Peristomal Skin Complications Research Articles

Evaluation of a New Elastic Ostomy Appliance to Decrease Skin Complications: Results of a Pilot Study

This pilot study was conducted to evaluate the safety and use of a new, reusable, nonadherent, elastic device. A convenience sample of nonhospitalized patients with ileostomies and colostomies was recruited through the Dutch ostomy patient association. Participant inclusion criteria stipulated the presence of ileostomy or colostomy, a body mass index (BMI) between 18 and 30, and presence of an osto-my for at least 1 month. Patients with existing prolapse or necrosis of the ostomy, inability to give consent, or concurrent usage of other aids to prevent leakage or skin problems were excluded. Participants were fitted with and asked to wear the appliance continuously for 4 weeks and report experiences in a structured diary. Patient charts were reviewed for baseline demographic characteristics that included age, gender, American Society of Anaesthesiologists classification, and BMI. Study nurses performed structured weekly interviews and inspections of the ostomies and peristomal skin. The primary outcome measure was occurrence of serious adverse events such as ostomy necrosis or perforation. Secondary outcome measures were patient reported incidents of leakage and satisfaction during wear and changing of the appli-ance. Peristomal skin complications also were recorded. Descriptive statistics were used to analyze results. In addition, subgroup analysis of patients with a parastomal hernia was performed because of the potential benefits of the device design in these cases. Participants included 23 patients (16 with colostomies, 7 with ileostomies); 13 participants (57%) were female. Mean age and BMI were 64 years and 28.3, respectively. Six (6) patients had a parastomal hernia. Due to shifting or discomfort while wearing the appliance, 16 participants discontinued use before the end of the study and were excluded from analysis from the point they left the study. Mean duration of participation was 12.8 days. No adverse events occurred. Mean number of incidents of leakage/week decreased from 3.5 ± 4.9 at start of the study to 1.8 ± 1.3 at week 4. The mean number of pouches used/week decreased from 10.5 ± 5.4 to 8 ± 2.6. Peristomal skin reactions present in 15 patients at start of the study decreased to 1 patient at the end of the study. Patient satisfaction did not change over the course of the study. Patients with parastomal hernias had similar results. No serious adverse events were reported and leakage and skin irritation were found to improve, but participant dropout rate was high and average usage time was only 12.8 days, which limited interpretation of the results. The data suggest that the appliance may offer an (intermittent) alternative to existing ostomy materials for patients experiencing troublesome leakages, peristomal skin problems, or parastomal hernias, but further research is needed to explore these outcomes.

Factors influencing the incidence of peristomal skin complications: evidence from a multinational survey on living with a stoma

Leakage of stomal effluents underneath the baseplate or inappropriate removal of stoma appliances can cause peristomal skin complications (PSCs), which are known to have many negative implications for people with a stoma. While numerous studies have examined the causes of PSCs, less is known about what drives the risk of a PSC developing. To address this gap in knowledge, the largest multinational survey to date was conducted, including 4235 people with a stoma on four continents and in 13 countries. The survey revealed that, besides leakage, other factors, such as age, gender, time since surgery and type of stoma, also drive the risk of PSCs. The survey also revealed that having a PSC resulted in greater use of stoma accessories and more frequent contact with health professionals, increasing overall healthcare costs. Collectively, the survey results reveal a need for more awareness on the risk factors for PSCs, which subsequently could have a positive effect on healthcare spending.

Implementation of best practice guidelines for ostomy care and management: Care outcomes

IntroductionCare provided to ostomized people is crucial in their progress and rehabilitation. The Registered Nurses’ Association of Ontario clinical practice guidelines include greatest evidence nursing interventions for ostomized patient care. The aim of the study is to analyse the impact on patients’ care and health outcomes after Care and management of ostomy guideline implementation. MethodPre-post quasi-experimental study, carried out in all patients who underwent a digestive or urological ostomy in 8 centres of Best Practices Spotlight Organisation® where the ostomy care and management guideline was implanted from 2012 to 2018. Clinical, process and health outcome variables were analysed and compared in 3 periods of time. Descriptive analysis and comparison of proportions between the periods was performed, using Chi square, applying Yates correction, considering a 95% confidence interval. ResultsPreoperative education went from 36.7 to 47.3% (p<.05); stoma site marking from 25.2 to 33.8% (p<.05); postoperative evaluation from 94.8 to 59% (p<.05); postoperative education from 75.5 to 91.9% (p<.05); peristomal skin complications from 16.6 to 10.9% (p<.05), and ostomy complications from 21.8 to 27.9% (p<.05). ConclusionsThe implementation of the ostomy care and management improved preoperative care, stoma site marking and peristomal skin complications.

