Peristomal Moisture-associated Skin Damage Research Articles

The Effectiveness of Development mHealth Apps on the Self-Care Ability of Patients with Ostomy.

Intestinal cancer, severe injury, and severe inflammation are most often treated with surgery, and an ostomy will be left in place after surgery[1]. An ostomy is a portion of the intestine that is surgically removed and pulled up to the abdominal wall, creating a temporary or permanent opening that serves as a pathway for intestinal waste to be discharged from the body, usually called a stoma. Stoma may be temporary (2 months to 6 months) or permanent. The goal for people with a stoma is to have the knowledge and ability to care for an ostomy to avoid peristomal moisture-associated skin damage. After patients return home, self-care knowledge and skills can help them adapt to the disease and maintain quality of life. Therefore, this study examined the effects of developing mobile Health applications on improving self-care knowledge and skills in patients who underwent ostomy surgery.

Treatment of chronic peristomal moisture associated skin damage with a combination of hyaluronic acid and silver sulfadiazine

Treatment of chronic peristomal moisture associated skin damage with a combination of hyaluronic acid and silver sulfadiazine

Peristomal Moisture-Associated Skin Damage Treatment: Use of Cyanoacrylate Liquid Skin Protectant: A Case Series.

Despite recent advances in ostomy care, the incidence of stoma and peristomal skin complications including peristomal moisture-associated skin damage (MASD) remains as high as 80% of patients living with ostomies. We evaluated a cyanoacrylate liquid skin protectant (CLSP) for the treatment and healing of peristomal MASD in patients with an ileostomy, ileal conduit, or colostomy. Five patients (24-85 years old) with peristomal MASD related to an ileostomy (n = 2), ileal conduit (n = 2), or colostomy (n = 1) were evaluated in this case study. All were treated with a CLSP in an attempt to reduce peristomal MASD caused by effluent leakage, which resulted in painful denudation of the peristomal skin. All patients received 1 to 2 applications of the CLSP prior to replacement of the pouching system. Prior to CLSP application, patients underwent assessment focusing on the causes of ostomy pouching system undermining and leakage. Interventions to prevent recurrent undermining and leakage, usually focused on modifications of the pouching system, were completed when indicated. For these 5 patients, complete resolution of peristomal MASD was observed at 2 to 8 days following CLSP treatment. More severe peristomal MASD cases required 7 to 8 days for complete resolution while less severe peristomal MASD resolved within 2 to 3 days. Patients showed less frequent pouching system changes, healing of peristomal skin, and reduced peristomal MASD associated with the CLSP treatment and addressing underlying etiology. On a pain scale of 0 to 10, patients reported less pain with an average of more than 7 out of 10 prior to the CLSP treatment and less than 4 out of 10 after treatment.

Construction and validation of the perioral moisture-related skin damage (PMASD) risk prediction model in patients with colorectal cancer.

