Skin Care Guidelines Research Articles

The Effect of Implementation of Skin Care Guidelines on Nurses’ Knowledge Regarding Skin Care and Incidence of Skin Injuries Among Neonates at a Private Tertiary Care Hospital

Background: Skin care of sick newborns is important because skin acts as a barrier to prevent neonates from infections which may lead to neonatal morbidity and mortality. The highly technological environment of the neonatal intensive care unit (NICU) makes them vulnerable to loss of skin integrity. In acute care setting maintenance of skin integrity is considered as an established quality indicator representing nursing care. Aim of Study: The study aimed to determine the effect of skin care guidelines on nurses’ knowledge related to skincare and the incidence of skin injuries among neonates. Methodology: Pre-post quasi-experimental study was conducted in the NICU of a private tertiary care hospital. A consecutive sampling technique was used. The intervention comprised educational sessions and demonstrations of skin care practices from AWHONN skin care guidelines. The data on the nurses’ knowledge were collected through self-developed and self-administered questionnaires. Skin injuries were recorded on a checklist through observation for 1 month before and after the intervention. A paired sample t-test was used for comparing knowledge and continuous demographical variables. While the incidence density ratio was calculated for skin injuries. Results: There was a statistically significant improvement in the nurses’ knowledge of skin care from pre (mean 15.06 ± 5.16) to post (mean19.40 ± 5.17) measurement P-value .001. Incidence density rate of skin injuries reduced from 19% to 3% after the implementation of skin care guidelines. Conclusion: Through the implementation guidelines nurses’ knowledge and practices regarding skin care improved while skin injuries among neonates were reduced.

Beauty and the Rash: The Hidden Risks of Cosmetics in Contact Dermatitis

Contact dermatitis is an inflammatory condition of the skin that occurs when it comes into contact with specific substances or irritants. Cosmetics have been identified as a common cause of contact dermatitis. This research will review previous studies on the relationship between cosmetics and contact dermatitis. Research identifying the most common allergens and irritants present in cosmetic products will be analysed, as well as patch tests used to detect possible allergic reactions. The results of studies that have demonstrated the presence of allergens and irritants in cosmetics, as well as the associated skin reactions, will be presented. Contact dermatitis prevention and management strategies will also be discussed, including identification and avoidance of specific allergens, patch testing, and skin care guidelines. The discussion will focus on the importance of education for both consumers and healthcare professionals about the risks of cosmetics in contact dermatitis. In conclusion, cosmetics pose a hidden risk for the development of contact dermatitis. It is critical that both consumers and healthcare professionals are aware of the common allergens and irritants present in cosmetic products, and take appropriate steps to prevent and manage this condition.

Efficacy of Nursing Skin Care Protocol on Prevention of Skin Related Problems among Newly Diagnosed Diabetic Patients

Background:Approximately 400 million people would be afflicted with diabetes by 2025, projected worldwide.In India, about 50.9 million people suffer from diabetes, and this figure willgo up to 80 million by 2025. Diabetes leads to blindness, kidney failure, heart attacks, stroke and foot ulcer. Skin problems are increasing in diabetic patients. It is estimated that 30% of diabetes patients will experience a skin problem at some stage throughout the course of their disease. Many skin care guidelines are given for diabetic foot care, but nursing skin care protocolfor diabetic patients is not available. Less attention is given to complete skin care in diabetes routine care.There is need to develop Nursing skin care protocols for prevention of skin problems in diabetes.
 Objectives:To validate the developed nursing skin care protocol on prevention of skin related problems among newly diagnosed diabetic patients, to assess the skin problems in experimental group and control group, and to assess the efficacy of nursing skin care protocolin experimental group and routine skin care with coconut oil in control group.
 Methodology: Study design is randomized controlled trial.Study will be carried out in hospital setting with 140 participants. Random allocation and concealment with single blinding will be done.Intervention is Nursing skin care protocolconsist of Daily skin inspection, Bathing, Drying, clothing, Application of lotion, Hydration, Injury prevention, Nail careandHair care, Sugar control, Dermatological consultation and Physician consultation. Semi structure questionnaire, skin assessment tool[ GI, Glammal score for xerosis,Visual Analogue Scale for pruritus, Questionnaire on erythema,hair and nail colourchanges] and self-reported practice checklist will be used to collect data.
 Expected Results: Investigator expects newly diagnosed diabetic patients will not develop any skin related problems after using Nursing skin care protocol.
 Conclusion: Diabetic patients will be able to utilized developed nursing skin care protocol routinely to prevent skin related problems.

A Quality Improvement Approach to Perineal Skin Care: Using Standardized Guidelines and Novel Diaper Wipes to Reduce Diaper Dermatitis in NICU Infants.

