Skin care types, frequencies and products: A cross-sectional study in German institutional long-term care.

AIM: The aim of the study was to describe types and frequencies of skin care interventions and products provided in institutional long-term care. MATERIALS AND METHODS: Baseline data from a cluster randomized controlled trial conducted in nursing homes in Berlin, Germany was collected before randomization. Numbers, proportions and frequencies of washing, showering and bathing, and the application of leave-on products were calculated. Product labels were iteratively and inductively categorized into overarching terms and concepts. RESULTS: A total of n = 314 residents participated in the study. In the majority, washing of the whole body was done once daily, and showering was performed once per week or more rarely. The majority received leave-on products daily on the face and once per week on the whole body. Most of the skin care interventions were delivered by nurses. There was marked heterogeneity in terms of product names, whereas the product names reveal little about the ingredients or composition. CONCLUSION: Personal hygiene and cleansing interventions are major parts of clinical practice in long-term care. Daily washing is a standard practice at the moment. In contrast, leave-on products are used infrequently. To what extent the provided care promotes skin integrity is unclear. Due to the heterogeneity and partly misleading labels of skin care products, informed decision making is difficult to implement at present. GOV IDENTIFIER: NCT03824886.

A Qualitative Study on the Experience and Training Needs of ICU Nurses for Incontinence-Associated Dermatitis.

OBJECTIVE: To explore the experience of incontinence-associated dermatitis (IAD) as perceived by nurses, obstacles in the nursing process, and need for IAD training and management. METHODS: This single-setting descriptive qualitative study was conducted from June 5, 2018, to June 22, 2018. Ten nurses working in the respiratory ICU of a local hospital participated in semistructured interviews. The content analysis method was used to analyze, summarize, and refine the interview data. RESULTS: The experience of ICU nurses with IAD can be divided into four types: nursing based on experiential knowledge, seeking self-improvement, disunity of cleaning methods and wiping skills, and postponement of nursing care because of priority allocation. Obstacles in the nursing process include a lack of relevant nursing knowledge and awareness, as well as the medical supplies needed. The goals of training and management include establishing IAD preventive nursing procedures, providing IAD care products, enhancing the practicality of training content and diversifying training methods, and establishing an information system to assist nurses caring for patients with IAD. CONCLUSIONS: The knowledge and behavior of ICU nurses regarding IAD need to be improved. Training and management are imperative. Facilities and nurse managers should actively seek solutions to stated obstacles, formulate training methods suitable for clinical needs, and promote the standardization of nursing for IAD.

Elaboration and validation of flowchart for the prevention and treatment of intestinal peristomal skin complications

Objective: To build and validate a flowchart for the prevention and treatment of intestinal peristomal skin complications. Method: For the construction of the algorithms, a systematic reviewwas carried out in health sciences databases comprising the last 10 years. The evaluation of the algorithms was carried out by 38 nurses. For the validation of the algorithms, theDelphi technique was used. The statistical analysis used was the content validity index and the Cronbach alpha coefficient. The questionnaire was sent by e-mail and in person after approval by the Ethics and Research Committee. Results: In the first evaluation of the algorithms, there was no agreement among the experts. However, after making the corrections suggested by the evaluators, the algorithms were resent, with a 100% consensus among the evaluators. The questions used to validate the algorithms contributed favourably to the internal consistency and content validation of the instrument, since the respective Cronbach alpha was 0.9062 and the global content validity index (g-CVI) was 0.91 in the first validation and 1.0 in the second validation. Conclusion: After an integrative literature review, the flowcharts were built and validated by a professional with experience in the area, showing 100% agreement among the experts in the second evaluation. (AU)

Development and Implementation of a Simple Wound Care Guideline for Minor Skin Lesions: A Quality Improvement Project.

