Improve Skin Integrity Research Articles

Dermal Delivery of Hypericum perforatum (L.) Loaded Nanogel: Formulation to Preclinical Psoriasis Assessment.

Nanophytosomes represent an effective choice for topical drug delivery systems thanks to their small size, general non-toxicity, ease of functionalization and high surface to volume ratio. The goal of the current study was to investigate the potential benefits of using Hypericum perforatum extract nanogel as a means of improving skin penetration and prolonging skin deposition in dermatitis similar to psoriasis. Nanophytosomes (NPs) were developed, optimised and thoroughly characterised. The optimised NPs were then placed in a Carbopol gel base matrix and tested ex-vivo (skin penetration and dermatokinetic) and in-vivo (antipsoriatic activity in an Imiquimod-induced psoriatic rat model). The optimised NPs had a spherical form and entrapment efficiency of 69.68% with a nanosized and zeta potential of 168 nm and -10.37mV, respectively. XRD spectra and transmission electron microscopy tests confirmed the plant botanical encapsulation in the NPs. Following 60 days of storage at 40 ± 2°C/75 ± 5% RH, the optimised formula remained relatively stable. As compared to extract gel, nano-gel showed a much-improved ex vivo permeability profile and considerable drug deposition in the viable epidermal-dermal layers. When developed nano-gel was applied topically to a rat model of psoriasis, it demonstrated distinct in vivo anti-psoriatic efficacy in terms of drug activity and reduction of epidermal thickness in comparison to other formulations and the control. ELISA and histopathologic studies also demonstrated that nano-organogel had improved skin integrity and downregulated inflammatory markers (IL-17, IL-6, IFN-γ and MCP-1). Findings suggest that a developed plant botanicals-based nanogel has a potential for the treatment of psoriasis-like dermatitis with better skin retention and effectiveness.

Nanophytosomal Gel of Heydotis corymbosa (L.) Extract against Psoriasis: Characterisation, In Vitro and In Vivo Biological Activity.

The current study was conducted to examine the possible advantages of Heydotis corymbosa (L.) Lam. extract nanogel as a perspective for enhanced permeation and extended skin deposition in psoriasis-like dermatitis. Optimised nanophytosomes (NPs) were embedded in a pluronic gel base to obtain nanogel and tested ex vivo (skin penetration and dermatokinetics) and in vivo. The optimised NPs had a spherical form and entrapment efficiency of 73.05 ± 1.45% with a nanosized and zeta potential of 86.11 nm and -10.40 mV, respectively. Structural evaluations confirmed encapsulation of the drug in the NPs. Topical administration of prepared nanogel to a rat model of psoriasis-like dermatitis revealed its specific in vivo anti-psoriatic efficacy in terms of drug activity compared to the control and other formulations. Nanogel had improved skin integrity and downregulation of inflammatory cytokines. These findings suggest that developed phytoconstituent-based nanogel has the potential to alleviate psoriasis-like dermatitis with better skin retention and effectiveness.

Sterile water moisturizer of the skin of extremely low birth weight infants.

To assess the feasibility of sterile water application to the skin of the extremely low birth weight (ELBW) newborns in the first week of life and examine its effects on their skin integrity and outcomes. Pilot randomized controlled trial. Open-bay, 18 bed Level III NICU in the Eastern United States. Twenty-eight ELBW neonates. Two newborns expired, sixteen newborns remained in the intervention group and twelve newborns in the control group. ELBW neonates were either assigned to receive frequent sterile water wash to skin or not during care for the first week of life. Using the Neonatal Skin Condition Scale (NSCS), assessments were performed twice a day during the first week. Fluid intake, serum electrolytes, culture proven sepsis and other morbidities, and length of stay (LOS) were compared while controlling for confounding variables using multiple regression analysis. There was no difference in the demographic or clinical characteristics between both groups. Sterile water wash application to skin was not associated with differences in skin health indices or fluid intake. However, it was associated with higher median sodium level and with early regression of bilirubin level when compared to controls. Frequent skin washes with sterile water are feasible and safe. However, they may not be associated with improved skin integrity or fluid intake.

Moisturisers, emollients, or barrier preparations for the prevention of pressure injury: a systematic review and meta-analysis.

