Riesgo y deterioro de la integridad cutánea en el área del pañal en el lactante. Revisión de la literatura / Risk and deterioration of cutaneous integrity of the diaper area. What do we know? Review of literature

Objetivo. Sintetizar la evidencia existente sobre las afecciones en el área de pañal respecto a las intervenciones enfermeras a partir de los resultados de estudios empíricos. Metodología. Revisión de la litera-tura con método Scoping Review en las bases PubMed, LiLACS, Cuiden y en las bibliotecas Cochrane y SciELO. Se incluyeron artículos de investigación originales sobre las afecciones de la zona de pañal. Criterios de inclusión: Niños 0-24 meses con riesgo o afectación de la piel del área del pañal, ámbito hospitalario, domiciliario o Atención Primaria. Castellano-inglés-portugués. Últimos diez años. Criterios de exclusión: adultos, diagnóstico diferencial y uso de productos tópicos con marca registrada y/o conflicto de intereses. Criterios de calidad metodológica: la pregunta de investigación se estructura en formato PICO; Declaración PRISMA; Escala Jadad para ECA, herramienta CASPe para revisión narrativa y cohortes y clasificación CEBM. Se utilizaron los DeCS Enfermedades de la Piel, Dermatitis del Pañal, Dermatitis Irritante Atención de Enfermería, Diagnóstico de Enfermería Cuidados de la Piel, Enfermería Basada en la Evidencia, Enfermería de Práctica Avanzada y correspondientes términos MeSH. Resultados. Se analizaron 23 artículos publicados entre 2007 y 2017: 3 descriptivos, 7 revisiones de la literatura, 3 scoping review, 1 estudio de cohorte y 9 ECAs. Del análisis de los contenidos resultaron siete categorías: cuidados de la piel, factores protectores y abordaje, factores de riesgo, leche maternal, aplicación tópica de productos naturales y productos de barrera. Conclusión. Existe gran variabilidad en el abordaje de las afecciones de la piel en el área del pañal del lactante realizándose de forma experimental y aleatoria. Relevancia clínica: necesidad de implementación de protocolos de las intervenciones enfermeras para la prevención y cuidados de las lesiones cutáneas en el área del pañal en la edad pediátrica

Objective. To synthesize the existing evidence regarding the diaper area affections and the nursing interventions based on the results of empirical studies. Methodology. Review of the literature with the scoping review method in the PubMed, LiLACS, Cuiden databases and in the Cochrane and SciELO libraries. Original research articles on the conditions of the diaper area were included. Inclusion criteria. Children 0-24 months with risk or rash of the skin of the diaper area, hospital, home or primary care. Spanish-English-Portuguese. Last ten years. Exclusion criteria: adults, differential diagnosis and use of topical products with registered trademark and / or conflict of interests. Methodological quality criteria: The research question is structured in PICO format; PRISMA statement; Jadad scale for ECA; CASPe tool for narrative review and cohorts and CEBM classification. The decs used are Skin Diseases, Diaper Dermatitis, Irritant Dermatitis, Nursing Care, Nursing Diagnosis Skin Care, Evidence Based Nursing, Advanced Practice Nursing and corresponding MeSH terms. Results. 23 articles published between 2007 and 2017 were analyzed: 3 descriptive articles, 7 reviews of the literature, 3 scoping reviews, 1 cohort study and 9 ECAs. The analysis resulted in 7 categories: skin care, protective factors and approach, risk factors, maternal milk, topical application of natural products and barrier products. Conclusions. Great variability of results. Approach carried out experimentally and randomly. Clinical relevance: protocolization of nursing interventions for the prevention and care of skin lesions in the diaper area in the pediatric age

Heridas en pediatría: Úlceras por presión, dermatitis asociada a incontinencia y lesiones por extravasación / Pediatric wounds: pressure ulcers, incontinence associated dermatitis and extravasation injures

