study focused on nutritional markers in wound fluid as possible objective tools and investigated whether they reflect the PU status according to the healing phase, infection, and granulation, especially after adjusting for serum values. Twenty‐eight patients with 32 full‐thickness PUs were studied. The concentration of albumin, total protein, glucose, and zinc in wound fluid were measured. For PU status, the healing phases and infection were evaluated by clinical signs, and the degree of granulation tissue formation was determined as the hydroxyproline concentration. The wound fluid/serum ratio for albumin was significantly lower during the inflammatory phase than during the proliferative phase (p=0.020). Infected wound fluid contained less glucose (0.3–1.0 mmol/L) than noninfected ones did (5.0–7.6 mmol/L) in an intraindividual comparison of three cases. The wound fluid/serum ratio for glucose was negatively correlated with hydroxyproline level in the proliferative phase (ρ=−0.73, p=0.007), while zinc level in wound fluid showed a positive correlation (ρ=0.61, p=0.028). Our results suggest that these traditional nutritional markers in wound fluid, especially wound fluid/serum ratio may be useful to evaluate local PU status.

Efficacy of an improved absorbent pad on incontinence-associated dermatitis in older women: cluster randomized controlled trial

BackgroundMost older adults with urinary incontinence use absorbent pads. Because of exposure to moisture and chemical irritating substances in urine, the perineal skin region is always at risk for development of incontinence-associated dermatitis (IAD). The aim of this study was to examine the efficacy of an improved absorbent pad against IAD.MethodsA cluster randomized controlled design was used to compare the efficacy of two absorbent pads. Female inpatients aged ≥65 years who had IAD and used an absorbent pad or diaper all day were enrolled. Healing rate of IAD and variables of skin barrier function such as skin pH and skin moisture were compared between the usual absorbent pad group (n = 30) and the test absorbent pad group (n = 30).ResultsThirteen patients (43.3%) from the test absorbent pad group and 4 patients (13.3%) from the usual absorbent pad group recovered completely from IAD. Moreover, the test absorbent pad group healed significantly faster than the usual absorbent pad group (p = 0.009). On the other hand, there were no significant differences between the two groups in skin barrier function.ConclusionThe test absorbent pad for older adults with urinary incontinence might be more efficacious against IAD than usual absorbent pad.Trial registrationUMIN-CTR: UMIN000006188

Estimation of protein loss from wound fluid in older patients with severe pressure ulcers

OBJECTIVE Protein loss from wound fluid is usually recognized as one of the factors contributing to the deterioration of the nutritional status in older patients with severe pressure ulcers. We quantified the protein loss owing to pressure ulcers and investigated associations with wound-related factors and nutritional status. METHODS This cross-sectional study included 25 patients (>or=60 y) from 10 institutions, with full-thickness pressure ulcers. Wound fluid was collected once after accumulating beneath a film dressing. The amount of protein loss per day was estimated by the volume of wound fluid per hour and the total protein concentration in the wound fluid. Wound evaluations and nutritional assessments were performed. Correlations between variables were obtained using Spearmans rank correlation. RESULTS The median age of the patients was 79 y (range 61-100), and median body mass index was 19.6 kg/m(2) (12.2-24.9). The median amount of protein loss was 0.2g/d (0.04-2.1), which corresponded to 0.01 g x kg(-1) x d(-1) (<0.01-0.04) and 0.6% (0.1-13.8) of protein intake. Four wounds characterized as infected or surgically debrided lost 1.5-2.1g of protein per day, which was substantially higher than other wounds lost. Protein loss was correlated with wound severity including area, depth, the wound severity score, and infectious markers (all Ps<0.05), but not with body mass index or arm muscle circumference (P>0.05). CONCLUSION The amount of protein loss could be small and thus may not be related directly to nutritional status, although it increased as the wound became more severe.

Development and validity of a new model for assessing pressure redistribution properties of support surfaces.

Pressure ulcers are a common problem, especially in older patients. In Japan, most institutionalized older people are malnourished and show extreme bony prominence (EBP). EBP is a significant factor in the development of pressure ulcers due to increased interface pressure concentrated at the skin surface over the EBP. The use of support surfaces is recommended for the prophylaxis of pressure ulcers. However, the present equivocal criteria for evaluating the pressure redistribution of support surfaces are inadequate. Since pressure redistribution is influenced by physique and posture, evaluations using human subjects are limited. For this reason, models that can substitute for humans are necessary. We developed a new EBP model based on the anthropometric measurements, including pelvic inclination, of 100 bedridden elderly people. A comparison between the pressure distribution charts of our model and bedridden elderly subjects demonstrated that maximum contact pressure values, buttock contact pressure values, and bone prominence rates corresponded closely. This indicates that the model provides a good approximation of the features of elderly people with EBP. We subsequently examined the validity of the model through quantitative assessment of pressure redistribution functions consisting of immersion, envelopment, and contact area change. The model was able to detect differences in the hardness of urethane foam, differences in the internal pressure of an air mattress, and sequential changes during the pressure switching mode. These results demonstrate the validity of our new buttock model in evaluating pressure redistribution for a variety of surfaces.

Vibration therapy accelerates healing of Stage I pressure ulcers in older adult patients.

OBJECTIVE: The present study investigated whether vibration therapy using a vibrator could facilitate the healing of Stage I pressure ulcers (PrUs) in older adults. METHODS: The study had a nonrandomized, blinded, controlled design. The subjects were hospital patients in long-term-care facilities with Stage I PrUs. In the experimental group, a vibrator (RelaWave; Matsuda Micronics Corp, Chiba, Japan) was used to apply vibration (frequency: 47 Hz; time: 10 seconds; amplitude modulation cycle: 15 seconds) for 15 minutes 3 times a day for up to 7 days, until Stage I PrUs healed. Apart from the vibration therapy, the experimental and control groups received the same care, which was provided according to PrU care guidelines. The number of healed ulcers was compared between 2 groups. RESULTS: The experimental group consisted of 16 patients with 20 Stage I PrUs; the control group consisted of 15 patients with 21 Stage I PrUs. In the experimental group, 8 (40.0%) PrUs healed; in the control group, 2 (9.5%) PrUs healed. The number of healed ulcers was significantly higher in the experimental group than in the control group (P = .033). The healing rate during the study period was significantly higher in the experimental group than in the control group (P = .018, logrank test). The hazard ratio adjusted for baseline risk factors was 0.031 (95% confidence intervals: 0.002-0.594, P = .021). The mean relative changes per day in wound area and intensity of redness were significantly greater in the experimental group than in the control group (P = .007, and P = .023, respectively). CONCLUSION: Based on these results, the use of the vibrator may facilitate the healing of Stage I PrUs.