This study aims to analyse the risk factors of Peristomal Moisture-Associated Skin Damage (PMASD) in colorectal cancer patients, construct a prediction model, and verify its effect. A total of 375 patients who underwent rectal cancer stoma surgery at the Liaoning Cancer Hospital between January and December 2020 were selected according to the inclusion and exclusion criteria. The clinical data were retrospectively analysed for modelling and internal validation (modelling group). According to the same criteria, the clinical data of 242 patients from January and June 2021 were retrospectively analysed for external validation (validation group). Baseline patient data were recorded. Patients in the modelling group were divided into those with and without PMASD based on the occurrence of PMASD during hospitalisation. Logistic regression analysis was used to examine the factors of PMASD and the PMASD nomogram model of colorectal cancer. Internal model validation was performed with the Bootstrap method, using the ROC and H-L goodness of fit test to evaluate the differentiation and calibration of the model. Last, external validation of the model was performed. In the modelling group, 212 patients with colorectal cancer developed PMASD. According to the results of the logistic regression analysis, high fasting plasma glucose and fasting blood glucose (FPG), a history of radiotherapy, the height of the stoma opening (i.e., flat or lower than the skin surface), and skin folds around the stoma are risk factors for PMASD (OR > 1, P < 0.05). The stool shaping and colostomy are protective factors for PMASD in patients with colorectal cancer (OR < 1, P < 0.05). To establish the prediction of colorectal cancer, patient development of PMASD line, graph model, and internal verification was carried out using the Bootstrap method: H-L test P=0.846, area under curve, area under the ROC curve (0 > 0.75, 95% CI: 0.778-0, AUC=0.820). The external validation included the H-L test (P=0.137, AUC [0.862] > 0.75, 95% CI: 0.815-0.909), with the maximum value of the Youden index as the best cut-off value for the model. The ROC curve had a Youden index of 0.559, a sensitivity of 0.877, and a specificity of 0.657. The prompt model area showed good calibration and discrimination. The PMASD in patients with colorectal cancer is affected by defecation traits, the stoma opening height, stoma type, FPG, skin folds around the stoma, and previous radiotherapy history. The nomogram model can provide an effective means to reasonably predict the risk of PMASD in patients with colorectal cancer.

The Use of a Stoma Rod/Bridge to Prevent Retraction: A Systematic Review.

We evaluated evidence related to the use of a rod (bridge) to prevent stoma retraction during loop ostomy construction. We completed a systematic review of the literature. We searched MEDLINE, EMBASE, and COCHRANE databases up to December 4, 2019. We posed the following question based on a PICO format. Do adult patients undergoing ostomy surgery experience less stomal retraction when compared to patients managed without placement of a stoma rod? Our initial search returned 182 articles; after reading studies in full, 5 articles were identified that collectively enrolled 1058 participants. Four studies were randomized controlled trials and one was a prospective cohort study. Meta-analysis could not be performed because of the small number of studies and the heterogeneity of outcomes measurements. The incidence of stoma retraction ranged between 0%-8% in patients managed with a rod and 0.78%-8.2% in patients with no rod. The number of reported adverse events was low. Placement of a stoma rod was associated with more adverse outcomes than in patients managed without a rod. Adverse events included local edema, stoma necrosis, skin necrosis, peristomal moisture-associated skin damage (irritant dermatitis), peristomal abscess, bleeding, and mucocutaneous separation. Stoma rod does not seem to reduce the risk of stoma retraction and might result in other adverse events. We recommend avoidance of stoma rod/bridge placement during ostomy surgery.

Validation and Clinical Experience With a Turkish Language Version of the Pittman Ostomy Complication and Severity Index.

The purpose of this study was to evaluate the content validity and interrater reliability of a Turkish language version of the Pittman Ostomy Complication and Severity Index (OCSI). Psychometric evaluation of instrument. The sample comprised 90 individuals living with an ostomy for 2 to 6 months. Their mean age was 59.48 years (SD 13.292); 52.2% were female. Almost two-thirds (73.3%, n = 66) had experienced at least 1 ostomy complication. The study was conducted in the Wound and Stoma Therapy Unit of the Dokuz Eylül University Hospital General Surgery Clinic and Polyclinic in Izmir, Turkey. A Turkish language version of the OCSI was created using a translation, back-translation technique. The instrument's content validity was analyzed by 26 experts. Interrater reliability test was evaluated using Cohen's κ and intraclass correlation coefficients. Data were collected between January 15, 2017 and July 30, 2017 through face-to-face interviews conducted in our Wound and Stoma Therapy Unit. The overall content validity index was 0.95. Cohen's κ coefficient varied from 0.70 and 1.0 for all items. The Pearson correlation coefficient and intraclass correlation coefficient were 0.982 (P = .000) and 0.986 (P = .000), respectively, indicating good internal consistency. The most prevalent complications were leakage (41.1%), peristomal moisture-associated skin damage (42.2%), and stomal retraction (27.7%). Findings indicate that the Turkish language version of the Pittman OCSI is a reliable and valid instrument for assessment of presence and severity of early postoperative complications in individuals with an ostomy. We found the instrument parsimonious, easy-to-use, and clinically practical. It can be used to determine appropriate interventions to prevent or treat complications and evaluate the effects of nursing interventions designed to improve outcomes for patients with ostomies.