PURPOSE: The purpose of this quality improvement project was to use the best available evidence and expert opinion to develop and implement a simple inpatient nursing care guideline ("The Guideline") for patients with minor skin lesions, including candidiasis, skin tears, incontinence-associated dermatitis, and stage 1 and stage 2 pressure injuries that would not require a WOC nurse consultation. PARTICIPANTS AND SETTING: The Guideline was developed for nurses working on inpatient adult acute care units in a large community hospital in southwest Minnesota. APPROACH: The Guideline was validated for its clarity and appropriateness by internal and external hospital-based wound care nurses and implemented through in-person rounding on the nursing units and distribution of badge cards and required completing an online education module. Surveys and wound documentation audits were conducted to measure changes in knowledge and skin care pre- and postimplementation of The Guideline. OUTCOMES: We conducted wound documentation audits of approximately 491 records that assessed whether patients received appropriate treatment and found an improvement from 45% (104 of 231) to 80% (209 of 260). Nurses' self-rating of their knowledge about which dressings and topical treatment to use improved from 18% (16 of 89) agreement to 57% (55 of 96). Nurses' self-rating of their knowledge about when to change dressings and reapply topical treatments improved from 27% (24 of 89) agreement to 65% (62 of 96). IMPLICATIONS FOR PRACTICE: Although there is evidence for a variety of dressings or products to treat wounds, this quality improvement project demonstrated increased adherence with providing appropriate care when fewer treatment options were recommended to nursing staff through our structured guideline. The Guideline continues to be used at the project site and is now being implemented at affiliate hospitals.

Root cause analysis to identify contributing factors for the development of hospital acquired pressure injuries.

INTRODUCTION: Many hospital settings are adopting a zero-tolerance policy towards pressure injury (PI) development; this requires good planning and the implementation of care, as the incidence of PIs reflects the quality of care given in a hospital or facility. AIM: To identify common contributing factors towards the development of PIs in a geriatric rehabilitation hospital and improve patient safety through the reduction of hospital-acquired PIs. METHOD: This was done using root cause analysis (RCA). All patients who developed a Stage 3 or 4 deep tissue injuries or unstageable hospital-acquired PI between December 2017 and April 2018 PIs were investigated using RCA. The RCA was facilitated through the use of a contributing framework developed by the National Pressure Ulcer Advisory Panel which guides investigations of different areas of care. Qualitative and quantitative data was collected from several sources and placed in a timeline to reconstruct the series of events. The investigator then identified if the PI was avoidable or not by comparing the evidence with pre-set criteria. Content analysis was further used to analyse the themes retrieved. RESULTS: A variety of root causes were common amongst all the cases. These included both flaws in the system, such as poor equipment and inadequate educational programmes, as well as human factors such as a lack of basic routine care. No skin assessment was being performed (n = 0) apart from the assessment done on admission. Documentation of action planning when it comes to PI prevention was also missing (n = 0). It was identified that 7 patients were mobilized on admission while the others (n = 3) had a delay in mobilisation, due to some fragmentation in care. There was no documentation of patient and relative education on the prevention of PIs (n = 0). All the patients were provided with the right pressure redistributing mattress however, some mattresses were bottoming out. Some causes overlapped, with system defects like lack of protocols, equipment and tools pushing human errors to occur. This created a series of events leading to the adverse event. The identification of these factors helped to provide an understanding of the changes that are needed to reduce future harm and improve patient safety. CONCLUSION: Recommendations were proposed to reduce contributing factors to the development of hospital-acquired PIs. These include audits to reinforce adherence to hospital guidelines, streamlining of the documentation system, investment in new equipment and improvements to educational programmes. The recommendations implemented resulted in a decreased incidence rate of HAPIs.

Acne vulgaris: management

This guideline covers management of acne vulgaris in primary and specialist care. It includes advice on topical and oral treatments (including antibiotics and retinoids), treatment using physical modalities, and the impact of acne vulgaris on mental health and wellbeing.

Evidence of Barrier Deficiency in Rosacea and the Importance of Integrating OTC Skincare Products into Treatment Regimens.

