Patients In Health Care Settings Research Articles

Emerging trends of invasive yeast infections and azole resistance in Beijing intensive care units

Invasive fungal infections pose a substantial threat to patients in healthcare settings globally. Recent changes in the prevalence of fungal species and challenges in conducting reference antifungal susceptibility testing emphasize the importance of monitoring fungi and their antifungal resistance. A two-phase surveillance project was conducted in Beijing, China, involving 37 centers across 12 districts, from January 2012 to December 2013 and from January 2016 to December 2017. We found that the proportion of Candida albicans in intensive care units (ICUs) during 2016–2017 exhibited a significant decline compared to the 2012–2013 period, although it remained the most predominant pathogen. In contrast, the prevalence of Nakaseomyces glabratus (formerly Candida glabrata) and Candida tropicalis notably increased during the two-phase surveillance. The high prevalence of C. tropicalis and its resistance to azole drugs posed a serious threat to patients in ICUs. The pathogens causing invasive fungal infections in Beijing were relatively sensitive to echinocandins. While C. albicans continued to exhibit susceptibility to azoles, the resistance and growth rates of C. tropicalis towards azoles were particularly prominent. Concerns were raised due to the emergence of multiple, short-term isolates of Clavispora lusitaniae and Candida parapsilosis complex in neonatal ICUs, given their similarity in antifungal susceptibilities. Such occurrences point towards the potential for transmission and persisting presence of these pathogens within the ICU environment. Our study complements existing data on the epidemiology of invasive fungal infections. It is imperative to exercise cautious medication management for ICU patients in Beijing, paying particular attention to azole resistance in C. tropicalis.

Unfinished nursing care in healthcare settings during the COVID-19 pandemic: a systematic review

BackgroundUnfinished nursing care is becoming increasingly more of a concern in worldwide healthcare settings. Given their negative outcomes, it is crucial to continuously assess those nursing interventions that are commonly postponed or missed, as well as the underlying reasons and consequences. The worldwide COVID-19 pandemic has made it difficult for health facilities to maintain their sustainability and continuity of care, which has also influenced the unfinished nursing care phenomenon. However, no summary of the studies conducted during the COVID-19 pandemic was produced up to now. The main aim of this study was to systematically review the occurrence of, reasons for, and consequences of unfinished nursing care among patients in healthcare settings during the COVID-19 pandemic.MethodsSystematic review registered in PROSPERO (CRD42023422871). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guideline and the Joanna Briggs Institute Critical Appraisal tool for cross-sectional studies were used. MEDLINE-PubMed, the Cumulative Index to Nursing and Allied Health Literature, and Scopus were searched from March 2020 up to May 2023, using keywords established in the field as missed care, unfinished nursing care, or implicit rationing.ResultsTwenty-five studies conducted mainly in European and Asiatic countries were included and assessed as possessing good methodological quality. The following tools were used: the MISSCARE Survey (= 14); the Basel Extent of Rationing of Nursing Care (= 1), also in its revised form (= 2) and regarding nursing homes (= 2); the Perceived Implicit Rationing of Nursing Care (= 4); the Intensive Care Unit-Omitted Nursing Care (= 1); and the Unfinished Nursing Care Survey (= 1). The order of unfinished nursing care interventions that emerged across studies for some countries is substantially in line with pre-pandemic data (e.g., oral care, ambulation). However, some interesting variations emerged at the country and inter-country levels. Conversely, labour resources and reasons close to the emotional state and well-being of nurses were mentioned homogeneously as most affecting unfinished nursing care during the pandemic. None of the studies investigated the consequences of unfinished nursing care.ConclusionsTwo continents led the research in this field during the pandemic: Europe, where this research was already well established, and Asia, where this research is substantially new. While unfinished care occurrence seems to be based on pre-established patterns across Europe (e.g., regarding fundamentals needs), new patterns emerged across Asiatic countries. Among the reasons, homogeneity in the findings emerged all in line with those documented in the pre-pandemic era.

