A new in vivo test method to compare wound dressing fluid handling characteristics and wear time.

A refined in vivo artificial wound model utilizing artificial wound fluid (AWF) was developed to overcome important limitations such as adhesive-skin interactions, movement, pressure, shear, and varying environmental conditions in in vitro models. Using this model, a study with primary endpoints of wear time and fluid handling capacity was conducted to compare two foam dressings: a high performance (HPF) dressing and an adhesive dressing (AAF). A 10-cm(2) artificial wound bed, created using a nonstick absorbent pad, was applied to the lower back of 24 healthy volunteers and the tip of a 23-gauge catheter was inserted into the pad to administer AWF. The pad and catheter were secured in place with paper tape and covered with the test dressings. This model and 1.0-mL AWF infusions every 12 hours was used to simulate highly exudating wounds. The HPF dressing absorbed 75% more fluid before failure and remained intact for a median of 6.1 days compared to 3.5 days for the AAF dressing (P <0.001, Cox proportional hazard model). Comparisons between dressing outcomes using this model and previously published in vitro results suggest the model may be valid and reliable. Studies to ascertain the ability of this model to predict clinical dressing performance and research to compare other wound outcomes that affect dressing change frequency and cost (eg, healing) are needed.

Assessment of diaper-clogging potential of petrolatum moisture barriers.

Petrolatum-based ointments often are used to treat and prevent incontinence dermatitis. However, anecdotal reports indicate that petrolatum ointments may affect the absorbency of disposable briefs also commonly used in incontinence management. To examine whether petrolatum ointments clog a commonly used absorbent brief, a randomized, balanced-block design study was conducted in a controlled laboratory setting to compare the brief-clogging potential of three petrolatum ointments to a non-alcohol barrier film. Test products were applied to 6-cm x 6-cm test sites on the volar forearms of 16 volunteers. Pre-weighed mini briefs were applied to the test sites in a manner that simulates normal brief wear. After 5 minutes of wear, the mini briefs were weighed to determine percent of product transfer from skin to mini brief. The mini briefs then were reapplied to the same test sites and a synthetic urine solution was introduced between the skin and the mini brief. Mini briefs subsequently were removed to determine fluid uptake by weight. Results indicate significant differences between the four test products (P < 0.01) both in percent transfer and in mini brief fluid absorption. From 59% to 69% of the petrolatum-based products transferred from the skin to the mini briefs and a 54% to 90% reduction in fluid uptake was noted, as determined by weight. The non-alcohol barrier film did not transfer to the mini brief and fluid uptake was minimally affected. Further study in the clinical and practice settings to determine the effect and consequences of barrier product transfer on absorbent garments is warranted.

A comparison of cost and efficacy of three incontinence skin barrier products.

Maintaining healthy, intact perineal skin in nursing home residents with incontinence is a challenge. Their condition puts them at risk for developing incontinence dermatitis, possibly predisposing them to develop pressure ulcers. To examine the cost-effectiveness of three perineal skin barriers (a polymer-based barrier film and two petrolatum ointments) used to prevent incontinence dermatitis, a 6-month descriptive study was conducted among residents (N = 250) from four long-term care facilities (nursing homes) in the upper Midwestern US. All residents were incontinent and had intact perineal skin when they enrolled in the study. An economic analysis was performed using time-motion data from a convenience sample of enrolled residents and their caregivers. Residents had an average of 4.1 (+/-2.307) incontinent episodes per day, the occurrence of incontinence dermatitis was 3.3 % and not significantly different between the different protocols of care (P = 0.4448). Results of the economic analysis showed that daily barrier application costs ranged from $0.17 for the barrier film to $0.76 for the ointments evaluated. With labor included in the analysis, costs were also lower for the barrier film that required the least frequent application ($0.26) compared to ointments that required more frequent application ($1.40). Results of this study suggest that the daily or three times weekly barrier film protocols are affordable alternatives to using petrolatum ointments in the prevention of incontinence dermatitis.