En comparación con los adultos, la piel de los pacientes pediátricos presenta importantes diferencias que les hacen susceptibles de padecer determinadas lesiones con mayor facilidad, especialmente los neonatos. Entre ellas destacan las úlceras por presión (UPP), las dermatitis asociadas a incontinencia (DAI) y las lesiones por extravasación periférica. En todas ellas el papel de la enfermera es vital. El presente artículo describe y aporta pautas de actuación basadas en las últimas evidencias científicas para el diagnóstico precoz, la prevención y el tratamiento de estas lesiones que sirvan de ayuda a las enfermeras que atienden población pediátrica que presenta o tiene riesgo de presentar estas lesiones

Comparing to adults, children's skin has important differences that make them liable to suffer some skin lesions easily, specially neonates. Among these lesions stand out pressure ulcers, incontinence associated dermatitis and extravasation injuries. In all of them Nursing rol is vital. This article describes and provide standards of practice based in last scientific evidences for early diagnosis, prevention and treatment that are useful to nurses who cares pediatric patients with or at risk of these lesions

Intervenciones de enfermería en la dermatitis asociada a la incontinencia-revisión integradora de la literatura / Intervenções de enfermagem na dermatite associada à incontinência-revisão integrativa da literatura / Nursing interventions in incontinence-associated dermatitis-integrative literature review

Introducción: La dermatitis asociada a la incontinencia se define como el daño de la piel asociado a la exposición de orina y/o heces, un tipo de dermatitis irritativa de contacto, que causa gran incomodidad y dolor y tiene tratamiento difícil, a largo plazo y caro. El objetivo principal pasa por identificar y adoptar intervenciones en la prevención, gestión y tratamiento de la dermatitis asociada a la incontinencia. Método: El método utilizado ha sido una revisión integradora de la literatura, realizada en las bases de datos establecidas: EBSCO Host Web - CINAHL Plus, MEDLINE y BOn, utilizando los descriptores 'nurse', 'nurse care' e 'incontinence associated dermatitis' y el carácter booleano 'and'. La cuestión central de esta revisión ha sido: ¿Cuáles son los cuidados de enfermería más adecuados a la dermatitis asociada a la incontinencia?. Resultados: Los resultados han sido seleccionados en tres dimensiones: I. Una primera que aclara la caracterización de la dermatitis asociada a la incontinencia efectuada en torno a dos categorías (definición de dermatitis asociada a la incontinencia y diferenciación de dermatitis asociada a la incontinencia/úlcera por presión), II. Relacionada con las cuestiones de diagnóstico y evaluación y III. Sobre las intervenciones adecuadas para la prestación de cuidados de calidad y que se ha subdividido en tres categorías (prevención, tratamiento, enseñanza y formación). Conclusión: La naturaleza comprensiva de la revisión integradora nos reveló la necesidad de inversión en la formación y adopción de una práctica basada en la evidencia que nos lleve a una prestación de cuidados de enfermería de calidad superior

Introdução: A dermatite associada à incontinência define-se como o dano da pele associado à exposição de urina e/ou fezes. É caracterizada por um tipo de dermatite irritativa de contacto que causa grande desconforto e dor, sendo de difícil tratamento, prolongado e caro. O objetivo principal passa por identificar intervenções a adotar na prevenção, gestão e tratamento da dermatite associada à incontinência. Método: O método utilizado foi a revisão integrativa da literatura, realizada nas bases de dados estabelecidas: EBSCO Host Web-CINAHL Plus, MEDLINE e BOn, utilizando os descritores 'nurse', 'nurse care' e 'incontinence associated dermatitis', auxiliando a pesquisa com o caracter booleano 'and'. A questão central desta revisão foi: 'Quais os cuidados de enfermagem mais adequados à dermatite associada à incontinência?'. Resultados: Foram selecionados onze artigos, cujos resultados foram agrupados em três dimensões: I. a primeira apresenta-nos a caracterização da dermatite associada à incontinência efetuada em torno de duas categorias (definição de dermatite associada à incontinência e diferenciação de dermatite associada à incontinência/úlcera por pressão), II. relacionada com as questões do diagnóstico e avaliação e III. sobre as intervenções adequadas a uma prestação de cuidados com qualidade e que se subdividiu em três categorias (prevenção, tratamento, ensino e formação). Conclusão: A natureza compreensiva da revisão integrativa revelou-nos a necessidade de investimento na formação e adoção de uma prática baseada na evidência, que nos leve a uma prestação de cuidados de enfermagem de qualidade superior