Search terms were derived with database searches including ProQuest, CINAHL, Medline, Science Direct, Scopus and the Cochrane library. The Robins1 and Risk of Bias 2 (Rob2) quality appraisal tools were used. A meta-analysis of the effects of interventions was conducted (random effects). Four studies met the inclusion criteria, with heterogeneous quality. Pooling of non-randomised studies found that the application of emollients, moisturisers or barrier preparations did not significantly reduce incidence of pressure injury compared to standard care (relative risk 0.50 95% CI 0.15-1.63, Z=1.15 p=0.25). This review suggests that the use of inert moisturisers, emollients, or barrier preparations for preventing pressure injuries was not effective to prevent pressure injury in aged care or hospital settings. However, there was a distinct lack of randomised controlled trials, with only one meeting the inclusion criteria. One included study which utilised a combination of neutral body wash and emollient demonstrated a significant reduction in development of stage one and two pressure injuries. This combination of care may further support skin integrity and should be further examined in future trials.

The combined effect of commercial tilapia collagen peptides and antioxidants against UV-induced skin photoaging in mice.

Chronic over-exposure to UV radiation leads to the damage of skin tissue. The aim of this study was to investigate the effects of collagen peptide (CP) and antioxidant (astaxanthin, vitamin C (Vc), and vitamin E (Ve)) combinations on skin photoaging. Forty male UV-induced BALB/c mice were randomized and fed saline or CP and antioxidants for 7 weeks using gavage feeding. The results showed that oral administration of CP, CP combined with Vc and Ve (VCE) or Haematococcus pluvialis extract (HPE) significantly (P < 0.05) reduced a* of mouse skin and increased the content of Hyp and type I collagen to varying degrees, thereby improving skin integrity. Furthermore, the combination of CP, HPE, and VCE showed increased upregulation of antioxidant enzyme expression, reduced serum ROS, and decreased inhibition of metalloproteinase expression compared to the other treatment groups. Thus, this combination showed better effects in inhibiting collagen degradation and maintaining the redox balance. The Nrf2/ARE and TGF-β/Smad transcription systems are likely involved in these effects. Therefore, the results suggest that a diet containing CP, astaxanthin, and vitamins might be recommended to improve skin health and appearance.

Consistent pressure ulcer prevention practice: The effect on PU prevalence and PU stages, and impact on PU prevention-A quasi-experimental intervention study.

This study evaluates the effect of nursing staff's renewed consistent pressure ulcer (PU) prevention practice on PU prevalence and the PU prevention implemented for residents. A quasi-experimental intervention study was conducted. The data were collected from 232 residents (n=115 in intervention and 117 in comparison group) in two public long-term older people care (LOPC) facilities in Finland using the Pressure Ulcer Patient instrument (PUP-Instrument). The facilities were chosen with convenience sampling, after which they were randomly allocated as either intervention or comparison facility. Based on international guidelines for PU prevention, the renewed, consistent PU prevention practice with six areas was developed and implemented using the operational model for evidence-based practices (OMEBP). After the intervention, a significant difference between the intervention and the comparison facility was seen in the prevalence of PUs and in the residents' highest stage of PUs in the sacrum, buttock and hip areas, and heels. Between the facilities, a significant difference was seen in the use of PU and nutrition risk assessment instruments and nutritional supplements, time used for repositioning in the daytime and at night-time, lifting belt use, and avoiding shearing or stretching residents' skin. The successful intervention improved skin integrity in LOPC facilities.

Brewers’ spent hop revalorization for the production of high added-value cosmetics ingredients with elastase inhibition capacity

This article summarizes the analysis of α and β-acids and prenylflavonoids from brewers’ spent hop (BSH) as source of bioactive molecules to improve skin integrity by inhibiting elastase activity. To maximize the efficacy of the BSH extracts, it was necessary to identify the most bioactive hop compounds and the extraction parameters to maximize elastase inhibition and total antioxidant capacity. Thus, a computational methodology was carried out to test the anti-elastase potential of these hop molecules, detecting cis-iso-α-cohumulone and 8-prenylnaringenin as main inhibitors. Then, BSH extracts were optimized to ensure the maximum extraction of bioactive compounds, using compatible solvents (water and 100% plant-based propanediol) according to the green cosmetic standards. Finally, a determination and quantification method based on HPLC–MS/MS was used to guarantee the presence of the bioactive molecules, detecting a higher concentration of cis-iso-α-cohumulone and 8-prenylnaringenin in those samples with high anti-elastase activity. By optimizing extraction conditions and agents, a BSH extract was designed, showing high antioxidant (81.9 mmol Trolox/L) and high anti-elastase capacities.