Preoperative Stoma Site Marking Decreases Stoma and Peristomal Complications

We systematically reviewed the literature in order to determine whether evidence indicated that preoperative stoma site marking reduces the occurrence of postoperative stoma and peristomal complications. Systematic review with meta-analysis of pooled findings. We systematically reviewed 6 electronic databases including PubMed, MEDLINE, CINAHL, Cochrane Library for English language articles, along with the Airiti Library and Wanfang Data for Chinese articles for evidence related to the effects of stoma site marking on stoma and peristomal complications. We sought articles published from their inception to January 31, 2018. Ten studies that included 2109 participants, each comparing 2 groups of patients who did and did not undergo preoperative stoma site marking, were retrieved and analyzed. In patients who underwent stoma site marking, the marking was associated with reduced stoma and peristomal complications in all stoma types (odds ratio [OR] = 0.52; 95% CI, 0.42-0.64; P < .001). Patients who underwent stoma and had fecal ostomies experienced fewer complications (OR = 0.34; 95% CI, 0.25-0.47; P < .001) than patients with unmarked stomas. In contrast, patients with urostomies did not experience fewer complications when compared to those with unmarked ostomies (OR = 0.531; 95% CI, 0.23-1.21; P = .132). Persons with fecal ostomies also had fewer hernias and peristomal skin complications (ORs = 0.25 and 0.30; 95% CIs, 0.09-0.71 and 0.20-0.44, respectively; both Ps < .001). The results revealed that stoma site marking was associated with reduced early and late stoma and peristomal complications (ORs = 0.76 and 0.38; 95% CIs, 0.61-0.94 and 0.32-0.46; P = .010 and P < .001, respectively). Preoperative stoma site marking is associated with a reduced occurrence of stoma and peristomal complications and should be considered as a standard of preoperative care.

Enterostomies for acute abdominal surgical condition in children: An experience in a developing country

Background: Pediatric abdominal surgical condition that is complicated by gross peritoneal contamination may require enterostomy as a damage control or salvage procedure. Late presentations mostly seen in developing countries make creation of enterostomy a relatively common surgical procedure. The aim of this study was to evaluate the creation of enterostomy in children who presented with acute abdominal surgical conditions. Methods: This was a retrospective study of children that had enterostomy in the pediatric surgery unit of Enugu State University Teaching Hospital, Enugu, Nigeria. Medical records of pediatric patients that had enterostomy over a 10-year period were assessed. Results: There were 32 cases of enterostomies performed during the study period. There were 25 males (78.1%) and 7 females (21.9%) with a male to female ratio of 3.6:1. The age range of the patients was 3 weeks to 180 months, with a median age of 96 months. There were 1 neonate (3.1%), 10 infants (31.3%) and 21 children (65.6%) older than 1 year. The primary diagnoses were typhoid intestinal perforation in 21 patients (65.6%), intussusception 10 (31.3%) and intestinal atresia 1 (3.1%). Ileostomy was performed in 31 patients (96.9%) and jejunostomy in 1 patient (3.1%). Enterostomy was created at the time of initial laparotomy (damage control) in 21 patients (65.6%) while 11 patients (34.4%) had their enterostomy as a salvage procedure at the time of re-exploration. Peristomal skin complication was the most common complication recorded in our patients. Mortality was 12.5%. Conclusion: Enterostomy is lifesaving in the management of acute abdominal surgical condition when there is gross peritoneal contamination in severely ill children. Proper surgical technique and electrolyte derangements are important considerations when enterostomies are created.

Developments in silicone technology for use in stoma care.