Clinical governance for ostomates at risk of peristomal skin complications.

This clinical study focuses on peristomal skin complications (PSCs). For many patients, the causative factor behind peristomal moisture-associated skin damage was contact dermatitis caused by effluent leakage, resulting in sore and excoriated skin. PSCs are costly to the patient in relation to pain, time and worry and also impact nursing activity levels and healthcare costs. The study identifies the number of patients presenting with PSC, the causative factors and their resolution using medical grade Manuka honey flanges.

Effect of Ostomy Care Team Intervention on Patients With Ileal Conduit.

The purpose of this study was to investigate the effect of a nurse-led multicomponent intervention on ostomy-related complications, self-efficacy, and health-related quality of life in patients with an ileal conduit. Randomized controlled trial. Forty-six patients who underwent radical cystectomy and creation of an ileal conduit participated in the trial; data were collected over a 6-month period. The study setting was Shanghai Pudong Hospital, affiliated with Fudan University, located in Shanghai, China. Participants were randomly allocated to an experimental or control group. Participants in the control group received routine care over a 6-month period following ostomy surgery, while those in the experimental group received a nurse-led, multicomponent, structured intervention delivered by an ostomy care team. The Chinese language versions of the Stoma Self-Efficacy Scale (SSES) and the City of Hope Quality of Life-Ostomy (COHQOL-O) questionnaire were used to assess self-efficacy in stoma care and health-related quality of life. Ostomy-related complications including peristomal moisture-associated skin damage and uric acid crystal deposits in the peristomal area were also assessed. Fisher's exact test was used to compare the incidence of ostomy-related complications between the 2 groups. Independent-samples t tests were used to compare SSES and COHQOL-O scores. No statistically significant differences were found between demographic characteristics of the control and experimental groups. After 6 months, the incidence of complications was significantly lower in the experimental group as compared to the control group (4.35% vs 30.43%, P = .047). In addition, the mean SSES score was significantly higher in the experimental group (indicating greater self-efficacy in stoma care) (107.13 ± 11.87 vs 85.65 ± 12.87, P = .000), and the mean COHQOL-O score was also significantly higher in the experimental group, indicating higher health-related quality of life (154.48 ± 16.01 vs 138.26 ± 13.42, P = .001). The nurse-led multicomponent intervention provided by the ostomy care team reduced ostomy-related complications and improved the self-efficacy level and health-related quality of life in persons with a new urostomy.

Analysis on the present situation and influencing factors of peristomal moisture-associated skin damage in 276 postoperative patients with fecal ostomies

Objective To investigate the occurrence of moisture-associated skin damage (MASD) around the stoma in patients with colorectal tumor after enterostomy. Methods Using convenience sampling method, during March 2016 to December 2017 in Anhui Provincial Cancer Hospital wound and stoma outpatient, choose 276 patients with enterostomy (including temporary enterostomy and permanent enterostomy), using self-made general questionnaire and ostomy self nursing competence scale to investigate them. Results Totally 276 cases of enterostomy patients, including 119 cases (43.1%) underwent colostomy, 157 cases ileum ileostomy (56.9%). There were 92 cases (33.3%)of patients with MASD , the binary classification Logistic regression analysis showed that enterostomy time (P = 0.004), the type of enterostomy (P = 0.009), height of enterostomy (P = 0.001), enterostomy self-care knowledge (P= 0.012) and nursing skills (P = 0.002) were MASD influence factors. Conclusion The present study shows that MASD is widespread in patients with enterostomy, and targeted measures should be taken to reduce its incidence or to intervene in time. Key words: Enterostomy; Postperative complications; Dermatitis, contact

Peristomal Moisture-Associated Skin Damage and Independence in Pouching System Changes in Persons With New Fecal Ostomies.