Quality of examination gloves in health facilities in Addis Ababa, Ethiopia

Background: Examination gloves are used in health facilities to protect health professionals and patients from the risk of infection and reduce opportunities for cross-transmission of infectious microorganisms. Poor-quality examination gloves can expose health professionals to infectious diseases such as Covid-19, Hepatitis, HIV/AIDS, and other contagious diseases. Hence, this study aimed to assess the quality of examination gloves in health facilities in Addis Ababa.
 Methods: A cross-sectional study design was employed. The examination gloves were collected from randomly selected health facilities in Addis Ababa. The gloves were examined following standard procedure in the Ethiopian Food and Drug Authority. Holes in the examination gloves were detected using the watertight (leakage test) and geometrical dimensions such as thickness, width, and length were measured.
 Results: A total of 2500 selected examination gloves were collected between Feb 10 and Feb 20, 2021. The gloves were sampled from health facilities in Addis Ababa. From the total samples collected, only 2280 examination gloves of five different brands were tested, which makes the response rate 91.2%. The proportion of gloves with holes detected ranged from 5.7% to 21.9%. Overall, only 0.17% and 3.2% of the gloves had width and length below standard, respectively. None of the gloves tested in this study had a thickness below the standard.
 Conclusions: All brands of examination gloves tested had a higher hole (leakage) rate than the acceptable quality limit. This implies there is a substantial risk of infectious disease transmission to health professionals and patients in healthcare settings. Hence, regulatory enforcements need to be strengthened across the life cycle of the product.

Candida auris in US Correctional Facilities.

Candida auris is an emerging fungal pathogen that typically affects patients in healthcare settings. Data on C. auris cases in correctional facilities are limited but are needed to guide public health recommendations. We describe cases and challenges of providing care for 13 patients who were transferred to correctional facilities during January 2020-December 2022 after having a positive C. auris specimen. All patients had positive specimens identified while receiving inpatient care at healthcare facilities in geographic areas with high C. auris prevalence. Correctional facilities reported challenges managing patients and implementing prevention measures; those challenges varied by whether patients were housed in prison medical units or general population units. Although rarely reported, C. auris cases in persons who are incarcerated may occur, particularly in persons with known risk factors. Measures to manage cases and prevent C. auris spread in correctional facilities should address setting-specific challenges in healthcare and nonhealthcare correctional environments.

Understanding Multilevel Factors Related to Retention Among the Direct Care Workforce: Incorporating Lessons Learned in Considering Innovative Interventions.

This article explores how broad, contextual factors may be influential in the retention of direct care workers (DCWs; i.e., entry-level caregivers) who provide vital support to patients in healthcare settings. We reflect on lessons learned from an evaluation of a multisite intervention to improve retention among DCWs employed primarily in hospital settings at three health systems. We evaluated a multitiered program for entry-level caregivers that included a risk assessment, a 4-day curriculum, and follow-up sessions, as well as workforce coaching at the three health systems. As part of our evaluation, we collected data on roughly 3,000 DCWs from the three health systems; the information included hiring date, any transfer date, and any termination date for each new DCW, as well as demographic information, position characteristics, and termination status and reasons for any termination. In addition, we collected information about organizational characteristics, including staffing and number of employees. We also conducted interviews with 56 DCWs and 21 staff members who implemented a retention program across each of the three health systems and remotely conducted virtual observations of the curriculum sessions at each system. Although the program we evaluated focused on individual-level factors that may affect retention, our findings revealed other broader, contextual challenges faced by DCWs that they said would have an impact on their willingness to stay in their positions. These challenges included (1) job-related factors including limited compensation, aspects of the job itself, and the inability to advance in one's position; (2) health system challenges including the mission, policies, staffing, and organizational culture; and (3) external factors including federal policies and the ongoing COVID-19 pandemic. As the direct care workforce continues to grow, interventions to improve retention should consider the interconnectedness of these multilevel factors rather than solely individual-level factors. In addition, further research is needed to rigorously evaluate any potential intervention and consider how such an approach can target DCWs in hospital-based settings who are most affected by the multilevel challenges identified. Finally, any intervention to improve retention must be also aligned to ensure equity, especially in this population of low-wage DCWs, many of whom are marginalized women and individuals of color.