Aruncus dioicus var. kamtschaticus Extract Ameliorates Psoriasis-like Skin Inflammation via Akt/mTOR and JAK2/STAT3 Signaling Pathways in a Murine Model

Goat's beard (Aruncus dioicus var. kamtschaticus) is a traditional medicinal plant, widely used in Chinese and Korean traditional medicine because of its anti-inflammatory, anti-oxidant, antimicrobial, and anti-cancer activity. However, its effect on skin inflammatory diseases like psoriasis is unknown. The aim of this study was to investigate the therapeutic potency of A. dioicus extract (ADE) in in vitro and in vivo psoriasis models. ADE treatment significantly attenuated skin inflammation and improved skin integrity in imiquimod-treated mice by suppressing keratinocyte hyperproliferation, inhibiting the infiltration of immune cells, and downregulating the expression of psoriatic markers. Further, ADE treatment suppressed protein kinase B/mammalian target of rapamycin (Akt/mTOR) and Janus kinase 2/signal transducers and activators of transcription 3 (JAK2/STAT3) signaling in HaCaT cells. Overall, the application of ADE relieves psoriasis-like skin inflammation possibly by regulating the Akt/mTOR and JAK2/STAT3 signaling pathways, making it an effective alternative for psoriasis therapy.

161 Botanical extract effectiveness on overall well-being and well-aging. An in-vivo study

Well-being is one of the main consumers preoccupations with well-aging. Oxytocin, known as the “feel-good molecule”, participates to global well-being, and frequently related to positive social interactions. Gentle touch, perceptible by the presence of mechanosensory nerve fibers in the skin, triggers the release of oxytocin in the body, like in saliva or in keratinocytes having a beneficial effect on skin. A botanical extract has been developed to target mechanosensory receptors in the skin to increase skin oxytocin level and to improve skin integrity.

THE EFFECTIVENESS OF GIVING NIGELLA SATIVA OIL TO SKIN INTERGITY DISORDERS IN ADOLESCENTS SUFFERS ACNE VULGARIS

Introduction: Changing cosmetics can cause acne vulgaris.&#x0D; Objective: The research objective was to analyze the effectiveness of Nigella Sativa oil administration on skin integrity problems in adolescents with acne vulgaris in Kedensari Village RT 17 RW 05 Tanggulangin Sidoarjo.&#x0D; Methods: This study used Quasi Experimental with a pre-posttest control group design approach. The study population was all adolescents with acne vulgaris who experienced skin integrity problems in Kedensari Village RT 17 RW 05 Tanggulangin Sidoarjo. The sample was selected using the simple random sampling technique of 28 adolescents who were then divided into two groups, namely the experimental group of 14 people and the control group of 14 people. The independent variable was the administration of Nigella Sativa oil, while the dependent variable was the degree of skin integrity disorders in adolescents with acne vulgaris. The research instrument was a skin condition observation sheet. Data analysis used the Wilcoxon test and the Mann Whitney test with a significance value of α = 0.05.&#x0D; Results: The results showed: 1) There were significant differences in skin integrity before and after intervention in the intervention group p =0,001,(0,001&lt;0,05) There were significant differences in skin integrity in the intervention group and the control group (p =0,000 &lt;0.005).&#x0D; Conclusions: Giving nigella sativa oil is effective in improving skin integrity problems in adolescent with acne vulgaris. It is hoped that the nurses can use nigella sativa oil in providing care for adolescents with acne vulgaris.&#x0D;

Skin assessment in adults.

The skin has often been described in fictional literature as the window to the soul. It is the largest organ in the body and integral to both physical and psychosocial health. A complete skin assessment is essential for holistic care and must be completed by nurses and other health professionals on a regular basis. Providing patients and relatives with information on good skin hygiene can improve skin integrity and reduce the risk of pressure damage and skin tears.

Skin tears: introducing best practice.