PURPOSE:The purpose of this study was to evaluate factors related to peristomal moisture-associated skin damage (MASD) in patients who underwent ostomy surgery because of colorectal cancer, and their independence in pouching system changes. Findings were used to determine pre- and postsurgical care for these patients.DESIGN:Retrospective review of medical records.SUBJECTS AND SETTING:The study setting was an 800-bed hospital in metropolitan Tokyo, Japan. The sample comprised 89 patients (median age: 65 years; male vs female: 58 vs 31) who visited a stoma clinic within 8 weeks of ostomy surgery. Fifty-two subjects had ileostomies and 37 had colostomies; data were collected between January 2008 and July 2014.METHODS:Data were collected from outpatient and inpatient records. Potential relationships between MASD and independence in pouching system changes were evaluated via univariate tests to identify possible associations, followed by logistic regression analysis.RESULTS:Patients living with an ileostomy were more likely to experience peristomal MASD than were patients living with a colostomy (odds ratio [OR] = 3.782; 95% confidence interval [CI]: 1.34-10.64; P = .012). Analysis also found that patients with postsurgical chemotherapy were more than 2.5 times more likely to experience peristomal MASD than patients who did not require postoperative chemotherapy (OR = 2.702; 95% CI: 1.02-7.18; P = .046). We also found that patients 65 years or older were significantly more likely to have difficulty in changing their pouching system than were younger patients (OR = 7.193; 95% CI: 2.21-23.41; P = .001), as were those with diabetes mellitus (OR = 11.842; 95% CI: 2.56-54.77; P = .002).CONCLUSIONS:Patients undergoing ileostomy and those receiving postoperative chemotherapy are more likely to experience peristomal MASD. Older patients (>65 years) and those with diabetes mellitus are less likely to achieve independence. These findings influenced our management of persons undergoing ostomy surgery for management of colorectal cancer in our clinic. We recommend additional research using a larger and more diverse sample to confirm our findings.

Changes in Peristomal Skin Condition and User Experience of a Novel Ostomy Barrier Ring With Assisted Flow: A 6-Week Feasibility Study.

This purpose of this study was to evaluate a novel barrier ring with an assisted flow mechanism by assessing changes in peristomal moisture-associated skin damage (MASD) and perceptions of comfort, security, handling, and discretion in persons with an ileostomy for 6 months or longer. Single-arm, open-labeled feasibility study. Twenty participants (aged ≥18 years) with an ileostomy for 6 months or more participated in the study and 12 completed data collection. The primary reason for dropouts concerned compatibility issues with the barrier ring when used with certain convex pouching systems. Participants used the barrier ring along with their normal ostomy pouching system for a period of 6 weeks. Changes in skin condition were assessed using the Ostomy Skin Tool (OST). Participants' perception of the barrier rings' comfort, security, handling, and discretion were also recorded on a 10-point scale, where participants would offer a low score if their experience was negative and a higher score if their experience was positive. Participants changed pouches and barrier rings at their own discretion. For participants who completed the study, the average skin condition and median ratings of comfort, security, handling, and discretion at 6 weeks were compared to baseline values. Twelve of the 20 participants (60%) completed the study. For those who completed, the mean score on the OST decreased from 6.2 ± 1.90 (mean ± SD) at baseline to 3.4 ±1.73 at 6 weeks, indicating a mean reduction of 2.8 (95% CI, -1.6 to -3.9; P < .001). The peristomal skin condition of 9 participants improved, whereas 3 experienced no change. All participants who completed the study rated comfort, handling, security, and discretion highly (median score 10 at baseline and at 6 weeks). Study findings indicate the novel ostomy barrier ring may reduce levels of peristomal MASD in persons living with an ileostomy, though a more extensive trial with a control group is recommended.

North America Wound, Ostomy, and Continence and Enterostomal Therapy Nurses Current Ostomy Care Practice Related to Peristomal Skin Issues.