Barriers Contributing to Loss to Follow-up among HIV-patients in Limpopo Province, South Africa: Patients’ and Nurses’ Perspectives

Background: Antiretroviral therapy is a lifelong commitment that requires patients to adhere to their daily medication dose schedules and make frequent visits to health services for their care. People living with HIV can live healthy long lives when retained on antiretroviral therapy. Retention in care has been identified as the benchmark in the HIV Care Continuum, where most people living with HIV fail. Interventions are urgently needed to address this benchmark to achieve the worldwide 95-95-95 goals. Despite the South African government`s efforts to expand access to antiretroviral therapy services from urban centers to resource-constrained rural communities, there were 140,000 HIV- related deaths in 2014 and 85,796 HIV- related deaths in 2021. Patients have become lost to follow-up, putting their health and that of their communities at risk. Moreover, the loss of follow-up care among HIV-positive people who are on antiretroviral treatment continues to be a significant problem. The study determined barriers contributing to the Loss of follow-up rates among people living with HIV. Methods: A qualitative research study was conducted; Non-probability purposive sampling was used to select eight nurses from clinics with the highest and lowest loss-to-follow-up rates. The probability systematic sampling method was used to select patients from the selected clinics. Data were collected through semi-structured interviews, and content analysis was used to analyse the data. Results: Patients’ and nurses’ perspectives on barriers contributing to the loss of follow-up among people living with HIV included lack of confidentiality, lack of understanding of antiretroviral treatment, patients’ self-transfer, and feeling better physically. Conclusion: Understanding the reasons for the Loss of follow-up could inform the development of retention in care interventions for Limpopo province. The study can be most beneficial with HIV education, skills building, and outreach programme strategies; this will, in turn, increase the knowledge needed to better attract and retain HIV-positive patients in healthcare settings.

Core competencies in critical care for general medical practitioners in South Africa: A Delphi study.

Despite a high burden of disease that requires critical care services, there are a limited number of intensivists in South Africa (SA). Medical practitioners at district and regional public sector hospitals frequently manage critically ill patients in the absence of intensivists, despite these medical practitioners having had minimal exposure to critical care during their undergraduate training. To identify core competencies in critical care for medical practitioners who provide critical care services at public sector hospitals in SA where intensivists are not available to direct patient management. A preliminary list of core competencies in critical care was compiled. Thereafter, 13 national and international experts were requested to achieve consensus on a final list of core competencies that are required for critical care by medical practitioners, using a modified Delphi process. A final list of 153 core competencies in critical care was identified. The core competencies identified by this study could assist in developing training programmes for medical practitioners to improve the quality of critical care services provided at district and regional hospitals in SA. The study provides consensus on a list of core competencies in critical care that non-intensivist medical practitioners managing critically ill patients in healthcare settings in South Africa, especially where intensivists are not readily available, should have. The list can form the core content of training programmes aimed at improving critical care competence of general medical practitioners, and in this way hopefully improve the overall outcomes of critically ill patients in South Africa.

Healthy Workplaces for Nurses: A Review of Lateral Violence and Evidence-Based Interventions

Most nurses in the United States have experienced workplace bullying, also referred to as lateral violence. Workplace bullying is serious within professional nursing practice. These behaviors are often associated with detrimental consequences for nurses, their patients, and the greater health care organization. We performed a literature review to summarize recent studies on this pervasive yet persistent problem as well as evidence-based solutions. In environments where managers, supervisors, and administrators are unable or unwilling to address lateral violence, a common pattern is that offenders continue to target new employees and cause turmoil for workers and patients in healthcare settings. This work environment also causes harm and endangers patients. Although workplace bullying cannot be fixed with just one solution, there are different initiatives healthcare settings and educational institutions can implement to help prevent and eliminate workplace bullying, such as improving leadership training and interprofessional communication. Once these initiatives are put into practice, healthcare practices can start saving money, increasing employee satisfaction, retaining workers, and providing better healthcare services for their patients.

Low Rate of Bacterial Coinfections and Antibiotic Overprescribing During COVID-19 Pandemic: A Retrospective Study from Oman.

The recommended treatment for COVID-19 includes antiviral drugs, corticosteroids, immunomodulatory drugs, low molecular weight heparin, as well as antibiotics. Although COVID-19 is a viral disease, many studies indicate that antibiotics are prescribed frequently, mainly to treat suspected bacterial coinfection. At the same time, the prevalence of bacterial coinfections during COVID-19 is rather low indicating the significant antibiotic overuse in these patients. It is well known that this can trigger antibiotic bacterial resistance, and once it emerges the reversal of resistance is a complex and long-lasting process. The aims of this study were to estimate the prevalence of bacterial coinfections during the COVID-19 and to analyze the antibiotic treatment justification during this pandemic in Oman. This retrospective analysis was conducted using the Royal Hospital COVID-19 Registry Database. The study analyzed demographic and clinical characteristics, as well as laboratory parameters and antibiotic treatment of hospitalized patients. During the study period, 584 patients were enrolled in the analysis. Coinfection was rare as it was confirmed in 0.9% of patients. Superinfections were present in 15.2% of patients. Gram-negative bacteria were isolated in 95 (69.9%) samples, gram-positive bacteria in 25 (18.4%) samples, while Candida spp. was found in 16 (11.8%) samples. On admission, empirical antibiotic treatment was started in 543 (93.0%) patients. During COVID-19, coinfections are rarely seen and the overuse of antibiotics is not justified. The incidence of superinfections is the same as in other patients in healthcare settings caused by the same resistant microorganisms, which implies the use of even more.