Introduction: Dermatitis associated to Incontinence is defined as a damage of the skin connected to the exposure to urine and/or faeces, a type of contact dermatitis, which causes a great discomfort and pain, that has a difficult treatment, extended in time and expensive. The main goal is the identification of the interventions to adopt in the prevention, management and treatment of the dermatitis associated to incontinence. Methods: The used method is the integrative review of literature, performed in established data bases: EBSCO host Web - CINAHL Plus, MEDLINE and Bon. The main question of this review was: 'Which are the most adequate nursing care to incontinence associated dermatitis?'. Results: Eleven articles were selected and the results were grouped into three dimensions: I. the first presents the characterization of incontinence-associated dermatitis around two categories (definition of incontinence associated dermatitis and differentiation of incontinence / pressure ulcer), II. Related to the issues of diagnosis and evaluation and III. On interventions appropriate to quality care and divided into three categories (prevention, treatment, education and training). Conclusion: The comprehensive nature of the integrative review has revealed to us the need for investment in training and adoption of an evidence-based practice that will lead us to a higher quality nursing care

Dermatite associada à incontinência em idosos hospitalizados: conhecimento autorreferido de enfermeiros / Incontinence-associated dermatitis in hospitalized elderly patients: nurses' self-reported knowledge la dermatitis asociados con / La incontinencia en ancianos hospitalizados: percepción subjetiva de conocimiento del enfermero

Objetivo: Identificar los conocimientos de auto-reporte de las enfermeras en cuanto a la prevención, el diagnóstico y el tratamiento de la dermatitis asociada a la incontinencia (DAI) en ancianos hospitalizados y proponer la construcción de un protocolo de cuidados de enfermería de diagrama de flujo. Métodos: Este exploratorio, descriptivo cualitativo, a través de entrevistas semiestructuradas con enfermeros de unidades de un hospital en la segunda mitad de 2016. Los datos de las entrevistas fueron analizados mediante el análisis temático. Resultados: presentado en tres categorías: Admisión de la Tercera Edad y prevenir la DAI: La mayoría de la clientela es de edad avanzada, en la que la adopción de la higiene y la aplicación de barrera consiste en la prevención; El diagnóstico de la DAI en los ancianos: Sin darse cuenta de la puesta en escena de la DAI; El tratamiento de la DAI: Incluye dispositivos que eviten el contacto con la piel eliminaciones dificultades para diferenciar las categorías de lesiones existentes. Conclusión: La falta de uniformidad entre las enfermeras sobre los productos que tratan la piel con DAI

Objetivo: Identificar o conhecimento autorreferido dos enfermeiros em relação a prevenção, diagnóstico e tratamento da dermatite associada a incontinência (DAI) em idosos hospitalizados e propor a construção de um protocolo de cuidados de enfermagem a partir de fluxograma. Métodos: Pesquisa exploratória descritiva, qualitativa, através de entrevista semiestruturada com enfermeiros de unidades de um hospital, no segundo semestre de 2016. Os dados das entrevistas foram analisados mediante análise temática. Resultados: Apresentados em três categorias: Admissão do idoso e prevenção da DAI: A maioria da clientela é idosa, na qual a adoção de medidas de higiene e aplicação de barreira consistem na prevenção; Diagnóstico da DAI no idoso: Desconhecem o estadiamento da DAI; Tratamento da DAI: Inclui dispositivos que evitam o contato das eliminações com a pele existindo dificuldades em diferenciar as categorias da lesão. Conclusão: Ausência de uniformização entre os enfermeiros acerca dos produtos que tratam a pele com DAI