BACKGROUND: Rosacea, an inflammatory skin disease that leads to an impaired skin barrier function commonly involves the face. Symptoms of rosacea can be bothersome and include pain, stinging, burning, itching, and facial flushing. This review explored skin barrier impairment in rosacea and reduced symptomatology when using over the counter (OTC) skincare products. METHODS: Nine dermatologists (the panel) completed a survey on OTC products they recommend for rosacea. The survey results were summarized, presented, and discussed during the online meeting, together with the results of a literature review. The outcome of these discussions, coupled with the panel's expert opinion and experience, is shown in the current review. RESULTS: Addressing barrier dysfunction by use of moisturizer and cleanser formulations that restore skin hydration, normalize skin pH, restore the microbiome, and skin lipids can assist in improving rosacea signs and symptoms. The panel's consensus was that in addition to the use of prescription medications, skincare recommendations are a crucial part of successful rosacea therapy. In addition to occlusives and humectants, barrier restoring ingredients such as ceramides, hyaluronic acid, and niacinamide were considered beneficial. Equally important was the absence of potentially irritating substances. CONCLUSIONS: The use of OTC products can improve rosacea symptomatology and signs. As adjuncts, these products are recommended before and during prescription therapy and as part of a maintenance regimen. J Drugs Dermatol. 20(4):384-392. doi:10.36849/JDD.5861 THIS ARTICLE HAD BEEN MADE AVAILABLE FREE OF CHARGE. PLEASE SCROLL DOWN TO ACCESS THE FULL fTEXT OF THIS ARTICLE WITHOUT LOGGING IN. NO PURCHASE NECESSARY. PLEASE CONTACT THE PUBLISHER WITH ANY QUESTIONS.

Effects of skin moisturizer on the skin barrier dysfunction model: An evaluation of the heel via tape-stripping in healthy, young adults.

BACKGROUND: This study seeks to establish the skin barrier dysfunction model at the heel via tape-stripping (TS) by evaluating the skin moisturizing effects. MATERIALS AND METHODS: Nineteen young, female participated in the study. A sequence of TS was performed at the heel and trans-epidermal water loss (TEWL), stratum corneum (SC) hydration, and surface pH were measured. Following TS, the subjects were divided into three groups: moisturizer, emollient, and overcoat. These agents were applied daily at night, and the skin parameters were measured the next morning for a week. RESULTS: The TEWL value of TS immediately and 5 min after TS were significantly higher than what was obtained before TS, while the SC hydration after TS was significantly lower than what was obtained before TS. However, there were no significant differences in the skin parameters among the three agents on day 7 after application, with the two-way ANOVA showing no interaction among the agents and number of days. CONCLUSION: The skin barrier dysfunction model at the heel was established by TS in healthy, young adults. However, the physiological function of the skin at the heel did not change drastically and showed no differences even after continuous application for 7 days.

The Effect of Aromatherapy on Elderly Persons With Dry Skin: A Randomized Controlled Trial.

Dry skin, which is one of the most frequent dermatological problems seen in the elderly population, is an important problem that increases with aging. This study was conducted as a randomized controlled experimental trial to determine the effect of aromatherapy, applied to elderly persons residing in a nursing home in a city center, on dry skin. Elderly persons were grouped into a control group (20 elderly persons), an olive oil group (20 elderly persons), and an aromatherapy group (20 elderly persons). When examining between-measurements differences of the groups in the study, skin moisture levels of the elderly individuals in the aromatherapy group increased in all zones, arm, leg, back, and chest, at measurements of the second and fourth weeks compared with the first measurements. This improvement was determined to be higher after the second week. Skin moisture levels of elderly persons in the olive oil group were determined to significantly increase at the arm zone in the fourth week and at the back zone in the second and fourth weeks compared with the first measurements. Skin moisture levels of elderly persons in the control group, on the contrary, did not change in the second and fourth weeks compared with the first measurements and their dry skin continued at the same level. The intervention performed in this manner in the present study can be used in the clinical practice as an effective nursing intervention to reducing dry skin among elderly persons.

Prevalence and Likelihood Ratio of Six Objective Signs among Good Responders to Natrum muriaticum: Multi-centre Observational Assessment.

BACKGROUND: The reliability of homeopathic prescriptions may increase through resource to objective signs and guiding symptoms with significant positive likelihood ratio (LR). We estimated LR for six objective signs attributed to the homeopathic medicine Natrum muriaticum (Nat-m). METHODS: In this multi-centre observational assessment, we investigated the prevalence of six signs in the general patient population and among good responders to Nat-m in daily homeopathic practice. Next, we calculated LR for these six signs. RESULTS: Data from 36 good responders to Nat-m and 836 general population patients were compared. We found statistically significant positive LR (95% confidence interval) for signs such as lip cracks (1.94; 1.15 to 3.24), recurrent herpes (2.29; 1.20 to 4.37), hairline eruptions (2.07; 1.03 to 4.18), and dry hands (2.13; 1.23 to 3.69). CONCLUSIONS: Objective signs with significant positive LR might increase the reliability of homeopathic prescriptions. Further studies are warranted to confirm the validity of this approach.

