背景:老年养老院居民容易同时出现不同的皮肤状况,包括皮肤干燥症,皮肤眼泪,压疮,失禁相关性皮炎或间期。指南和建议主要分别解决这些皮肤状况。这项研究的总体目标是衡量实施护肤和预防方案的效果。
方法:进行了一项双臂集群随机对照试验。
方法:在被分配到干预组的疗养院中,实施了为期六个月的循证和结构化护肤和预防计划。对照组的疗养院居民照常接受标准护理。失明的皮肤科医生进行了从头到脚的皮肤评估,研究人员评估了皮肤屏障参数,包括角质层水合作用和上肢和下肢在3个月和6个月后的经表皮水分流失。结果包括失禁相关性皮炎的累积发生率,皮肤眼泪,压疮和intertrigo,并呈现为意向治疗和方案分析。皮肤干燥和居民报告的结果(疼痛,痒,生活质量)进行评估。
结果:对柏林联邦州的17个疗养院进行随机抽样,德国,在干预组(n=9)和对照组(n=8)中随机分组。总的来说,165名参与者被分配到干预中,149名参与者被分配到对照组.皮肤撕裂的累积发生率(19.2%,95%CI12.8-27.8),压疮(13.6%,95%CI8.1-21.9)和intertrigo(27.0%,与对照组相比,干预组的95%CI18.4-37.7)较低,皮肤撕裂的累积发生率为27.2%(95%CI19.3-36.9),压疮为16.9%(95%CI10.6-25.9),和37.8%(95%CI27.5-49.4)为intertrigo。干预组失禁相关性皮炎的发生率较高(26.3%,95%CI17.9-36.8)与对照组(23.1%;95%CI14.6-34.5)相比。干预组的平均皮肤干燥度较低,但表现出差异。对疼痛的影响,痒,生活质量微不足道。
结论:目前的研究结果表明,实施量身定制的循证护理程序可以改善长期护理中的皮肤健康和安全性。证据表明,通过定期皮肤评估和个性化护肤程序可以预防多种不良皮肤状况。观察到对皮肤干燥的积极影响,但皮肤生理参数并不表明皮肤屏障功能的变化。
背景:本研究在德国临床试验注册中心注册(注册编号:DRKS00015680;注册日期:1月29日,2019)和ClinicalTrials.gov(NCT03824886;注册日期:1月31日,2019)。
BACKGROUND: Older nursing home residents are prone to develop different skin conditions at the same time, including xerosis cutis, skin tears, pressure ulcers, incontinence-associated dermatitis or
intertrigo. Guidelines and recommendations mainly address these skin conditions separately. The overall aim of this study was to measure the effects of the implementation of a skincare and prevention package.
METHODS: A two-arm cluster-randomised controlled trial was conducted.
METHODS: In nursing homes being assigned to the intervention group, an evidence-based and structured skincare and prevention programme was implemented for six months. Nursing home residents in the control group received standard care as usual. Blinded dermatologists conducted head-to-toe skin assessments, and the researchers assessed skin barrier parameters including stratum corneum hydration and transepidermal water loss at the upper and lower extremities after three and six months. Outcomes included the cumulative incidence of incontinence-associated dermatitis, skin tears, pressure ulcers and
intertrigo, and were presented as intention-to-treat and per protocol analysis. Skin dryness and resident-reported outcomes (pain, itch, quality of life) were assessed.
RESULTS: A random sample of 17 nursing homes in the federal state of Berlin, Germany, was drawn and randomised in intervention (n = 9) and control groups (n = 8). In total, 165 participants were allocated to the intervention, and 149 participants were allocated to the control group. The cumulative incidence of skin tears (19.2 %, 95 % CI 12.8-27.8), pressure ulcers (13.6 %, 95 % CI 8.1-21.9) and
intertrigo (27.0 %, 95 % CI 18.4-37.7) was lower in the intervention compared to the control group, with cumulative incidences of 27.2 % (95 % CI 19.3-36.9) for skin tears, 16.9 % (95 % CI 10.6-25.9) for pressure ulcer, and 37.8 % (95 % CI 27.5-49.4) for
intertrigo. The incidence of incontinence-associated dermatitis was higher in the intervention group (26.3 %, 95 % CI 17.9-36.8) compared to the control group (23.1 %; 95 % CI 14.6-34.5). Mean skin dryness was lower in the intervention group but showed variation. The impact on pain, itch, and quality of life was trivial.
CONCLUSIONS: The present study results indicate that the implementation of tailored and evidence-based nursing routines improves skin health and safety in residential long-term care. Evidence suggests that multiple adverse skin conditions can be prevented by regular skin assessments and individually tailored skincare routines. Positive effects on skin dryness were observed, but skin physiology parameters did not indicate changes of the skin barrier function.
BACKGROUND: This study is registered at the German Clinical Trials Register (registration number: DRKS00015680; date of registration: January 29th, 2019) and ClinicalTrials.gov (NCT03824886; date of registration: January 31st, 2019).