Objective: Identifying the self-reported knowledge of nurses concerning the prevention, diagnosis, and treatment of incontinence-associated dermatitis (IAD) in hospitalized elderly patients, as well as proposing the construction of a nursing care protocol based on a flowchart. Methods: Descriptive and qualitative exploratory research through a semi-structured interview with hospital nurse professionals in the second semester of 2016. Interview data were analyzed through thematic analysis. Results: Presented in three categories: Elderly Admission and IAD Prevention: The majority of the clientele is elderly people, for whom the adoption of hygiene care and barrier application consist in prevention; IAD Diagnosis in elderly people: They do not know the staging of the IAD; IAD Treatment: It includes devices that avoid the contact of the eliminations with the skin, in which there have been difficulties in differentiating the injury categories. Conclusion: There was no consistency among the nurses about the products that should treat the skin with IAD

Efeito da pomada de óxido de zinco e da película de barreira não irritante na prevenção da dermatite associada à incontinência em idosos hospitalizados: ensaio clínico randomizado / Effect of zinc oxide ointment and non-irritant barrier film on the prevention of incontinence-associated dermatitis in hospitalized elderly: a randomized clinical trial

Observa-se na prática clínica pacientes internados com Dermatite Associada à Incontinência (DAI), uma inflamação cutânea que ocorre como consequência do contato entre a pele perineal, perigenital, perianal e áreas adjacentes com urina e fezes, além de epiderme com erosão e maceração. O cuidado com a prevenção deve ser estabelecido, mas pouco se sabe sobre esse cuidado. É necessário evitar ou minimizar a exposição a fatores causais e uma combinação de cuidados específicos da pele, como a limpeza da região, aplicação de produtos barreira. Normalmente, são utilizados sabão e água e é aplicado a pomada de óxido de zinco, um creme de barreira. No entanto, desde a década de 1990, uma película de barreira não irritante (PBNI), livre de álcool foi projetado para proteger a pele. O objetivo deste estudo foi comparar o efeito do uso de pomada de óxido de zinco e PBNI na prevenção de DAI em pacientes incontinentes internados em unidades de clínica médica. É um estudo experimental, do tipo ensaio clínico randomizado realizado em um hospital geral, de grande porte, público e de ensino. A população do estudo foi constituída por 114 pacientes idosos, que apresentavam eliminações urinárias e fecais em fralda descartável. Foram definidos três grupos de estudo, com 38 paciente em cada grupo: controle com o uso da higienização com água e sabão, intervenção I com a higienização e aplicação da pomada de óxido de zinco e intervenção II com higienização e aplicação do PBNI spray. Para a análise descritiva, foram utilizadas as distribuições de frequência simples, medidas de tendência central e medidas de variabilidade; para a avaliação do efeito das intervenções, o teste de regressão de Cox. Quanto ao efeito dos tratamentos sobre o risco de adquirir a DAI, identificou-se que os pacientes que receberam a intervenção II apresentaram menor risco (HR=0,54; p= 0,183) quando comparado ao grupo que recebeu intervenção I (HR=1,06; p=0,895) e ao grupo que recebeu somente a higienização. Contudo, não se encontrou diferença estatisticamente significativa entre os dois grupos de intervenção e o controle, não sendo possível afirmar qual a melhor intervenção. As variáveis que tiveram influência no aparecimento da DAI foram: dias de uso de tamanho adequado da fralda, número de dias de fezes pastosas, pacientes em risco nutricional e nível de saturação de oxigênio, sendo, portanto, fatores que devem ser monitorados pela enfermagem para evitar o surgimento do problema.(AU)