In an Essity-sponsored symposium, three key opinion leaders discussed the importance of developing, sharing and applying best practice in skin tear management. Camila Fronzo summarises the key points presented at the EWMA and Journées Cicatrisations conference 2021 This conference report offers an introduction to the symposium 'Skin integrity: introducing best practice in skin tears', held in October as part of the joint European Wound Management Association (EWMA) and Journées Cicatrisations virtual conference 2021. The first speaker, Karen Campbell, listed the individual and mediating factors that could affect skin tear development. She then summarised the three types of skin tears, and mentioned the dos and don'ts when treating these wounds. The next speaker, Wendy White, highlighted the importance of creating awareness, changing perceptions and implementing change around skin tear management. She shared the results on staff education from a recent quality improvement project, aimed at improving skin integrity and reducing skin tears in an aged care facility in Western Australia. The third and final speaker, Sitthichai Rees, presented further findings from the same project, focusing on the effects on skin tear incidence. His call to action can be followed by any health professional managing skin tears.

Secreted PEDF modulates fibroblast collagen synthesis through M1 macrophage polarization under expanded condition

Tissue expansion is widely used to obtain new skin tissue for repairing defects in the clinical practice of plastic surgery. One major complication can be dermal thinning during expansion, which usually leads to skin rupture. Collagen synthesis can determine dermal thickness and can be influenced by macrophage polarization during expansion. The aim of the study was to test whether pigment epithelium-derived factor (PEDF) could be a modulator of collagen synthesis in fibroblasts by regulating macrophage polarization during skin expansion. Our results showed that PEDF mRNA expression was increased in expanded human and mouse epidermis. PEDF protein levels were elevated in the subcutaneous exudates of a rat skin expansion model. Increased PEDF mRNA expression was accompanied by dermal thinning during a three-week expansion protocol. Subcutaneous injection of PEDF in vivo further resulted in dermal thinning and cell number increase of M1 macrophage in the expanded skin. PEDF also promoted macrophage polarization in vitro to the M1 subtype under hypoxic conditions. PEDF did not influence collagen gene expression in fibroblasts directly, but attenuated collagen synthesis in a macrophage-mediated manner. Additionally, blockage of PEDF receptors on macrophages with inhibitors rescued collagen synthesis in fibroblasts. Our research demonstrated PEDF elevation in expanded skin leads to dermal thinning through M1 macrophage-mediated collagen synthesis inhibition in fibroblasts. Our results could form a basis for the development of novel strategies to improve skin integrity in expanded skin by using PEDF.

Development of a protein replacement therapy for peeling skin syndrome

British Journal of DermatologyVolume 184, Issue 6 p. e197-e197 Plain Language SummaryFree Access Development of a protein replacement therapy for peeling skin syndrome First published: 06 June 2021 https://doi.org/10.1111/bjd.20101AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Abstract Linked article: Valentin et al. Br J Dermatol 2021; 184:1123–1131. Peeling skin syndrome type 1 is a severe form of congenital ichthyosis. Patients have severe itch and generalized peeling of the skin. Current therapeutic approaches are very unsatisfactory. The disease is the result of mutations (mistakes) in the CDSN gene, which cause a lack of the protein corneodesmosin (CDSN) in the skin. We wanted to develop the first steps towards a specific protein replacement therapy for CDSN deficiency. The aim is to improve the cell–cell connection in two layers of the epidermis (the granular and corneal layers). Human CDSN was produced in bacterial cells. A liposomal carrier system was developed to transport the CDSN to the outer membrane of the epidermal cells. The liposomal carrier system was checked for stability and toxicity. Also, the effect on epidermal cells and artificial skin models was investigated. The liposomes were found to be successfully present at the epidermal cell membranes. The CDSN-deficient skin models were treated with liposomal CDSN and demonstrated the presence of the replaced protein within the granular layer. Finally, the skin barrier test and microscopy showed improved skin integrity (skin that functioned better), if the skin models were treated with liposomal CDSN. We believe that this study presents helpful laboratory results to develop a protein replacement therapy for patients with peeling skin syndrome and other diseases where there is also a lack of CDSN. Volume184, Issue6June 2021Pages e197-e197 RelatedInformation

Topical emollient for preventing infection in preterm infants.

