This review is used to support national practice recommendations on hair removal by the Association for Perioperative Practice (AfPP Standards and Recommendations for Safe Perioperative Practice 2007, Harrogate, AfPP Publishing). This review is also included in the draft version of the NICE surgical site infection guidelines

Preoperative hair removal to reduce surgical site infection

http://www.thinktag.it/system/files/711/ricerca_art.pdf?1292011494

Preoperative hair removal to reduce surgical site infection (Review)

In 2009, a multinational group of clinicians was charged with reviewing and evaluating the research base pertaining to incontinence-associated dermatitis (IAD) and synthesizing this knowledge into best practice recommendations based on existing evidence. This is the first of 2 articles focusing on IAD; it updates current research and identifies persistent gaps in our knowledge. Our literature review revealed a small but growing body of evidence that provides additional insight into the epidemiology, etiology, and pathophysiology of IAD when compared to the review generated by the first IAD consensus group convened 5 years earlier. We identified research supporting the use of a defined skin care regimen based on principles of gentle perineal cleansing, moisturization, and application of a skin protectant. Clinical experience also supports application of an antifungal powder, ointment, or cream in patients with evidence of cutaneous candidiasis, aggressive containment of urinary or fecal incontinence, and highly selective use of a mild topical anti-inflammatory product in selected cases. The panel concluded that research remains limited and additional studies are urgently needed to enhance our understanding of IAD and to establish evidence-based protocols for its prevention and treatment.

Incontinence-associated dermatitis: a comprehensive review and update.

Background Pressure ulcers are associated with substantial health burdens but may be preventable. Purpose To review the clinical utility of pressure ulcer risk assessment instruments and the comparative effectiveness of preventive interventions in persons at higher risk. Data sources MEDLINE (1946 through November 2012), CINAHL, the Cochrane Library, grant databases, clinical trial registries, and reference lists. Study selection Randomized trials and observational studies on effects of using risk assessment on clinical outcomes and randomized trials of preventive interventions on clinical outcomes. Data extraction Multiple investigators abstracted and checked study details and quality using predefined criteria. Data synthesis One good-quality trial found no evidence that use of a pressure ulcer risk assessment instrument, with or without a protocolized intervention strategy based on assessed risk, reduces risk for incident pressure ulcers compared with less standardized risk assessment based on nurses' clinical judgment. In higher-risk populations, 1 good-quality and 4 fair-quality randomized trials found that more advanced static support surfaces were associated with lower risk for pressure ulcers compared with standard mattresses (relative risk range, 0.20 to 0.60). Evidence on the effectiveness of low-air-loss and alternating-air mattresses was limited, with some trials showing no clear differences from advanced static support surfaces. Evidence on the effectiveness of nutritional supplementation, repositioning, and skin care interventions versus usual care was limited and had methodological shortcomings, precluding strong conclusions. Limitation Only English-language articles were included, publication bias could not be formally assessed, and most studies had methodological shortcomings. Conclusion More advanced static support surfaces are more effective than standard mattresses for preventing ulcers in higher-risk populations. The effectiveness of formal risk assessment instruments and associated intervention protocols compared with less standardized assessment methods and the effectiveness of other preventive interventions compared with usual care have not been clearly established.

Pressure ulcer risk assessment and prevention: A systematic comparative effectiveness review

The great diversity of wounds and the broad range of available dressings complicate the selection of proper chronic wound treatment. Choosing the right treatment is the essential step in the healing process. In this review, we focus on chronic nonhealing ulcers, which are a critical problem in clinical practice, and current knowledge about persistent wound care. Here, we present the objectives of local treatment with description of several types of dressings and their ingredients, features, indications, and contraindications. These include hydrocolloid, alginate, hydrogel, and dextranomer dressings; polyurethane foam and membrane dressings; semipermeable polyurethane membrane dressings; and TenderWet (Hartmann, Rock Hill, SC) and flax dressings. There is also a brief section on the use of other alternative wound-healing accelerators, such as platelet-rich plasma and light-emitting diode therapy.

https://www.jaad.org/article/S0190-9622(11)00836-X/pdf

The local treatment and available dressings designed for chronic wounds

It is estimated that 30% of nursing home residents may be faecally incontinent, with those figures rising to 60% for patients in long-stay hospitals (Royal College of Physicians, 1995). Maintaining skin integrity for these patients can be complex. With little clinical information to support carers, choosing a skin care regime that maintains skin integrity for this high-risk group can be difficult. This study aims to compare two recognized skin care regimes, used in the cleansing of patients' skin following an episode of incontinence, and their impact on patients' skin integrity. A total of 93 patients were recruited to the trial from five care of the elderly or dependent service providers. The subjects were randomly allocated to either group A (soap and water; n = 49), or group B (Clinisan (Vernacare); n = 44). Initially, 33 patients in both groups started with healthy skin. However, the results of the final assessment identified only 17 subjects in group A remaining healthy, compared with 27 in group B.

Comparison of two skin care regimes for incontinence.

Nurse Specialists in Tissue Viability, Department of Tissue Viability, Aberdeen Royal Infirmary, Aberdeen Healthy intact skin acts as a barrier to pathogens, trauma, irritants and ultraviolet (UV) light. As individuals grow older, their skin ages and becomes less able to deal with the potential irritants, chemicals and trauma that healthy skin has to manage every day (Butcher and Whyte, 2005). The skin becomes increasingly vulnerable and sensitive and maintaining its integrity can be a daily challenge. As people are generally living longer, healthcare professionals will find themselves increasingly caring for individuals with age-related disease and its associated side-effects. grazes and are prone to bleeding 8 The caustic effect of urine and faeces increases the pH of the skin in the peri-anal area, which in turn increases the irritant effect on the skin leading to the large areas of excoriation observed in individuals who are faecally or doubly incontinent 8 Maceration of the skin due to excess moisture, combined with bacterial and enzymatic activity, can result in the breakdown of vulnerable skin.

Comparing Tena Wash Mousse with Clinisan Foam Cleanser: the results of a comparative study

The use of skin care regimes for the cleansing of skin when a patient has been incontinent is becoming accepted practice in maintaining healthy skin. Clinisan, produced by Venture Healthcare, is a soap-free, pH balanced foam which has been specifically formulated to cleanse the skin of incontinent patients who are vulnerable to skin breakdown.

The use of Clinisan in the skin care of the incontinent patient

The use of moisture-retentive dressings (dressings that are capable of maintaining a warm moist environment) has been shown to provide the optimal environment for wound healing, accelerating the healing process and promoting tissue growth. TenderWet, produced by Paul Hartmann, is an innovative dressing that not only provides a moist warm environment but also incorporates the unique properties of Ringer's solution which actively cleanses (debrides) the wound.

TenderWet: an innovation in moist wound healing

Aims: To assess the efficacy of two dressing regimens for the management of skin tears in fragile skin of the elderly. Methods: A pilot study of 21 patients was conducted across two centres. Ten patients were treated with Tegaderm® Absorbent (3M Health Care) dressing and 11 with a combination of Mepitel® and Mepilex® Border (Molnlycke Health Care) dressings. Results: Both dressing regimens had positive clinical outcomes. Where the smaller size dressings were used, the cost differences between the groups were minimal. However, in cases where larger dressings were required, Tegaderm Absorbent proved more cost-effective. Conclusions: The authors found that both methods of treating skin tears had positive clinical outcomes, with healing or progression towards healing in all of the cases. Recruiting subjects for the study was challenging, suggesting that clinical audit may prove a more useful method of evaluation for investigators in the future. Conflict of interest: None.

Pilot RCT of two dressing regimens for the management of skin tears

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