An interventional study comparing skin hydration in nursing home residents using traditional versus...

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)

2

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

3

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



4

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



5

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



6

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



http://taalhelden.org/bericht/belgie

7

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



8Dublin, 4-5th November 2015


Control group n=46

Intervention group n=120

46 residents45 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

9

Measurements



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

10

Measurements

16th Healthcare Interdisciplinary Research ConferenceDublin, 4-5th November 2015

http://www.delfintech.com

11

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***



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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



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

13

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



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

16th Healthcare Interdisciplinary Research Conference 14

* significance at <0,05 level ** significance at ≤0,001 level


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



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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.



17

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



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Thank you for your attention!



[email protected]@odisee.be

http://www.recruitingblogs.com

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