The ABC Topical Management of Atopic Dermatitis in Philippines: Expert Recommendations.

Atopic dermatitis (AD) has been shown to have an increasing incidence in Asia, congruous with the trends observed worldwide. The severity of the condition has been associated with challenges in disease control. Moreover, a significant number of patients do not adhere to their physicians’ recommendations correctly and prefer alternative treatments. Better education regarding the nature of the disease and its appropriate management may improve patient compliance and lead to better control. An ABC scheme of AD management entails anti-inflammatory, barrier repair and basic skin care strategies to adequately manage AD. It is an easy-to-follow model which helps lessen distress and improve the quality of life amongst patients. An expert panel composed of specialists in the field of dermatology and pediatric dermatology in the Philippines convened to review current data and management practices in order to provide key treatment recommendations and identify current gaps in the treatment of mild to moderate atopic dermatitis. This scientific expert panel, likewise, seeks to provide guidance for all healthcare professionals involved in the care and management of AD patients.J Drugs Dermatol. 2021;20(1):84-87. doi:10.36849/JDD.5080.

Evaluating the Effectiveness of a Novel Skin Barrier Protectant in a Patient with Acute Radiodermatitis of the Vulva: A Case Report.

OBJECTIVE: To evaluate the use of a novel skin barrier protectant in a patient treated with radiotherapy for vulvar cancer. METHODS: This case report was conducted in a radiotherapy department with two women undergoing radiotherapy for vulvar carcinoma. A novel skin barrier protectant was evaluated in one patient; the other underwent the institutional standard skin care protocol. Skin reactions and pain were evaluated using the Radiotherapy Oncology Group Criteria. MAIN RESULTS: The patient who was treated with the skin protectant showed accelerated healing toward the end of radiotherapy, and this was accompanied with a decrease in pain (maximum pain score 6/10). In comparison, the patient treated with the standard skin care protocol had an extended healing process, experienced a higher pain level (maximum pain score 9/10), and required more nursing care. CONCLUSIONS: This case report is the first to suggest that this novel skin barrier protectant could effectively manage acute radiodermatitis in patients with cancer. This case report hopes to lay the foundation for future randomized controlled trials with a larger and broader patient population.

Facial cleanliness indicators by time of day: results of a cross-sectional trachoma prevalence survey in Senegal.

BACKGROUND: The World Health Organization-recommended strategy for trachoma elimination as a public health problem is known by the acronym "SAFE", where "F" stands for facial cleanliness to reduce transmission of ocular Chlamydia trachomatis infection. Accurately and reliably measuring facial cleanliness is problematic. Various indicators for measuring an unclean face exist, however, the accuracy and reliability of these indicators is questionable and their relationship to face washing practices is poorly described. METHODS: Clean face indicator (ocular or nasal discharge, flies on the face, and dirt on the face), trachoma clinical sign, and ocular C. trachomatis infection data were collected for 1613 children aged 0-9 years in 12 Senegalese villages as part of a cross-sectional trachoma prevalence study. Time of examination was recorded to the nearest half hour. A risk factor questionnaire containing Water, Sanitation and Hygiene (WASH) questions was administered to heads of compounds (households that shared a common doorway) and households (those who shared a common cooking pot). RESULTS: WASH access and use were high, with 1457/1613 (90.3%) children living in households with access to a primary water source within 30 min. Despite it being reported that 1610/1613 (99.8%) children had their face washed at awakening, > 75% (37/47) of children had at least one unclean face indicator at the first examination time-slot of the day. The proportion of children with facial cleanliness indicators differed depending on the time the child was examined. Dirt on the face was more common, and ocular discharge less common, in children examined after 11:00 h than in children examined at 10:30 h and 11:00 h. CONCLUSIONS: Given the high reported WASH access and use, the proportion of children with an unclean face indicator should have been low at the beginning of the day. This was not observed, explained either by: the facial indicators not being reliable measures of face washing; eye discharge, nose discharge or dirt rapidly re-accumulated after face washing in children in this population at the time of fieldwork; and/or responder bias to the risk factor questionnaire. A high proportion of children had unclean face indicators throughout the day, with certain indicators varying by time of day. A reliable, standardised, practical measure of face washing is needed, that reflects hygiene behaviour rather than environmental or cultural factors.

