Identifying, managing and preventing skin maceration: a rapid review of the clinical evidence

Whitehead, Floy Eugenia; Giampieri, Silvia; Graham, Tanya; Grocott, Patricia

doi:10.12968/jowc.2017.26.4.159

Cited by 27 publications

(23 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…21 Third, the prevalence of ST 2.0% (95% CI 1.62-2.40) in medical staff was higher than 1.06% in patients in a multicenter study, 14 but significantly lower than 22% elderly patients in a systematic review. 22 Fourth, the susceptible parts of skin injuries in medical staff were on the nose bridge, cheeks, ears, and forehead (Table 1), and in patients, DRPI mainly located on ears and feet, 10,23 MASD occurred on skin fold, periwounds, or peristoma, [19][20][21][22]24,25 and ST occurred on extremities. 14,22 The reasons possibly were as follows.…”

Section: Discussionmentioning

confidence: 99%

The Prevalence, Characteristics, and Prevention Status of Skin Injury Caused by Personal Protective Equipment Among Medical Staff in Fighting COVID-19: A Multicenter, Cross-Sectional Study

Jiang

Song

Zhou

et al. 2020

Advances in Wound Care

141

235

View full text Add to dashboard Cite

Objective: To investigate the prevalence, characteristics, and preventive status of skin injuries caused by personal protective equipment (PPE) in medical staff. Approach: A cross-sectional survey was conducted online for understanding skin injuries among medical staff fighting COVID-19 in February 8-22, 2020. Participants voluntarily answered and submitted the questionnaire with cell phone. The questionnaire items included demographic data, grade of PPE and daily wearing time, skin injury types, anatomical sites, and preventive measures. Univariable analyses and logistic regression analyses were used to explore the risk factors associated with skin injuries. Results: A total of 4,308 respondents were collected from 161 hospitals and 4,306 respondents were valid. The overall prevalence of skin injuries was 42.8% (95% confidence interval [CI] 41.30-44.30) with three types of devicerelated pressure injuries, moist-associated skin damage, and skin tear. Co-skin injuries and multiple location injuries were 27.4% and 76.8%, respectively. The logistic regression analysis indicated that sweating (95% CI for odds ratio [OR] 87.52-163.11), daily wearing time (95% CI for OR 1.61-3.21), male (95% CI for OR 1.11-2.13), and grade 3 PPE (95% CI for OR 1.08-2.01) were associated with skin injuries. Only 17.7% of respondents took prevention and 45.0% of skin injuries were treated. Innovation: This is the first cross-sectional survey to understand skin injuries in medical staff caused by PPE, which is expected to be a benchmark. Conclusion: The skin injuries among medical staff are serious, with insufficient prevention and treatment. A comprehensive program should be taken in the future.

show abstract

Section: Discussionmentioning

confidence: 99%

The Prevalence, Characteristics, and Prevention Status of Skin Injury Caused by Personal Protective Equipment Among Medical Staff in Fighting COVID-19: A Multicenter, Cross-Sectional Study

Jiang

Song

Zhou

et al. 2020

Advances in Wound Care

141

235

View full text Add to dashboard Cite

show abstract

“…43,44 Reduced maceration may optimise skin strength and resistance to bacterial colonisation and infection. 45 This study focused on a rare genetic skin condition. As a result our findings are specific to a particular group, RDEB, and are not necessarily representative of the wider population.…”

Section: Box 4: Results Of V1 Surrogate Testsmentioning

confidence: 99%

Iterative codesign and testing of a novel dressing glove for epidermolysis bullosa

et al. 2019

View full text Add to dashboard Cite

Background: Recessive Dystrophic Epidermolysis Bullosa is a rare genetic skin disorder which requires intensive hand therapy to delay fusion of the digits. Existing dressings do not conform to the complex structure of the hand and are applied in patches held with additional bandages leading to an occlusive environment. Objectives: To co-design a dressing glove based on user experiences and needs. Methods: Qualitative interviews and focus groups with children and adults with Recessive Dystrophic Epidermolysis Bullosa and their carers were conducted. Iterative feedback of design cues, bench and surrogate testing of materials and prototype refinement were achieved through collaborative co-design with patients, carers, clinicians and manufacturers. Results: Thematic analysis generated eight user needs and corresponding design cues addressing issues of absorbency, adherence, comfort, adaptability, ease of application and removal, breathability, protection, and hand hygiene. One prototype was selected for proof of concept testing. Conclusion: This novel dressing glove design meets the patient's requirements of a dressing, which conforms to the structure of the hand and sits into the web spaces to keep fingers separated. Proof of concept testing has since been undertaken with patients to determine performance, value for money and whether further developments are required and will be published in a separate paper.

show abstract

“…In healthy skin, when occlusion is removed, the accumulated water will evaporate at a higher rate than normal until a healthy equilibrium is restored, meaning that even repeated short-term occlusion should not have adverse effects (Gioia et al, 2002). However, prolonged occlusion can lead to maceration, along with mild skin irritation, which can adversely affect barrier function and lead to moisture-associated skin damage (MASD) (Bowstra et al, 2003;Warner et al, 2003;Jungersted et al, 2010;Whitehead et al, 2017). Even short-term occlusion can be problematic in scar tissue, which has a raised TEWL, and in stretch marks at the affected site, which can have altered barrier properties (Dabboue et al, 2015).…”

Section: Moisture-associated Skin Damagementioning

confidence: 99%

Developments in silicone technology for use in stoma care

et al. 2021

View full text Add to dashboard Cite

Soft silicone's flexibility, adhesive capacity and non-toxic, non-odourous and hypoallergenic nature have made it an established material for adhesive and protective therapeutic devices. In wound care, silicone is a component of contact layer dressings for superficial wounds and silicone gel sheeting for reducing the risk of scarring, as well as of barriers for incontinence-associated dermatitis. Regarding stoma accessories, silicone is established in barrier films to prevent contact dermatitis, adhesive removers to prevent skin stripping and filler gels to prevent appliance leaks. Until recently, silicone has not been used in stoma appliances flanges, as its hydrophobic nature has not allowed for moisture management to permit transepidermal water loss and prevent maceration. Traditional hydrocolloid appliances manage moisture by absorbing water, but this can lead to saturation and moisture-associated skin damage (MASD), as well as increased adhesion and resultant skin tears on removal, known as medical adhesive-related skin injury (MARSI). However, novel silicone compounds have been developed with a distinct evaporation-based mechanism of moisture management. This uses colloidal separation to allow the passage of water vapour at a rate equivalent to normal transepidermal water loss. It has been shown to minimise MASD, increase wear time and permit atraumatic removal without the use of adhesive solvents. Trio Healthcare has introduced this technology with a range of silicone-based flange extenders and is working with the University of Bradford Centre for Skin Sciences on prototype silicone-based stoma appliance flanges designed to significantly reduce the incidence of peristomal skin complications, such as MARSI and MASD. It is hoped that this will also increase appliance wear time, reduce costs and improve patient quality of life.

show abstract

Identifying, managing and preventing skin maceration: a rapid review of the clinical evidence

Cited by 27 publications

References 29 publications

The Prevalence, Characteristics, and Prevention Status of Skin Injury Caused by Personal Protective Equipment Among Medical Staff in Fighting COVID-19: A Multicenter, Cross-Sectional Study

The Prevalence, Characteristics, and Prevention Status of Skin Injury Caused by Personal Protective Equipment Among Medical Staff in Fighting COVID-19: A Multicenter, Cross-Sectional Study

Iterative codesign and testing of a novel dressing glove for epidermolysis bullosa

Developments in silicone technology for use in stoma care

Contact Info

Product

Resources

About