Evolución de las opiniones estudiantiles sobre el ciberaprendizaje en la carrera de obstetricia

IntroductionDuring the COVID-19 lockdown, educational institutions implemented online learning, revealing that some university teachers and students were not prepared for this transition. Additionally, students were unable to attend clinical preceptorship in healthcare settings. The objective of this study was to analyze the evolution of agreement-disagreement levels among obstetrics students with virtual learning and identify variables that can predict changes in opinion. MethodA predictive longitudinal study was conducted using a Likert-adapted and validated survey administered to students at the beginning and end of the lockdown. Bayesian statistical analysis was performed using ordinal regression model analogs due to their advantages over frequentist methods. ResultsOpinions evolved from disagreement at the beginning to neutral opinions in half of the survey items at the end. It can be predicted that students will disagree with online learning when they are in their final semesters. ConclusionsAgreement with teleeducation improved due to its association with multiple advantages and the computer skills acquired during this period, especially among students. However, students in their final semesters expressed disagreement with online learning, which can be attributed to the lack of clinical preceptorship with patients in healthcare settings. Digital competencies must be improved among students and teachers to take advantage of the benefits offered by online learning.

Professional Boundaries in The Relationship Between Nurses and Patients in Healthcare Settings: A Scoping Review

Professional Boundaries in The Relationship Between Nurses and Patients in Healthcare Settings: A Scoping Review

Decolonization of hospital patients may aid efforts to reduce transmission of carbapenem-resistant Enterobacterales

Background: Multimodal approaches are often used to prevent transmission of antimicrobial-resistant pathogens among patients in healthcare settings; understanding the effect of individual interventions is challenging. We designed a model to compare the effectiveness of hand hygiene (HH) with or without decolonization in reducing patient colonization with carbapenem-resistant Enterobacterales (CRE). Methods: We developed an agent-based model to represent transmission of CRE in an acute-care hospital comprising 3 general wards and 2 ICUs, each with 20 single-occupancy rooms, located in a community of 85,000 people. The model accounted for the movement of healthcare personnel (HCP), including their visits to patients. CRE dynamics were modeled using a susceptible–infectious–susceptible framework with transmission occurring via HCP–patient contacts. The mean time to clearance of CRE colonization without intervention was 387 days (Zimmerman et al, 2013). Our baseline included a facility-level HH compliance of 30%, with an assumed efficacy of 50%. Contact precautions were employed for patients with CRE-positive cultures with assumed adherence and efficacy of 80% and 50%, respectively. Intervention scenarios included decolonization of culture-positive CRE patients, with a mean time to decolonization of 3 days. We considered 2 hypothetical intervention scenarios: (A) decolonization of patients with the baseline HH compliance and (B) decolonization with a slightly improved HH compliance of 35%. The hospital-level CRE incidence rate was used to compare the results from these intervention scenarios. Results: CRE incidence rates were lower in intervention scenarios than the baseline scenario (Fig. 1). The baseline mean incidence rate was 29.1 per 10,000 patient days. For decolonization with the baseline HH, the mean incidence rate decreased to 14.5 per 10,000 patient days, which is a 50.2% decrease relative to the baseline incidence (Table 1). The decolonization scenario with a slightly improved HH compliance of 35% produced a relative reduction of 71.9% relative to the baseline incidence. Conclusions: Our analysis shows that decolonization, combined with modest improvement in HH compliance, could lead to large decreases in pathogen transmission. In turn, this model implies that efforts to identify and improve decolonization strategies for better patient safety in health care may be needed and are worth exploring.Disclosures: None

Detection of multidrug-resistant pathogens as a risk for patients in healthcare settings

