Economic comparison of methods of wound closure: wound closure strips vs. sutures and wound adhesives.

Our objective was to review and assess the treatment of low-tension wounds and evaluate the cost-effectiveness of wound closure methods. We used a health economic model to estimate cost/closure of adhesive wound closure strips, tissue adhesives and sutures. The model incorporated cost-driving variables: application time, costs and the likelihood and costs of dehiscence and infection. The model was populated with variable estimates derived from the literature. Cost estimates and cosmetic results were compared. Parameter values were estimated using national healthcare and labour statistics. Sensitivity analyses were used to verify the results. Our analysis suggests that adhesive wound closure strips had the lowest average cost per laceration ($7.54), the lowest cost per infected laceration ($53.40) and the lowest cost per laceration with dehiscence ($25.40). The costs for sutures were $24.11, $69.91 and $41.91, respectively; the costs for tissue adhesives were $28.77, $74.68 and $46.68, respectively. The cosmetic outcome for all three treatments was equivalent. We conclude adhesive wound closure strips were both a cost-saving and a cost-effective alternative to sutures and tissue adhesives in the closure of low-tension lacerations.

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.