Diaper dermatitis (DD) causes discomfort and emotional distress and creates possible sources of infection among newborn intensive care unit infants. Diaper dermatitis remains prevalent despite studies documenting an understanding of prevention and treatment modalities. Standardizing perineal skin care guidelines could reduce DD. Implement perineal skin care guidelines, while introducing novel diaper wipes, to decrease the incidence of DD by 20% within a 1-year period. Our unit reviewed evidence-based literature to develop a standardized perineal care guideline for prevention and treatment, encompassing the use of novel, preservative-free diaper wipes with grapefruit seed extract. The outcome measures were the incidence and duration of DD. Process compliances were monitored. The balancing measure was the rate of fungal skin infection while using preservative-free wipes. Between July 2017 and March 2019, 1070 infants were admitted for 1 or more days, with 11% of those being born at less than 30 weeks of gestational age. After guideline implementation in January 2018, the incidence of DD decreased by 16.7%. The incidence of severe cases dropped by 34.9%, with 3.5 days per 100 patient-days shortened duration. Process compliance was achieved. Neonates tolerated the novel wipes without increased fungal skin infection. The Perineal Skin Care Guidelines could reduce the rate and duration of DD. Newborn intensive care unit infants tolerated the novel diaper wipes. Additional research on wipes containing other types of extracts or ingredients.

COVID-19 Pandemic & Skin Care Guidelines for Health Care Professionals.

The Novel corona virus is bringing multiple challenges for health care professionals. Skin is the biggest organ and the first line of defense against different infections and external factors. Being the front line warriors, health care professionals are susceptible to various skin conditions due to prolonged use of personal protective equipment. These adverse skin conditions are redness, irritation, itching, contact dermatitis, and aggravation of underlying skin conditions like seborrheic dermatitis and acne vulgaris. In the current global situation, the potential incidence of such adverse dermatological effects does not in any manner cause the HCPs to deviate from the strict specific precautionary hygiene rules. These skin problems are manageable with the few precautionary measures. This article explores the different skin conditions that result from personal hygiene measures and usage of protective gear and will suggest some practical advice about how to manage and protect from these different adverse skin conditions.

Gentle skin care guidelines for patients with mycosis fungoides.

Gentle skin care is an umbrella term used to describe protective and non-interventional skin care regimens for patients to adhere to within the confines of their own home. Simple recommendations such as cleanser/moisturizer choices and shower habits are mainstays of gentle skin care regimens.

Treatment of Hailey-Hailey Disease of the vulva: a retrospective case series

Background: Hailey-Hailey disease (familial benign chronic pemphigus) of the vulva is a rare autosomal dominant dermatosis characterized by malformation of desmosomes and bullae, particularly in intertriginous areas. Cases: We reviewed the cases of 5 women followed at a single academic institution over a period of 17 years. Of the 5 patients, 4 carried a diagnosis of Hailey-Hailey at the time of presentation to our institution, and one was diagnosed on biopsy. 3 were members of a family group. Initial treatment of choice was a topical steroid (betamethasone in 3, fluocinonide and hydrocortisone in 1 each), vulvar skin guidelines, tepid soaks, a skin protectant (A&D ointment, zinc oxide) and additional treatment (crotamiton in 1, clotrimazole in 2, and Polysporin in 1). Final treatment regimens in 3 patients followed long term were zinc oxide/A&D and betamethasone-clotrimazole ointment in all 3, nystatin-triamcinolone ointment in 2, oral minocycline in 1, oral fluconazole prn in 1, and topical tacrolimus in 1. Treatment courses were complicated by superimposed fungal infections, superimposed bacterial infections, and lichen simplex chronicus flares. These were treated with antifungals, topical clindamycin and metronidazole, and steroid-antifungal bursts, respectively. Three of five patients followed long term achieved successful remission with occasional flares. Discussion: Treatment of Hailey-Hailey disease must be tailored to the individual patient. Adherence to vulvar skin care guidelines is critical for the remission of Hailey-Hailey disease. Treatment is long-term and may be complicated by episodes of fungal and bacterial superinfection and lichen simplex chronicus.

Market trends in baby skin care products and implications for clinical practice.

Although the U.S. pediatric skin care market is a $1.7billion industry, little is known regarding the usage pattern of skin care products in very young children. We have begun to recognize that common over-the-counter skin care products may have positive or negative effects on skin barrier function. Thus, knowing what and how skin care products are used early in life is important. The goal of the current study was to better understand skin care product use in the United States using market research data. We found that the prevalence of use was greater than 50% for all skin care product categories and age groups. Premoistened cleansing wipes and cloths were the most frequently used product, followed by baby oil and lotion and body and baby powder. Baby bath and shampoo products were used at least five times per week per household, and caregivers generally preferred products that were fragrance-free and made for sensitive skin. Lower-income households reported a higher frequency of product use and were less likely to purchase fragrance-free products or ones that were made for sensitive skin. Our findings suggest that the prevalence of pediatric skin care product use is high and conflicts with current recommended skin care guidelines. Product use and preferences may also vary according to race and ethnicity and household income level.