Soft silicone's flexibility, adhesive capacity and non-toxic, non-odourous and hypoallergenic nature have made it an established material for adhesive and protective therapeutic devices. In wound care, silicone is a component of contact layer dressings for superficial wounds and silicone gel sheeting for reducing the risk of scarring, as well as of barriers for incontinence-associated dermatitis. Regarding stoma accessories, silicone is established in barrier films to prevent contact dermatitis, adhesive removers to prevent skin stripping and filler gels to prevent appliance leaks. Until recently, silicone has not been used in stoma appliances flanges, as its hydrophobic nature has not allowed for moisture management to permit trans-epidermal water loss and prevent maceration. Traditional hydrocolloid appliances manage moisture by absorbing water, but this can lead to saturation and moisture-associated skin damage (MASD), as well as increased adhesion and resultant skin tears on removal, known as medical adhesive-related skin injury (MARSI). However, novel silicone compounds have been developed with a distinct evaporation-based mechanism of moisture management. This uses colloidal separation to allow the passage of water vapour at a rate equivalent to normal trans-epidermal water loss. It has been shown to minimise MASD, increase wear time and permit atraumatic removal without the use of adhesive solvents. Trio Healthcare has introduced this technology with a range of silicone-based flange extenders and is working with the University of Bradford Centre for Skin Sciences on prototype silicone-based stoma appliance flanges designed to significantly reduce the incidence of peristomal skin complications, such as MARSI and MASD. It is hoped that this will also increase appliance wear time, reduce costs and improve patient quality of life.

Enhancing recovery: raising awareness of everyday struggles of patients with ostomies

Background Preserving the skin’s acid mantle can help reduce the formation of peristomal skin complications (PSCs). Ostomy products should strive to address this ongoing challenge.

Investigating ICU nurses’ understanding of incontinence-associated dermatitis: an analysis of influencing factors

Background Preserving the skin’s acid mantle can help reduce the formation of peristomal skin complications (PSCs). Ostomy products should strive to address this ongoing challenge.

ET/WOC nursing – leadership lessons learned from the COVID-19 pandemic: an opinion

For people living with an ostomy, leakage and peristomal skin complications (PSC) are common issues that often appear together. Better means of preventing these issues could improve the quality of life of these patients. The purpose of the research presented here was to identify and build a model of risk factors for PSC.

Preventing facial pressure injury for healthcare providers adhering to COVID-19 personal protective equipment requirements

For people living with an ostomy, leakage and peristomal skin complications (PSC) are common issues that often appear together. Better means of preventing these issues could improve the quality of life of these patients. The purpose of the research presented here was to identify and build a model of risk factors for PSC.

Effect of Vacuum Assisted Closure System on Wound Healing Duration in Parastomal Wounds: A Retrospective Study

Introduction: In cancer patients, wound healing is seriously impaired due to cachexia and tumour-related catabolism. Therefore, several surgical complications may develop in patients with malignant diagnosis. Parastomal wounds are also among the most frequent surgical complications in this patient group which causes serious deterioration of the patients’ quality of life. Various factors influence the duration of parastomal wound healing and multiple methods are used in its treatment. Among them, new method is the treatment with the Vacuum-Assisted Closure (VAC) system. Aim: To examine the effect of VAC system on the duration of wound healing in parastomal wounds. Materials and Methods: A retrospective study was conducted in which the data of 31 patients who underwent surgery with a diagnosis of intra-abdominal malignancy at the surgical oncology clinic between January 2010 to January 2018, and who developed a parastomal wound were evaluated retrospectively, through the hospital database. The patients’ clinical and demographic data, peristomal skin complications and the applied treatment methods were determined from the hospital database. The effect of the patient-related factors and the VAC treatment on the duration of wound healing was analysed. The patients whose data could not be accessed and had no stoma complications were excluded from the study. In this study, analyses were performed using IBM SPSS statistical version 23.0. Results: A total of 38 patients developed parastomal wounds. The seven patients whose data could not be accessed were excluded from the study, so 31 patients who developed parastomal wounds, participated and out of them 10 (32.2%) were men and the mean age was found as 51.77±15.23. There were 20 patients with ileostomy and 11 patients with colostomy. The most frequent diagnosis in the patient population was colorectal cancer. The VAC treatment was applied to 14 (45.2%) of the patients, the others were applied conventional wound care methods. When the relationship between clinical, demographic data, parastomal wound treatment methods and the durations of wound healing were viewed, the effect of being above 65 years of age (p=0.044), presence of Diabetes mellitus (DM) (p=0.012), and having a Body Mass Index (BMI) value of 25 or above (p=0.046) on parastomal wound healing was found to be statistically significant. Parastomal wound healing took a longer time in these patients. When the VAC treatment and other conventional wound treatment methods were compared, the duration of hospital stay was found to be short, statistically and significantly, in the VAC group (p=0.016). Conclusion: In malignant patients, being above the age of 65, the presence of DM and having a BMI value of 25 and above lengthen the duration of parastomal wound healing. The healing duration in parastomal wounds treated with VAC is shorter than other conventional methods. Thus, VAC is a successful and feasible method in parastomal wound treatment. Although, the results of this retrospective study are helpful in predicting and managing parastomal wounds, but prospective, randomised and large-scale studies are needed.