Breakdown of the developmentally immature epidermal barrier may permit entry for micro-organisms leading to invasive infection in preterm infants. Topical emollients may improve skin integrity and barrier function and thereby prevent invasive infection, a major cause of mortality and morbidity in preterm infants. To assess the effect of topical application of emollients (ointments, creams, or oils) on the risk of invasive infection and mortality in preterm infants. We searched CENTRAL via Cochrane Register of Studies (CRS) Web and MEDLINE via Ovid (updated 08 January 2021) and the reference lists of retrieved articles. Randomised or quasi-randomised controlled trials that assessed the effect of prophylactic application of topical emollient on the risk of invasive infection, mortality, other morbidity, and growth and development in preterm infants. We used the standard methods of Cochrane Neonatal. Two review authors separately evaluated trial quality, extracted data, and synthesised effect estimates using risk ratio (RR), risk difference (RD), and mean difference. We used the GRADE approach to assess the certainty of evidence for effects on mortality and invasive infection. We included 22 trials with a total of 5578 infant participants. The main potential sources of bias were lack of clarity on the methods used to generate random sequences and conceal allocation in half of the trials, and lack of masking of parents, caregivers, clinicians, and investigators in all of the trials. Eight trials (2086 infants) examined the effect of topical ointments or creams. Most participants were very preterm infants cared for in healthcare facilities in high-income countries. Meta-analyses suggested that topical ointments or creams may have little or no effect on invasive infection (RR 1.13, 95% confidence interval (CI) 0.97 to 1.31; low certainty evidence) or mortality (RR 0.94, 95% CI 0.82 to 1.08; low certainty evidence). Fifteen trials (3492 infants) assessed the effect of topical plant or vegetable oils. Most of these trials were undertaken in low- or middle-income countries and were based in healthcare facilities. One large (2249 infants) community-based trial occurred in a rural field practice in India. Meta-analyses suggested that topical oils may reduce invasive infection (RR 0.71, 95% CI 0.52 to 0.96; I² = 52%; low certainty evidence) but have little or no effect on mortality (RR 0.94, 95% CI 0.82 to 1.08, I² = 3%; low certainty evidence). One trial (316 infants) that compared petroleum-based ointment versus sunflower seed oil in very preterm infants in Bangladesh showed little or no effect on invasive infection (RR 0.91, 95% CI 0.57 to 1.46; low certainty evidence), but suggested that ointment may lower mortality slightly (RR 0.82, 95% CI 0.68 to 0.98; RD -0.12, 95% CI -0.23 to -0.01; number needed to treat for an additional beneficial outcome 8, 95% CI 4 to 100; low certainty evidence). One trial (64 infants) that assessed the effect of coconut oil versus mineral oil in preterm infants with birth weight 1500 g to 2000 g in India reported no episodes of invasive infection or death in either group (very low certainty evidence). The level of certainty about the effects of emollient therapy on invasive infection or death in preterm infants is low. Since these interventions are mostly inexpensive, readily accessible, and generally acceptable, further good-quality randomised controlled trials in healthcare facilities, and in community settings in low- or middle-income countries, may be justified.

Fludarabine modulates expression of type VII collagen during haematopoietic stem cell transplantation for recessive dystrophic epidermolysis bullosa.

Recessive dystrophic epidermolysis bullosa (RDEB) is a severe, complicated inherited blistering skin disease with few treatment options currently available. Recently, haematopoietic stem cell transplantation (HCT) has been used as an alternative therapy that can improve skin integrity, but it is not known if the preparative HCT regimen also contributes to the therapeutic response. To determine whether chemotherapy drugs used in the HCT preparative regimen influence type VII collagen (C7) expression, which is inherently reduced or absent in RDEB skin, and to explore the pathomechanisms of such responses, if present. Drugs from the HCT preparative regimen (busulfan, cyclophosphamide, ciclosporin A, fludarabine and mycophenolate) with inhibitors (PD98059, U0126, LY294002, SR11302, SIS3 and N-acetyl-l-cysteine) were added to normal human dermal and human RDEB fibroblasts. C7 expression was measured using reversetranscription polymerase chain reaction and immunoblotting. We uncovered a previously unknown consequence of fludarabine whereby dermal fibroblasts exposed to fludarabine upregulate C7. This effect is mediated, in part, through activation of the mitogen-activated protein kinase/extracellular signal-regulated kinase, phosphoinositide 3-kinase/protein kinase B and transforming growth factor-β pathways. Activation of these pathways leads to activation of downstream transcription factors, including activator protein 1 (AP-1) and SMAD. Subsequently, both AP-1 and SMAD bind the COL7A1 promoter and increase COL7A1 expression. Fludarabine influences the production of type VII collagen in RDEB fibroblasts.