Peripheral Intravenous Catheter Extravasation Wound Care Guidelines

The hospital peripheral intravenous (PIV) infiltration and extravasation protocol was developed in 2005 and outlined clear guidelines for treatment, assessment, and documentation requirements. The care of infiltration/extravasation wounds primarily resulting from Stage 3–4 infiltrations was identified as being inconsistent. In the hospitalized neonatal patient with a PIV extravasation, what is the best practice for managing extravasation wounds to minimize tissue damage and optimize wound healing? An evidence-based practice project team composed of nurses representing the neonatal intensive care unit, infant medical–surgical unit, surgical services, and WOCN was developed. The Johns Hopkins Nursing Evidence-Based Practice model was used. Literature search and evidence appraisal were completed for the past 15 years. Expert opinion evidence was provided by the WOCN team member. One neonatal clinical practice guideline addressing intravenous infiltration was found (Association, 2007Association of Women's Health, Obstetric and Neonatal Nurses Evidence based clinical practice guideline: Intravenous infiltration.in: 2nd ed. Neonatal skin care guidelines. Author, Washington, DC2007: 53-74Google Scholar) representing Level I evidence. The extravasation wound care section of this guideline was supported by Level IV and V evidence. Several additional studies were reviewed with similar evidence levels. Using the Oncology Nursing Society's evidence classification schema, the body of evidence was determined to be “interventions recommended for practice and/or likely to be effective.” An evidence-based standard of practice with algorithm was developed to guide wound care for three potential wound types: (a) closed with blister, (b) open and dry, and (c) open and moist/exudate. This algorithm was pilot tested in the neonatal intensive care unit. Based on nurses' feedback, small changes were made to the guideline during the pilot test. The practice standard will be reviewed by the Clinical Practice Council for potential hospital-wide implementation.

Clinical trial design—effect of prone positioning on clinical outcomes in infants and children with acute respiratory distress syndrome

Purpose This paper describes the methodology of a clinical trial of prone positioning in pediatric patients with acute lung injury (ALI). Nonrandomized studies suggest that prone positioning improves oxygenation in patients with ALI/acute respiratory distress syndrome without the risk of serious iatrogenic injury. It is not known if these improvements in oxygenation result in improvements in clinical outcomes. A clinical trial was needed to answer this question. Materials and Methods The pediatric prone study is a multicenter, randomized, noncrossover, controlled clinical trial. The trial is designed to test the hypothesis that at the end of 28 days, children with ALI treated with prone positioning will have more ventilator-free days than children treated with supine positioning. Secondary end points include the time to recovery of lung injury, organ failure–free days, functional outcome, adverse events, and mortality from all causes. Pediatric patients, 42 weeks postconceptual age to 18 years of age, are enrolled within 48 hours of meeting ALI criteria. Patients randomized to the prone group are positioned prone within 4 hours of randomization and remain prone for 20 hours each day during the acute phase of their illness for a maximum of 7 days. Both groups are managed according to ventilator protocol, extubation readiness testing, and sedation protocols and hemodynamic, nutrition, and skin care guidelines. Conclusions This paper describes the process, multidisciplinary input, and procedures used to support the design of the clinical trial, as well as the challenges faced by the clinical scientists during the conduct of the clinical trial.

Early adaptation of human skin following birth: a biophysical assessment

Background/aims: Successful adaptation to postnatal life requires rapid physiological transitions in multiple organ systems. Mechanisms regulating stratum corneum water interactions and evaporative heat loss, for example, are pivotal in making the transition from the warm, aqueous prenatal state to a cold, dry postnatal environment. Understanding these mechanisms is important in formulating skin care guidelines in early infancy.Methods: One hundred and one full term infants were enrolled prospectively and evaluated in three maternity hospitals over the first few hours after birth. Skin surface electrical capacitance and optical imaging were performed over selected body sites after placement under a radiant warming device. A selected group of infants were occluded with a plastic wrap following towel drying in the delivery room. Specific measurements included baseline skin hydration, continuous capacitive reactance, peak water sorption, rate of water desorption, skin pH, and grading of optical images for abnormal skin desquamation.Results: Occlusion of the skin surface following birth delays the normal fall in surface hydration and transepidermal water movement (TEWM). Sites exposed to the radiant warmer (chest) exhibited decreased hydration and increased pH compared to non‐exposed sites (back). Desquamation was increased over the chest compared to the back as judged by optical image grades. Significant inverse correlations were noted between baseline skin hydration and the ability to desorb surface water. Unexpectedly, females exhibited significantly increased desorption of exogenously applied water with a near significant increase in maternal‐infant bonding time.Conclusions: Newborn infant stratum corneum undergoes a slow (minutes to hours) diminution in surface hydration following birth; this is a function of body site, position, and exposure to the radiant warmer. Practices such as occlusion of the skin surface at birth delay the normal drying process. The data support potential gender specific differences in skin surface water handling and/or delivery room practices. Focus on the complex process of newborn skin adaptation provides a physiological framework for skin care protocols extending into infancy, childhood, and later life.