It is observed in clinical practice patients hospitalized with Incontinence-Associated Dermatitis (IAD), a cutaneous inflammation that occurs as a consequence of the contact between the perineal, perigenital, perianal skin and adjacent areas with urine and feces, as well as epidermis with erosion and maceration. Care with prevention should be established, but little is known about such care. It is necessary to avoid or minimize exposure to causative factors and a combination of specific skin care, such as cleaning the region, applying barrier products. Usually, soap and water are used and it is applied to zinc oxide ointment, a barrier cream. However, since the 1990s, a non-irritating barrier film (NIBF), alcohol-free was designed to protect the skin. The objective of this study was to compare the effect of the use of zinc oxide ointment and NIBF in the prevention of IAD in incontinent patients hospitalized in medical clinic units. It is an experimental study, of the type randomized clinical trial conducted in a general hospital, large, public and teaching. The study population consisted of 114 elderly patients, who had urinary and fecal eliminations in a disposable diaper. Three study groups were defined, with 38 patients in each group: control with the use of soap and water hygiene, intervention I with the hygiene and application of the zinc oxide ointment and intervention II with hygiene and application of NIBF spray. For the descriptive analysis, we used the simple frequency distributions, measures of central tendency and measures of variability; for the evaluation of the effect of the interventions, the Cox regression test. Regarding the effect of the treatments on the risk of acquiring the IAD, it was identified that the patients who received the intervention II had a lower risk (HR = 0.54; p = 0,183) when compared to the group that received intervention I (HR = 1.06, p = 0.895) and the group that received only the hygiene. However, no statistically significant difference was found between the two intervention groups and the control, and it was not possible to state the best intervention. The variables that influenced the appearance of IAD were: days of adequate diaper size, number of days of pasty stools, patients at nutritional risk and oxygen saturation level, and therefore, factors that should be monitored by nursing to prevent the problem from arising.

Incontinence-associated dermatitis: a cohort study in critically ill patients. / Dermatite associada à incontinência: estudo de coorte em pacientes críticos.

OBJECTIVES: Estimate incidence, determine risk factors and propose a prediction model for the development of incontinence- associated dermatitis critically ill adult patients. METHOD: Concurrent cohort study with 157 critically ill patients. Data collection was daily performed between February and July 2015, at a public teaching hospital of Belo Horizonte, Minas Gerais. Data was entered in a database and subjected to descriptive, survival and multivariate analysis. RESULTS: An overall incidence of 20.4% was obtained. Nineteen (19) risk factors significantly associated with the disorder were found. The variables identified in the risk prediction model were male, trauma, use of hypnotics/sedatives, lactulose, nutritional support, loose stools and complaints of burning. CONCLUSION: The results showed that dermatitis is a common clinical finding in critically ill adult patients and requires special attention from the nursing staff.

Construcción de un instrumento de valoración del riesgo y gravedad de las lesiones del área del pañal en lactantes RDIC-lac / Construction of an instrument of risk assessment and injury severity for the diaper area in infants: RDIC-lac

Objetivo. Diseño de una escala para valorar el deterioro de la integridad cutánea en el área del pañal del lactante y la gravedad de la lesión para la prevención y manejo de la dermatitis irritativa de pañal. Metodología. Estudio en 3 etapas: 1) revisión exhaustiva y lectura crítica de literatura para el diseño preliminar del instrumento; 2) evaluación crítica de propuesta inicial por grupo de expertos (enfermería y medicina pediátrica) con cuestionarios de opinión y guía de preguntas ad hoc; 3) análisis de contenido mediante tabulación de datos para la modificación y diseño final del instrumento. Ámbito. Gerencia de Atención Primaria de Tenerife. Resultados. En la 1.ª fase se diseña una propuesta de instrumento: dos grupos de factores de riesgo (10 moduladores del riesgo y 9 de alto riesgo) y escala de gravedad con 5 aspectos a valorar de 4-5 ítems cada uno (profundidad, localización, extensión, tipo de lesión, signos de infección). En la 2.ª fase participan 19 profesionales. Se realiza una tabulación de los datos agrupados en factores a añadir u omitir. La 3.ª fase finaliza con una versión del instrumento modificada: 10 factores moduladores, 5 de alto riesgo y 4 ítems para cada aspecto a valorar en escala de gravedad. Discusión-Conclusiones. La escasa bibliografía encontrada y la ausencia de herramientas similares justificaron el diseño. La siguiente fase será la validación del instrumento RDIC-lac. Relevancia clínica. Susceptibilidad de prevenir lesiones cutáneas en el área del pañal en la edad pediátrica (AU)