Purpose of review Healthcare-acquired Infections and antimicrobial resistance are major challenges for both healthcare management and patient safety. Every year, resistant microorganisms seem to outperform our ability to develop new interventions to counteract this escalation. This review, focusing mainly on bacteria, aims to provide an update on the recent advances in diagnostics and on the strategies to manage healthcare-acquired infections. Recent findings Both phenotypic and molecular methods are profitably growing in recent years. In addition to these classical techniques, new methodologies are continuously developed with more focus on other methods like the use of nanotechnologies, the implementation of computational analysis, and the machine-learning approach. An increasing effort is also given to developing alternatives to antibiotics such as phage therapy and the use of probiotics or other antagonizing microorganisms. Summary Unfortunately, even if new methods are developed each year, on the surveillance and infection prevention side of the problem, the main approach is still based on observational and descriptive studies. A shift in how we implement infection control measures by using modern diagnostic tools and novel typing approaches is essential in resolving the problem.

Standard precautions should include 'safe ventilation' to minimise far-afield airborne transmission in health and social care settings.

Standard precautions should include 'safe ventilation' to minimise far-afield airborne transmission in health and social care settings.

Patient Safety: A Systematic Review of the Literature with Evidence based Measures to Improve Patient Safety in Healthcare Settings

Patient safety is a crucial component of healthcare delivery aimed at minimizing and preventing medical errors that can cause harm or injury to patients. This systematic review identified 50 studies that evaluated interventions aimed at improving patient safety in healthcare settings, including medication reconciliation, surgical safety checklists, hand hygiene programs, and electronic health record systems. The findings suggest that most interventions led to significant improvements in patient safety outcomes, including a reduction in adverse events and preventable harm. Evidence-based measures to improve patient safety include effective communication, hand hygiene, medication safety, patient identification, fall prevention, surgical safety, infection control, and staff training. The implementation of these measures can help improve patient safety and reduce the risk of harm to patients in healthcare settings. Further research is needed to identify the most effective interventions and to evaluate the long-term impact of these interventions on patient outcomes. Keywords: Adverse events, Interventions, Medical errors, Patient safety, Preventable harm.

Medical attitudes towards transgender patients

Those identifying as transgender make up a significant and growing number of individuals. They face discrimination in healthcare and have been known to have adverse physical and mental health outcomes because of stigma. A study was carried out to ascertain how doctors perceive and interact with their transgender patients. The attitudes of doctors, working in mental and physical healthcare settings in a borough in south-east England, towards transgender patients were evaluated by administering a standardised questionnaire. The response rate was 22%. Most doctors who responded had encountered a transgender patient, but consultants were more likely to identify and interact with them comfortably, used their preferred pronouns, and knew about policies relating to their care than trainee doctors. These findings add to the growing data regarding the perceptions about transgender patients in healthcare settings.

A randomised controlled trial investigating the effect of improving the cleaning and disinfection of shared medical equipment on healthcare-associated infections: the CLEaning and Enhanced disiNfection (CLEEN) study

BackgroundHealthcare-associated infections (HAIs) are a common, costly, yet largely preventable complication impacting patients in healthcare settings globally. Improving routine cleaning and disinfection of the hospital environment has been shown to reduce the risk of HAI. Contaminated shared medical equipment presents a primary transmission route for infectious pathogens, yet is rarely studied. The CLEEN study will assess how enhanced cleaning and disinfection of shared medical equipment affects the rate of HAIs in a tertiary hospital setting. The initiative is an evidence-based approach combining staff training, auditing and feedback to environmental services staff to enhance cleaning and disinfection practices.MethodsThe CLEEN study will use a stepped wedge randomised controlled design in 10 wards of one large Australian hospital over 36 weeks. The intervention will consist of 3 additional hours per weekday for the dedicated cleaning and disinfection of shared medical equipment on each ward. The primary outcome is to demonstrate the effectiveness of improving the quality and frequency of cleaning shared medical equipment in reducing HAIs, as measured by a HAI point prevalence study (PPS). The secondary outcomes include the thoroughness of equipment cleaning assessed using fluorescent marker technology and the cost-effectiveness of the intervention.DiscussionEvidence from the CLEEN study will contribute to future policy and practice guidelines about the cleaning and disinfection of shared medical equipment. It will be used by healthcare leaders and clinicians to inform decision-making and implementation of best-practice infection prevention strategies to reduce HAIs in healthcare facilities.Trial registrationAustralia New Zealand Clinical Trial Registry ACTRN12622001143718.