Introduction of pressure injury preventive measures and improvement initiatives for patients undergoing prolonged surgery at a government hospital in the United Arab Emirates

Background Preserving the skin’s acid mantle can help reduce the formation of peristomal skin complications (PSCs). Ostomy products should strive to address this ongoing challenge.

Successful treatment of an ileal conduit fistula with negative pressure: report of a case

Background Preserving the skin’s acid mantle can help reduce the formation of peristomal skin complications (PSCs). Ostomy products should strive to address this ongoing challenge.

Nurses and nursing - endurance and initiative

Background Preserving the skin’s acid mantle can help reduce the formation of peristomal skin complications (PSCs). Ostomy products should strive to address this ongoing challenge.

Development of an incontinence-associated dermatitis prevention bundle using an evidence-based framework

Background Preserving the skin’s acid mantle can help reduce the formation of peristomal skin complications (PSCs). Ostomy products should strive to address this ongoing challenge.

A new APP for prevention and treatment of complications of intestinal peristomal skin

ObjectivesTo develop an application program for prevention and treatment of complications of intestinal peristomal skin. MethodThe framework of the application software development were: Phase 1 – “Design, identification of the needs for the application development”: In this phase, the authors identified during their clinical practice that some professionals and caregivers find it difficult to provide care for at-risk ostomized patients or those with some kind of peristomal skin complication; Phase 2 – “Application prototype development”: this phase included the integrative literature review in the main databases; Phase 3 – “Creating the application”: this phase was intended to generate a decision tree algorithms, structure the database, and develop the software; Phase 4 – “Transition”: performing the application functionality testing. ResultsThe application “Dermatite Periestoma App” has 36 screens and 21 figures describing the procedures for prevention and treatment of complications of intestinal peristomal skin. It is freely available from the Play Store and has been registered with the Instituto Nacional da Propriedade Industrial Ministério do Desenvolvimento, indústria e Comércio Exterior (Brazilian Ministry of Development, Industry and Foreign Trade, National Institute of Industrial Property). ConclusionThis study made it possible to describe the stages of planning and development of the mobile application “Dermatite Periestoma App”. The steps taken indicate that the “Dermatite Periestoma App” has great potential for clinical practice in the evaluation of patients with stomal complications or at risk for developing peristomal skin complications, preventive measures, therapeutic approaches, and for nursing education through the use of technology.

Post-operative Peristomal Skin Complications in Children with Colostomy.

Background: Colostomies are common in pediatric surgical practice. Despite improvements in surgical methods, surgical morbidity and complications rates are still high; Peristomal skin complications affect 18%–73% of children So this study aimed to assess post-operative peristomal skin complications in children with colostomy. Descriptive research design was used in this study. Subjects included 30 children with colostomy from pediatric surgical unit in Assiut University Children Hospital and Pediatric Surgery clinic. Two tools were used for gathering the necessary data which included a structured questionnaire for personal and medical data of children and Ostomy Skin Tool to assess the condition of peristomal skin complications. Results showed that, (66.7%) of children had moderate peristomal skin complications at one week from the operation while at the first month; two fifths of children had severe complications. At the second month, (66.7%) of children had severe peristomal skin complications while majority of them in the third month had severe complications. Conclusion discoloration and erosion complications were the most peristomal skin complications that occurred after colostomy. Therefore, it is recommended that further research should be expanded to include a larger sample, focusing on effects of peristomal skin problems on the child and family.