Objective. To design an instrument to measure impairment of skin integrity in the diaper area of infants and severity of injury for the prevention and management of irritative diaper dermatitis. Methodology. Design in 3 phases: 1) comprehensive review and critical appraisal of literature to design the preliminary content of the instrument; 2) critical evaluation of initial proposal by an expert group (nursing and pediatric medicine) with opinion survey and ad hoc questions; 3) content analysis using data tabulation for the modification and final design of the instrument. Setting. Primary Care Management of Tenerife Results. In the 1st phase a proposed instrument is designed: two groups of risk factors (10 modulators risk and 9 high risk); and a severity scale with 5 aspects to assess including 4-5 items each (depth, location, extension, type of injury, signs of infection). The 2nd phase involved 19 professionals. A Tabulation of the data grouped into add or omit factors was used. The 3rd phase ends with a modified version of the instrument: 10 modulating factors, 5 of hig risk and 4 items for each aspect to assess severity. Discussion-Conclusions. The scarce bibliography found and the absence of similar tools explain the design. The next phase will be the validation of RDIC-lac instrument. Clinical relevance. Susceptibility to prevent skin lesions in the diaper area in the pediatric age (AU)

[Local barrier creams for skin care in newborns, infants and toddlers with incontinence-associated dermatitis (IAD) ­ Narrative Review] / Lokale Barrierecremes zur Hautpflege bei Neugeborenen, Säuglingen und Kleinkindern mit Inkontinenz-assoziierter Dermatitis (IAD) ­ Eine narrative Literaturübersicht.

Background: The incontinence-associated dermatitis (IAD) is a common condition in newborns, infants and toddlers. For the therapy nurses and parents have the choice between numerous barrier creams based on zinc oxide, Dexpanthenol or Vaseline in various combinations of active agents and with additional ingredients. Research question: Which combination of active ingredients in local barrier creams reduce pain, severity of or duration of healing in IAD in neonates, infants and young children? Method: MEDLINE and CINAHL was systematically search for randomized controlled trials on the effect of barrier creams in pediatric patients with IAD. These were evaluated on validity and applicability. Results: 15 RCTs were found, of which six were included in the systematic review. The methodological quality of these trials ranges from good to poor, partially high bias risk were recognizable. Barrier creams containing the active ingredients zinc oxide / lanolin, zinc oxide / cod liver oil, zinc oxide / Dexpanthenol, paraffin / beeswax / Dexpanthenol show effects. They reduce the IAD-associated symptoms. Conclusions: The investigated barrier creams can be used in the pediatric nursing for the treatment of IAD. Because of limitations it cannot be ruled out that further studies will change the results.

Dermatite associada à incontinência: estudo de coorte em pacientes críticos / Dermatitis asociada con incontinencia: estudio de cohorte en pacientes críticos / Incontinence-associated dermatitis: a cohort study in critically ill patients

RESUMO Objetivos Estimar incidência, determinar fatores de risco e propor modelo de predição de risco para desenvolvimento de dermatite associada a incontinência em pacientes adultos críticos. Método Trata-se de um estudo de coorte concorrente realizado com 157 pacientes críticos. A coleta de dados foi conduzida diariamente entre fevereiro e julho de 2015 em hospital público e de ensino de Belo Horizonte, MG. Os dados foram lançados em banco de dados, submetidos a análise descritiva de sobrevida e multivariada. Resultados Obteve-se uma incidência global de 20,4%. Foram encontrados 19 fatores de risco que apresentaram associação significativa com o problema. As variáveis encontradas no modelo de predição de risco foram: sexo masculino, trauma, uso de hipnótico/sedativos, lactulona, suporte nutricional, fezes pastosas e queixa de ardência (local). Conclusão Os resultados mostraram que a dermatite é um achado clínico comum em pacientes adultos críticos e merece atenção especial para maior qualidade da assistência de enfermagem.