PURPOSE:The purpose of this study was to describe the practice of 796 ostomy nurses in North America in 2014 related to peristomal skin issues.DESIGN:Descriptive study.SUBJECTS AND SETTING:Participants were 796 wound, ostomy, and continence (WOC) and enterostomal therapy (ET) nurses currently practicing in the United States or Canada and caring for patients with ostomies. The collection of data occurred in conjunction with an educational program on peristomal skin complications and practice issues and solicited the participant's perception on the incidence and frequency of peristomal skin issues as well as on practice patterns.METHODS:Participants attended an educational program. They were also asked to anonymously respond to multiple-choice questions on ostomy care management via an audience response system followed by discussion of each item and their responses. This descriptive study reports on the answers to the questions as well as the pertinent discussion points.RESULTS:Participants estimated that approximately 77.70% of their patients developed peristomal skin issues. The most commonly encountered problem was irritant contact dermatitis (peristomal moisture-associated skin damage). Contributing factors were inappropriate use of a pouching system owing to lack of follow-up after hospital discharge. Reported interventions for the prevention and management of peristomal skin issues included preoperative stoma site marking, use of a convex pouching system, and barrier rings. However, subsequent discussion revealed that the frequency of use of these products varied considerably. Participants identified shortened hospital stays, absence of preoperative stoma marking, and limited outpatient follow-up as contributing to development of peristomal skin problems.CONCLUSION:WOC and ET nurses estimate that more than three-quarters of persons living with an ostomy develop peristomal skin problems. Multiple interventions for managing these problems were identified, but some variability in management approaches emerged.

Peristomal Moisture–Associated Skin Damage in Adults With Fecal Ostomies

Approximately 1 million persons living in North America have an ostomy, and approximately 70% will experience stomal or peristomal complications. The most prevalent of these complications is peristomal skin damage, and the most common form of peristomal skin damage occurs when the skin is exposed to effluent from the ostomy, resulting in inflammation and erosion of the skin. Despite its prevalence, research-based evidence related to the assessment, prevention, and management of peristomal moisture-associated skin damage is sparse, and current practice is largely based on expert opinion. In order to address current gaps in clinical evidence and knowledge of this condition, a group of WOC and enterostomal therapy nurses with expertise in ostomy care was convened in 2012. This article summarizes results from the panel's literature review and summarizes consensus-based statements outlining best practices for the assessment, prevention, and management of peristomal moisture-associated dermatitis among patients with fecal ostomies.

The Incidence of Stoma and Peristomal Complications During the First 3 Months After Ostomy Creation

The purpose of this study was to examine stoma and peristomal complications and related variables among adults with ostomies. The primary study aim was to determine the incidence of peristomal and stoma complications during the first 3 months after stoma creation. Data were collected using a prospective, repeated-measures descriptive study design. Data were collected at 2 university-based hospitals with outpatient ostomy clinics in the Midwestern United States. The sample included 43 adults with newly created colostomy, ileostomy, or urostomy stomas. Participants were examined for the presence of complications up to 4 times during a 3-month period: within 7 days of surgery. Patients were also evaluated at 2, 6, and 12 weeks after stoma creation. Data were collected using a validated instrument with acceptable interrater reliability. Peristomal skin complications developed in 27 participants, comprising 63% of the sample. The onset of peristomal skin complications occurred most frequently during the 21- to 40-day time period. The most common skin conditions at nearly all time intervals were irritation (peristomal moisture-associated skin damage) and infection. Of the 18 participants observed 70 days or longer, just 7 (38%) remained free of peristomal skin complications throughout the study. Six participants developed 1 or more stoma complications, all of which occurred 20 or more days after surgery. No demographic or clinical factors were found to be associated with the development of complications. Although the participants were evaluated at regular intervals by a specialized nurse, the majority experienced peristomal skin complications. These results underscore the importance of further work in interventions to prevent and treat peristomal skin complications and to provide ongoing outpatient follow-up to individuals with stomas.