Global escalation in carbapenem-resistant Enterobacterales and carbapenem-resistant Acinetobacter baumannii infections: Serious threat to human health from the pink corner

Rise in carbapenem-resistant Gram-negative bacterial infections, especially among immunocompromised patients in healthcare settings is an imminent threat as they are difficult to treat and result in a prolonged length of hospital stay, frequent treatment failures, increased economic burden on the patient and the nation, and a high rate of morbidity and mortality. Major carbapenemase-producing Gram-negative bacteria are carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Enterobacterales (CRE) such as Escherichia coli, Klebsiella pneumoniae, Enterobacter spp., and others. These bacteria that contaminate health-care settings are the major causes of a wide range of hospital-associated infections including life-threatening septicemia, pneumonia, meningitis, bones and joint infections, and skin and soft-tissue infections. Carbapenems are regarded as last resort available antibiotics to treat multidrug-resistant Gram-negative bacterial infections that show resistance to most of the beta-lactam antibiotics in addition to fluoroquinolones, aminoglycosides, and trimethoprim-sulfamethoxazole. Emergence and spread of carbapenem-resistant Gram-negative pathogens such as CRE and CRAB is a matter of serious concern because of limited treatment options and grave consequences. The World Health Organization has given level one priority to these pathogens and the United States Centers of Disease Control and Prevention considers CRE and CRAB as one of the top five most priority pathogens of public health importance. Strict control measures by the government and public is critical to prevent emergence and dissemination of these dangerous pathogens. In this article, the authors have summarized the microbiological and epidemiological perspectives of CRE and CRAB with a special focus on diagnosis, prevention, and novel promising alternative treatment strategies.

Factors associated with complications from COVID-19 in hospital workers: A retrospective cohort study.

SARS-CoV-2 infection in healthcare professionals represents a threat to the healthcare system. To identify factors associated with complications from COVID-19 in healthcare workers infected by SARS-CoV-2, in a specialized national hospital level III in Peru in 2020. This is a retrospective cohort study. Health personnel who were working at Instituto Nacional Materno Perinatal of Peru participated. The clinical and epidemiological characteristics and results of the Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) test were collected from the medical records and epidemiological files. Simple and multiple regression models were used to estimate the risk factors of complications due to COVID-19. We found 1048 suspected cases, and 26.2% had a confirmed SARS-CoV-2 infection. Of those infected, 20.8% had comorbidity, and 55% reported contact with COVID-19 patients in health care settings. Moreover, 27.4% of infected workers were administrative personnel, 24.1% were nursing technicians, 18.3% were nurses, and 13.1% were physicians. We also found that 24.1% presented complications from COVID-19, and three workers died. In a multiple regression, the risk factors for complications due to COVID-19 were the presence of comorbidity (risk ratio: 2.94; 95% confidence interval: 1.95 to 4.42), 30 years or older (1.28; 0.6 to 2.75), 60 years or older (2.04; 0.88 to 4.74), male sex (1.1; 0.71 to 1.7) and care work area (1.02; 0.06 to 2.62). The findings in the present study show an association between the presence of comorbidities and an increased risk of presenting complications due to COVID-19 in healthcare workers, regardless of age, sex and area of work.

The Science of Skin: Measuring Damage and Assessing Risk.

Significance: Healthy skin provides a barrier to contaminants. Breaches in skin integrity are often encountered in the patient health care journey, owing to intrinsic health issues or to various procedures and medical devices used. The time has come to move clinical practice beyond mere awareness of medical adhesive-related skin injury and toward improved care and outcomes. Recent Advances: Methods developed in research settings allow quantitative assessments of skin damage based on the measurement of baseline skin properties. These properties become altered by stress and over time. Assessment methods typically used by the cosmetic industry to compare product performance could offer new possibilities to improve clinical practice by providing better information on the status of patient skin. This review summarizes available skin assessment methods as well as specific patient risks for skin damage. Critical Issues: Patients in health care settings may be at risk for skin damage owing to predisposing medical conditions, health status, medications taken, and procedures or devices used in their treatment. Skin injuries come as an additional burden to these medical circumstances and could be prevented. Technology should be leveraged to improve care, help maintain patient skin health, and better characterize functional wound closure. Future Directions: Skin testing methods developed to evaluate cosmetic products or assess damage caused by occupational exposure can provide detailed, quantitative information on the integrity of skin. Such methods have the potential to guide prevention and treatment efforts to improve the care of patients suffering from skin integrity issues while in the health care system.