Extremely low gestational age infants: Developing a multidisciplinary care bundle.

Clinical experience in managing extremely low gestational age infants, particularly those born <24 weeks' gestation, is limited in Canada. Our goal was to develop a bedside care bundle for infants born <26 weeks' gestation, with special considerations for infants of <24 weeks, to harmonize and improve quality of care. We created a multidisciplinary working group with experience in caring for preterm infants, searched the literature from 2000 to 2019 to identify best practices for the care of extremely preterm infants and consulted colleagues across Canada and internationally. Iterative improvements were made following the Plan-Do-Study-Act methodology. A care bundle, created in October 2015, was divided into three time periods: initial resuscitation/stabilization, the first 72 hours and days 4 to 7, with each period subdivided in 8 to 12 care themes. Revisions and practice changes were implemented to improve skin integrity, admission temperature, timing of initiation of feeds, reliability of transcutaneous CO2 monitoring and ventilation. Of 127 infants <26 weeks admitted between implementation and end of 2019, 78 survived to discharge (61%). It will be important to determine, with ongoing auditing and further evaluation, whether our care bundle led to improvements of short- and long-term outcomes in this population. Our experience may be useful to others caring for extremely low gestational age infants.

Reduced Incidence of Healthcare-associated Infections in a Long-term Care Facility by Converting to Automated Touchless Dispensing and Closed-refill Systems

Background Automated touchless dispensing and closed-refill systems minimize touch points that help prevent cross contamination events and reduce dispenser contamination with clinically significant pathogens in healthcare settings. Additionally, most consumers prefer touchless dispensing when using public restrooms. However, many healthcare settings still utilize manual dispensers for soap and sanitizer. Some even have open, bulk, refillable dispensing systems and manual pumps and dispensers. A finding of a clinical in-use study revealed a significant reduction in the incidence of healthcare associated infections (HAIs) following the conversion to automated touchless soap and sanitizer dispensing systems with premeasured dosage amounts in a long-term care (LTC) care facility. Methods A LTC facility was qualified as a testing site for clinical in-use study of hand hygiene (HH) products’ impact on healthcare workers’ (HCWs) hands. The facility replaced all HH manual dispensing systems and locally purchased hygiene products with automated touchless dispensers, closed-refill systems, and quality formulations. In addition to the biophysical measurements of HCWs hands using bioengineering instrumentation, the baseline incidence of HAIs was recorded prior to the intervention and surveillance continued from 2014 to 2018. HAI rates provided by the testing site were compared to the baseline data collected in 2014 with specific emphasis on the infection outbreak season from October to December in each year. Results Descriptive data analysis of HAI incidence rates revealed significant and sustained reduction in HAI rates from 6.7% in October through December of 2014 to 1.6 % the same period in 2015, 2.8 % in 2016 and 2.4 % in 2017. Conclusions Converting the HH framework from manual dispensing to automated touchless dispensing with closed refill systems during a clinical-in-use study resulted in a sustained reduction of HAI rates over a 3-year period. Increased awareness of HH, touchless hygienic dispensing systems, and HCW improved skin integrity are variables to consider for HAI reduction. Automated touchless dispensing and closed-refill systems minimize touch points that help prevent cross contamination events and reduce dispenser contamination with clinically significant pathogens in healthcare settings. Additionally, most consumers prefer touchless dispensing when using public restrooms. However, many healthcare settings still utilize manual dispensers for soap and sanitizer. Some even have open, bulk, refillable dispensing systems and manual pumps and dispensers. A finding of a clinical in-use study revealed a significant reduction in the incidence of healthcare associated infections (HAIs) following the conversion to automated touchless soap and sanitizer dispensing systems with premeasured dosage amounts in a long-term care (LTC) care facility. A LTC facility was qualified as a testing site for clinical in-use study of hand hygiene (HH) products’ impact on healthcare workers’ (HCWs) hands. The facility replaced all HH manual dispensing systems and locally purchased hygiene products with automated touchless dispensers, closed-refill systems, and quality formulations. In addition to the biophysical measurements of HCWs hands using bioengineering instrumentation, the baseline incidence of HAIs was recorded prior to the intervention and surveillance continued from 2014 to 2018. HAI rates provided by the testing site were compared to the baseline data collected in 2014 with specific emphasis on the infection outbreak season from October to December in each year. Descriptive data analysis of HAI incidence rates revealed significant and sustained reduction in HAI rates from 6.7% in October through December of 2014 to 1.6 % the same period in 2015, 2.8 % in 2016 and 2.4 % in 2017. Converting the HH framework from manual dispensing to automated touchless dispensing with closed refill systems during a clinical-in-use study resulted in a sustained reduction of HAI rates over a 3-year period. Increased awareness of HH, touchless hygienic dispensing systems, and HCW improved skin integrity are variables to consider for HAI reduction.