Ostomy Complications, Risk Factors, and Applied Nursing Care: A Retrospective, Descriptive Study.

PURPOSE: This study aimed to describe the frequency of colostomy and ileostomy complications and types of nursing interventions as well as to examine patient and ostomy variables associated with early and late complications. METHODS: The records of 572 patients who received ostomy care from a wound ostomy care (WOC) nurse between 2013 and 2017 were abstracted. Patient demographic and ostomy variables, early period (< 30 days after surgery) and late period (> 30 days after surgery) complications, as well as documented nursing interventions were retrieved. Percentages and rates, chi-square statistics, and logistic regression were used to analyze the data. RESULTS: The mean patient age was 59.1 years (standard deviation [SD], 13.86), and the majority of patients were male (302 patients; 52.8%), married (454; 79.4%), and had a temporary (438; 76.6%) end colostomy (253; 44.2%). One (1) or more complications developed in 323 patients (56.5%) in the early period and in 207 patients (36.2%) in the late period. The most common complications in the early period were peristomal irritant contact dermatitis (PICD) (181; 31.6%) and mucocutaneous separation (135; 23.6%). PICD was also the most common complication in the late period (149; 26%). The risk of PICD was significantly higher in patients with a body mass index > 24.9 kg/m2 (odds ratio [OR] = 1.547), who had an ileostomy (OR = 1.654), or a temporary ostomy (OR = 1.728). Variables associated with an increased risk of mucocutaneous separation included obstacles to ostomy care (OR = 2.222), having an end ostomy (OR = 2.171), and ostomy height < 10 mm (OR = 1.964). Complications were treated by the WOC nurse in 67.5% of patients, and the most common intervention was application of skin barrier powder and wipe layers. CONCLUSIONS: The rate of ostomy complications, especially PICD and mucocutaneous separation, in this study was high. Results confirm that patient and ostomy characteristics might significantly affect the risk of complications. The findings support the importance of outpatient follow-up by a WOC nurse. Explorative or randomized controlled studies are needed to identify optimal nursing strategies to decrease complication rates.

Regulación y terminología dermocosmética: los orígenes de las normas INCI en España / Dermocosmetic's regulation and terminology: the origins of the INCI norms in Spain

INTRODUCCIÓN: el uso de normas concretas para identificar correctamente los ingredientes que componían los cosméticos resultó fundamental para su control. En este trabajo se analiza el costoso proceso requerido para la adopción de la terminología INCI en España realizado entre las décadas de 1960 y 1990. MÉTODOS: se ha realizado un análisis de la legislación publicada en España sobre el control de los productos cosméticos entre las décadas de 1940 y 1990. Se ha recuperado de forma sistemática aquellas cuestiones relacionadas con el registro de los productos cosméticos y las terminologías y nomenclaturas utilizadas para identificar los ingredientes con los que se fabricaban. También se han consultado fuentes primarias impresas, así como prensa periódica. Estas fuentes primarias se han discutido y contextualizado con la ayuda de publicaciones especializadas en historia de la ciencia más recientes. Resultados y CONCLUSIONES: la adopción de una nomenclatura o terminología cosmética precisa era necesaria tanto para su registro ante las administraciones sanitarias, como para los consumidores que eran informados en el etiquetado. La regulación sanitaria de los productos cosméticos era muy laxa hasta que, en la década de 1960, se desarrolló esta industria y su mercado en España. La consolidación del sector dermofarmacéutico se produjo en la década de 1970, en parte debido a los esfuerzos de diversos sectores farmacéuticos. La progresiva introducción de nomenclaturas cosméticas internacionales culminó en la década de 1990 con la adopción oficial de la terminología INCI en España