PMD62 THE ASSOCIATION BETWEEN STOMA RELATED COMPLICATIONS AND STOMA APPLIANCE PRESCREPTION SPEND

To identify the association between stoma complication and the prescription spend of stoma related appliances. This is a retrospective cross-sectional observational study investigating the association between stoma appliance consumption and faecal leakage from the stoma pouch (FL), peristomal skin complications (PSC), social concern (SC) and ballooning/pancaking (BP). Data is collected via a community-based patient support programme in the UK. We use multivariable regression with/without logarithmic transformation of the cost variable to model the absolute and relative association to costs of bags and plates and other reimbursed supporting products, separately and combined. 2713 patients from 31 clinical commissioning groups were included from 2016 to 2018. Mean age was 69.9yr, 47% were female. 25.1% had FL, 23.6% (PSC), 12.2% (SC) and 9.3% (BP). The mean total monthly cost of stoma appliances was £200.01 (£158.23 for bags/plates and £41.84 for supporting products). The parameter estimates (p-values) comparing patients with/without complications controlled for confounders for FL, PSC, SC and BP in the analysis of non-transformed monthly costs of bags/plates are £24.83 (0.002), £0.17 (0.973), £25.16 (<0.001) and £15.53 (0.025), respectively. The estimates in the log transformed analysis are 0.137 (<0.001), 0.048 (0.104), 0.157 (<0.001) and 0.104 (0.011). In the analysis of costs of supporting products, the estimates are £12.61 (<0.001), £2.25 (0.377), £10.58 (0.001), £5.86 (0.096) in the non-transformed analysis are0.226 (<0.001), 0.048 (0.394), 0.100 (0.150) and 0.124 (0.114) in the log transformed. The model analysing the non-transformed costs of all stoma products has the following parameter estimates, £35.55 (<.0001), £2.41 (0.697), £35.74 (<0.001) and £21.39 (0.013), respectively and 0.189 (<0.001), 0.011 (0.716), 0.126 (0.001) and 0.098 (0.020) in the log transformed analysis. FL, SC and BP are all associated with increasing stoma appliance related prescription spend.

Silicone-based adhesive removers for preventing peristomal skin complications caused by mechanical trauma

Peristomal skin complications (PSCs) are reported by 77% of people with a stoma, with a serious impact on their quality of life, as well as on healthcare resources. PSCs are usually caused by irritant contact dermatitis from stoma effluent or skin stripping from mechanical trauma to the stratum corneum caused by removal of the ostomy appliance. The risk of mechanical trauma is higher in neonates, young infants and older adults, who have more fragile, friable skin. The incidence and impact of PSCs can be reduced with an appropriate appliance change routine. Mechanical trauma is reduced by minimising the frequency of appliance changes and using an adhesive remover wipe or spray. In adults with a stoma, silicone-based solvents are considered the first choice, as they are skin-friendly and sting-free, and they release the adhesive from the skin quickly and evaporate within seconds, without leaving a residue. However, for neonates, wipes and specialist paediatric oil-based adhesive removers are advised instead. The efficacy of adhesive removers, and silicone-based solvents in particular, at maintaining skin integrity and reducing discomfort has been reported by both stoma care nurses and people with a stoma.

Educational handbook for healthcare professionals: Preventing complications and treating peristomal skin

ObjectiveTo create and validate a handbook for the prevention of peristomal skin complications. MethodsFor the elaboration of the handbook, a literature review was conducted in the following databases: Cochrane Library, SciELO, LILACS, and MEDLINE. The handbook “Preventing and treating the complications of intestinal peristomal skin” was elaborated in nine steps. The first step addressed the concepts of ostomy, stoma type, and ostomy classification. In the second step, the following were described: definition of the collection equipment, type of collection equipment, and technique of changing one- and two-piece equipment. In the third step, the peristomal skin cleansing technique was described. In the fourth step, the types of complications of the peristomal skin were listed. In the fifth step, preventive approaches to avoid complications with the peristomal skin were described. In the sixth step, the therapeutic approaches in the treatment of aforementioned peristomal skin complications were addressed. In the seventh step, the handbook layout was created by an Information Technology professional. In the eighth step, the handbook was validated by 25 nurses. In the ninth step, the final version of the instrument was laid out. ResultsThe final version of the “Preventing and treating the complications of intestinal peristomal skin” handbook has 37 pages. It was registered in the International Standard Book Number: 978-85-67647-46-3, standard format size (21cm high by 15cm wide), totaling 50 illustrations. In the first evaluation, the evaluators assessed the manual as partially adequate to completely adequate. In the first evaluation, the content validity index ranged between 0.88 to 1.0; no 100% agreement was observed among the evaluators' answers. In the second evaluation, as an agreement was observed in all items, the content validity index was 1.0. ConclusionThe handbook “Preventing and treating the complications of intestinal peristomal skin” was elaborated based on scientific principles and had its content, language, and design validated by specialists in the field.