Correlation of disease comorbidity with prescribed treatment among insured U.S. lymphedema patients

ObjectiveThe objective of this study was to define the current forms of treatment in a contemporary population of lymphedema (LED) patients for LED related to breast cancer, the most prevalently diagnosed LED comorbidity in Western countries, and phlebolymphedema with venous leg ulcer (PLEDU), a sequela of chronic venous disease. The goals of LED therapy are to reduce edema, thereby improving function and related symptoms, and to improve skin integrity to prevent development of infection. Treatment is generally nonsurgical: conservative care, including complex physical therapy, manual lymphatic drainage, and compression bandaging; or pneumatic compression device (PCD) therapy by a simple nonprogrammable device or an advanced programmable device. MethodsTo determine the frequency of individual types of treatment for LED and their relationship to breast cancer-related lymphedema (BCRL) and PLEDU, we queried claims from a deidentified Health Insurance Portability and Accountability Act-compliant commercial administrative insurance database with >165 million members. A total of 26,902 patients identified with LED who had been enrolled with continuous medical benefits for 12 months before and after the index date for the complete years 2012 through 2016 were separated into four treatment categories: no treatment, conservative care, simple PCD (SPCD), and advanced PCD. LED treatment was related to the BCRL and PLEDU comorbidities. ResultsBCRL patients, who represented 32.1% of all study patients, made up 41% of all patients receiving conservative care and 24% of patients receiving PCD therapy. By contrast, PLEDU patients (9.6% of study patients) were proportionally under-represented in the conservative care group (7.8%) but composed a disproportionately high share of the PCD therapy group (17.7%). PLEDU patients represented 23.5% of all LED patients prescribed SPCD therapy, whereas BCRL patients composed 10.3% of total LED patient SPCD prescriptions (P < .001). ConclusionsOur analysis of a large health care administrative database showed clear differences between the way BCRL and PLEDU patients are treated. Compared with BCRL patients, PLEDU patients were less likely to receive conservative care and more likely to be prescribed SPCDs for pneumatic compression therapy. These differences suggest that lymphatic therapy may be undervalued for treatment of chronic venous swelling and prevention and treatment of PLEDU.

Development of a Nursing Guideline for Improving Skin Integrity in High-Risk Infants.

High-risk infants are highly susceptible to skin impairment caused by invasive procedures, radiant warmers, and phototherapy, in addition to their intrinsic vulnerability. This leads to a vicious cycle that aggravates the risk of skin infections. Concerns have been raised that neonatal nurses may lack knowledge regarding feasible guidelines to improve skin integrity of high-risk newborns. A clinical guideline was developed for neonatal skin care practices based on skin physiology, and its educational effects on the knowledge and confidence of neonatal nurses was evaluated. A booklet was developed on skin care practice guidelines divided into topics determined through a nationwide survey. Using a quasi-experimental design with 46 neonatal nurses, education with this booklet improved nurses' knowledge of skin care practices but not their confidence. These findings highlight the importance of implementing a tailored systematic program rather than a single educational session on skin care in high-risk infants for neonatal nurses. [J Contin Educ Nurs. 2020;51(5):238-244.].