INTRODUCTION: the use of specific rules to correctly identify ingredients used in cosmetics was essential for their control. This paper analyses the complex process to adapt the INCI terminology between the 1960s and the 1990s. METHOD: analysis of the legislation published in Spain on the control of cosmetic products between the 1940s and the 1990s, focusing on cosmetic's registers and terminologies and nomenclatures used to identify their ingredients. Printed Primary sources, and periodical press have also been consulted. Primary sources have been discussed and contextualized with the help of more recent history of science publications. Results and CONCLUSIONS: The adoption of precise cosmetic nomenclature or terminology was required by health authorities registering these products, as well as for the labelling to inform consumer. The sanitary regulation of cosmetic products was very lax until the development of this industry and its market in Spain in the 1960s. The consolidation of the dermopharmaceutical sector occurred in the 1970s, in part due to the efforts of various pharmaceutical sectors. The gradual introduction of international cosmetic nomenclatures culminated in the 1990s with the official introduction of the INCI terminology in Spain

A Consensus About the Importance of Ceramide Containing Skincare for Normal and Sensitive Skin Conditions in Neonates and Infants.

Background: Neonates and infants are susceptible to skin barrier disruption as their skin anatomically and functionally is still developing. The process of skin acidification plays a vital role in barrier maturation and the activation of enzymes involved in the extracellular processing of stratum corneum lipids. The current consensus paper explores challenges, and current treatment approaches in neonatal and infant normal and sensitive skin and the role of ceramides containing moisturizers. Methods: For this purpose, an expert panel of pediatric dermatologists and dermatologists discussed information from systematic literature searches, coupled with expert opinion and experience of the panel, to adopt eight statements. The consensus process consisted of a modified Delphi technique. Results: During the first years after birth, the neonatal and infant skin is more permeable to topical agents and, therefore, requires particular caution with topical skincare regimens. Mildly acidic or pH-neutral cleansers have benefits for neonates and infants. Skincare for neonates and infants should be safe, effective, and fragrance free as well as sensitizing agent-free. Additionally, the skincare should be pleasant to use, containing ingredients that benefit the lipid and water content of the SC, such as those products containing ceramides. Conclusion: Taking into consideration the maturation process of neonatal and infant skin, the application of moisturizers and cleansers containing barrier lipids may help maintain the protective skin barrier and soothe with long-term moisturizing benefits. J Drugs Dermatol. 2020;19(8) 769-776: doi:10.36849/JDD.2020.5252 THIS ARTICLE HAD BEEN MADE AVAILABLE FREE OF CHARGE. PLEASE SCROLL DOWN TO ACCESS THE FULL TEXT OF THIS ARTICLE WITHOUT LOGGING IN. NO PURCHASE NECESSARY. PLEASE CONTACT THE PUBLISHER WITH ANY QUESTIONS.

Reliability and agreement of skin barrier measurements in a geriatric care setting.

BACKGROUND: The non-invasive skin barrier measurements transepidermal water loss, stratum corneum hydration and the skin surface pH are widely used in clinical skin research. Relative and absolute measurement errors of these measurements are unknown in geriatric care settings. MATERIAL AND METHODS: Transepidermal water loss, stratum corneum hydration, skin surface pH and temperature were measured on the volar forearm and lower leg twice by trained raters within a cross-sectional study in ten nursing homes. Intrarater reliability was calculated using the ICC (1,1). Intrarater agreement was analyzed using Bland Altman Plots with limits of agreement. RESULTS: Two hundred twenty-three residents were included and mean age was 84.2 years. The highest ICC was found for transepidermal water loss and skin surface temperature of the leg with 0.95 (95% CI 0.93 to 0.96). The ICC of the stratum corneum was 0.91 (95% CI 0.88 to 0.93) for both investigated skin areas. The measurement of the pH at the lower leg had the lowest ICC with 0.73 (95% CI 0.66 to 0.78). Highest limits of agreement of approximately 8 a.u. were calculated for stratum corneum hydration and lowest limits of agreement of approximately 1 °C were calculated for skin surface pH. CONCLUSION: Relative measurement errors of transepidermal water loss and stratum corneum hydration were very low indicating that single measurements provide reliable estimates in this population and setting. However, the absolute measurement errors were high for both of these parameters. To increase reliability of skin surface pH we recommend at least two repeated measurements.