Randomized controlled study of the effects of 2 fecal management systems on incidence of anal erosion.

PURPOSE: To compare the incidence of anal erosion between 2 indwelling fecal management systems. Anal erosion was defined as localized mucous membrane tissue impairments of the anal canal caused by corrosive fecal enzymes and/or indwelling devices. DESIGN: Randomized comparative effectiveness clinical trial comparing 2 commercially available indwelling fecal management systems. SUBJECTS AND SETTING: The target population was adults cared for on medical, surgical, and neurological intensive care units (ICUs) and non-ICU units with an order for indwelling fecal management system placement. The research setting was a 1200-bed quaternary-care medical center in the Midwestern United States. Seventy-nine patients participated in the study; 41 received system A and 38 received system B. Subjects' mean age was 64 ± 13.6 years (mean ± SD), and 52% were female. METHODS: Nurse researchers inserted 1 of 2 indwelling fecal management systems and assessed patients daily for anal erosion. Data were collected on patient demographics, medical history and insertion date, reason for the fecal management system, volume of water in balloon and balloon pressure daily, diet, body mass index, ease of insertion and removal, amount of resistance, and when and why the device was removed. Anecdotal comments from front-line staff nurses were also recorded. Occurrences of anal ulcer or erosion was compared using logistic regression models that adjusted for length of system use and time to event using Kaplan-Meier estimates and log rank tests. RESULTS: The incidence of anal erosion was 12.7%. There were no differences in incidence of anal erosions between the 2 groups (12.2% vs 13.2% for systems A and B, respectively, P = .88), or in time to development of the erosions (P = .82). Leakage of stool occurred in 70% of patients and was associated with anal erosion (P = .027). CONCLUSIONS: In this randomized comparative effectiveness research study, there was no difference in the incidence of anal erosion between groups. Purchasing decisions cannot be made based on differences in general product characteristics postulated to influence likelihood of anal erosion. Results regarding balloon water volume, mucosa pressure generated, and anal erosions require further study.

International Skin Tear Advisory Panel: a tool kit to aid in the prevention, assessment, and treatment of skin tears using a Simplified Classification System ©.

PURPOSE: To enhance the learner's competence with knowledge regarding utilization of a tool kit to aid in the prevention, assessment, and treatment of skin tears. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to:1. Demonstrate knowledge of skin tear prevention and classification as presented in the International Skin Tear Advisory Panel's tool kit.2. Apply information from the skin tear tool kit to patient care scenarios. ABSTRACT: The International Skin Tear Advisory Panel has created a tool kit for the prevention, identification, and treatment of skin tears. The tool kit is based on extensive literature reviews, international input from healthcare professionals, and on expert opinion. It has undergone a modified Delphi process.

Do patient and nurse outcome differences exist between 2 negative pressure wound therapy systems?

PURPOSE: We prospectively compared the effectiveness of foam- and gauze-based negative pressure wound therapy (NPWT) systems on wound healing, pain, cost, and hospital length of stay. We also compare ease of use and time in performing dressing changes reported by nurses. DESIGN: Randomized, controlled clinical trial comparing foam- and gauze-based NPWT systems. SUBJECTS AND SETTING: Eleven adult subjects with physician orders for NPWT participated in the study. Subjects were middle-aged, white, and male. METHODS: Six subjects were randomly allocated to foam-based and 5 to gauze-based NPWT systems. Wound healing rates and pain at the first dressing change were measured using a centimeter ruler and a visual analog scale, respectively. Wound care costs were tabulated from a checklist of supplies used and nurse perceptions were measured by responses to Likert-type surveys. Relationships between NPWT system and selected variables were measured using Wilcoxon rank sum tests. RESULTS: Median wound healing rates did not differ significantly between foam-based and gauze-based NPWT systems when measured in centimeters at first dressing change for length (10.6 vs 16.5, P = .58), width (2.7 vs 4.2, P = .41), depth (2.2 vs 2.5, P = .78), and tunneling and undermining (both 0 vs 0, P = .82 and .79, respectively). No differences were detected in pain rating at first dressing change (3.2 vs 2.4, P = .77), cost of wound care ($510.18 vs $333.54 P = .86), or hospital length of stay (26.33 vs 14.8 days; P = .58), respectively. There were no differences in nurses' experiences in ease of performing dressing changes and mean time to perform the first dressing change for foam- or gauze-based NPWT systems: 32.3 vs 38.8 minutes; P = .52, respectively. CONCLUSIONS: In a pilot study comparing the effectiveness of foam- and gauze-based NPWT systems, no statistically significant differences were found in patient wound healing, pain, length of stay, or cost of wound care. Nursing time and perceptions about the ease of preparing and completing dressing changes did not differ between systems. Additional research is needed to more definitively determine any differences in wound healing or nurse satisfaction using gauze- versus foam-based NPWT systems.