Post on 18-Jan-2016
An interventional study comparing skin hydration in nursing home residents using traditional versus disposable bed bath
Katrin Gillis (RN, MSc)
Inge Tency (RM, MSc, PhD)
Ella Roelant (MSc, PhD)
Dirk Lips (Msc, PhD)
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Background
• Research on demand, in particular for a nursing home group, Curando
• Research on innovative washing method is relevant for
• clinical practice• nursing education
Dublin, 4-5th November 2015
16th Healthcare Interdisciplinary Research Conference
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Introduction
• Growing population in nursing homes
• Modified barrier properties and skin hydration
• Skin tears and dry skin (or xerosis) are the most common problems
• Increased by agents containing soap
• Skin and soft tissues infections: 2nd most common type of infection
Dublin, 4-5th November 2015
16th Healthcare Interdisciplinary Research Conference
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Introduction
• Skin care is essential for the wellbeing of elderly people
• Need for an evidence based approach on personal hygienic care
• Lack of high-quality studies as a framework for evidence based skin care practice
Dublin, 4-5th November 2015
16th Healthcare Interdisciplinary Research Conference
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Objective of the study
To compare the effect of two washing methods (traditional versus disposable bed bath) on skin hydration at stratum cornea level in nursing home residents
Dublin, 4-5th November 2015
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Study design and population
• A cluster randomized trial
• 166 residents from six wards of
two nursing homes in Flanders• INTERVENTION GROUP: disposable glove bed
bath• Training session health care personnel• 8 pre-moistened paraben free disposable wash
gloves, 30 sec at 600W in microwave (exclusively used for the study) of which at least 4 gloves were used (SCA Hygiene products)
• CONTROL GROUP: traditional washing method
Dublin, 4-5th November 2015
16th Healthcare Interdisciplinary Research Conference
http://taalhelden.org/bericht/belgie
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Study design and population• All residents were eligible for
participation
• Written informed consent of residents (or legal representatives)
• Approved by the EC of AZ Nikolaas hospital
Dublin, 4-5th November 2015
16th Healthcare Interdisciplinary Research Conference
8Dublin, 4-5th November 2015
16th Healthcare Interdisciplinary Research Conference
Control group n=46
Intervention group n=120
46 residents45 observations
115 residents110 observations
42 residents40 observations
108 residents105 observations
Included at the baseline n=155
PRETEST
Included after implementation
n=155POSTTEST
5 residents no informed consent
2 residents died1 resident moved to another
nursing home1 resident hospitalized
3 residents died2 residents stopped the
intervention2 residents hospitalized
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Measurements
Dublin, 4-5th November 2015
16th Healthcare Interdisciplinary Research Conference
At the baseline
After 12 weeks of implementation
Stratum corneum hydration was measured using the MoistureMeter SC (Delfin Technologies Ltd)
Mean score of two measurements (AU, arbitrary units)
Registration of temperature (°C)
and humidity (%)
CHEEK
HAND
LEG
http://www.bsaffligem.be
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Measurements
16th Healthcare Interdisciplinary Research ConferenceDublin, 4-5th November 2015
http://www.delfintech.com
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Residents’ baseline characteristics, bath practices and environmental factors
Intervention
group
n=115
Control
group
n=46
P-value
Gender (n, %) Male 37 (31.6) 10 (22.2) 0.238*
Female 80 (68.4) 35 (77.8)
Age (Me, IQR, y) 87 [82-91] 86 [80-90] 0.224**
BMI (Mean, SE 23.8 ±0.59 23.9±0.67 0.969***
Frequency bathing or
showering (n,%)
no bathing or
showering
1 x/2 weeks
1x/week
15 (15.5)
3 (3.1)
79 (81.4)
0 (0)
0 (0)
39 (100)
0.007****
Soap (n,%) Bar of soap 35 (92.1) 14 (58.3) 0.001*
Liquid soap/oil 3 (7.9) 10 (41.7)
Environmental factors (Mean,
SE, °C/%)
Room temperature 24.0±0.13 25.9±0.18 <0.001***
Humidity 29.5±0.27 22.3±0.34 <0.001***
Dublin, 4-5th November 2015
16th Healthcare Interdisciplinary Research Conference
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Skin hydration at the baselineTotal skin
• Cheek: 22.8±15.2 AU• Hand: 17.9±8.2 AU• Leg: 18.7±8.8 AU
No difference between
• intervention and control group
• nursing home and bathing practice
Dublin, 4-5th November 2015
16th Healthcare Interdisciplinary Research Conference
CHEEK 19.7±12.3 AU
HAND 17.7±7.6 AU
LEG 18.9±9.5 AU
CHEEK 24.1±16.1 AU
HAND 18.0±8.5 AU
LEG 18.7±8.5 AU
(Mean±standard deviation)http://www.bsaffligem.be
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Skin hydration after implementationTotal skin
• Cheek: 36.5±23.9 AU• Hand: 20.6±10.9 AU• Leg: 23.1±10.8 AU
Significantly higher in intervention versus control group
• 88% cheek• 28% hand• 38% leg
Dublin, 4-5th November 2015
16th Healthcare Interdisciplinary Research Conference
CHEEK 22.2 ±19.7 AU
HAND 17.1±6.6 AU
LEG 18.1±6.3 AU
CHEEK 41,8±23.3 AU
HAND 21.9±11.8 AU
LEG 24.9 ±11.5 AU
(Mean±standard deviation)http://www.bsaffligem.be
Cheek post-pre** Hand post-pre* Leg post-pre** Total post-pre**
-5
0
5
10
15
20
25
30
35
Control group
Intervention group
Arb
itrar
y U
nits
Skin hydration post-minus-pre score
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* significance at <0,05 level ** significance at ≤0,001 level
Dublin, 4-5th November 2015
Total
**
**
**
*
LegHandCheek
Hydra
tion P
ost
– P
re (
AU
)
ControlIntervention
* p < 0,05; ** p < 0,001
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Determinants of skin hydration
Differed according to
• The skin site
• Prehydration status
• Gender
• Humidity
• Frequency of bathing
Dublin, 4-5th November 2015
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Conclusion
• A significant increase in hydration score at all skin sites and total skin after implementation of disposable wash gloves
• The use of disposable wash gloves in nursing homes can improve quality of care, thereby reducing the risk of dry skin.
Dublin, 4-5th November 2015
16th Healthcare Interdisciplinary Research Conference
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Further research
• Further RCT’s in similar and other health care settings are needed
• Determinants of skin hydration in elderly (e.g. environmental factors) needs further consideration
• Further research to compare different wash gloves as well as cost-effectiveness of the innovative wash method
Dublin, 4-5th November 2015
16th Healthcare Interdisciplinary Research Conference
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Thank you for your attention!
Dublin, 4-5th November 2015
16th Healthcare Interdisciplinary Research Conference
katrin.gillis@odisee.beinge.tency@odisee.be
http://www.recruitingblogs.com