RESUMEN Objetivos Estimar incidencia, determinar factores de riesgo y proponer modelo de predicción de riesgo para el desarrollo de la dermatitis asociada a la incontinencia en pacientes adultos críticos. Método Se trata de un estudio de cohorte concurrente de 157 pacientes críticamente enfermos. La recolección de datos se realizó diariamente entre febrero y julio de 2015, en un hospital público y de enseñanza de Belo Horizonte-MG. Los datos se introdujeron en la base de datos, sometidos a análisis descriptivo, de supervivencia y multivariada. Resultados Se obtuvo una incidencia global del 20,4%. Se encontraron 19 factores de riesgo asociados significativamente con el problema. Las variables identificadas en el modelo de predicción de riesgo fueron: sexo masculino, trauma, uso de hipnóticos/sedantes, lactulona, soporte nutricional, heces sueltas y queja de ardor (local). Conclusión Los resultados mostraron que la dermatitis es un hallazgo clínico frecuente en pacientes adultos críticos y merece una atención especial para una mayor calidad de los cuidados de enfermería.

ABSTRACT Objectives Estimate incidence, determine risk factors and propose a prediction model for the development of incontinence- associated dermatitis critically ill adult patients. Method Concurrent cohort study with 157 critically ill patients. Data collection was daily performed between February and July 2015, at a public teaching hospital of Belo Horizonte, Minas Gerais. Data was entered in a database and subjected to descriptive, survival and multivariate analysis. Results An overall incidence of 20.4% was obtained. Nineteen (19) risk factors significantly associated with the disorder were found. The variables identified in the risk prediction model were male, trauma, use of hypnotics/sedatives, lactulose, nutritional support, loose stools and complaints of burning. Conclusion The results showed that dermatitis is a common clinical finding in critically ill adult patients and requires special attention from the nursing staff.

Clinicians Discuss Diaper Dermatitis.

Diaper dermatitis in infants is commonly seen by clinicians in both primary care and acute care settings. The condition can cause significant discomfort for infants and distress for their parents and caregivers. Nursing for Women's Health convened a group of nursing clinicians who work in a variety of settings to discuss the issues and challenges related to preventing and treating diaper dermatitis in both healthy term newborns and premature newborns.

Experience of adapting and implementing an evidence-based nursing guideline for prevention of diaper dermatitis in a paediatric oncology setting.

BACKGROUND: Diaper dermatitis is one of the most common skin problems in children often caused by irritants that promote skin breakdown, such as moisture and faecal enzymes. It has been estimated that the incidence of diaper dermatitis is as high as 50% in children receiving chemotherapy. The scientific literature suggests a variety of preventative measures, but only a minority are systematically tested and supported by clinical evidence. AIM: The purpose of this paper is to adapt and implement a skincare guideline to better prevent diaper dermatitis in the paediatric oncology population. METHODS: The Knowledge to Action process was used to guide the adaptation and implementation of the new guideline. As part of this process, different tools were used to identify and review selected knowledge (Appraisal of Guidelines Research Evaluation instrument), to tailor and adapt knowledge to the local context (ADAPTE process), to implement interventions (Registered Nurses' Association of Ontario toolkit) and to evaluate outcomes (qualitative analysis). The main outcomes measured included implementation of the guideline and nursing practice change. RESULTS: The guideline was successfully implemented as reported by nurses in focus group sessions and as measured by changes in nursing documentation. CONCLUSION: The implementation of the guideline was successful on the account of the interplay of three core elements: The level and nature of the evidence; the context in which the research was placed; the method in which the process was facilitated.

Neonatal intensive care practices and the influence on skin condition.

BACKGROUND: Premature skin has a thinner epidermis with a poorly formed stratum corneum (SC) barrier compared to full term skin. Poor skin integrity increases the risk of exposure to irritants and infectious agents. Interventions that facilitate skin maturation are essential. OBJECTIVE: The objective was to examine the effects of prematurity and time from birth on SC maturation and to identify factors that impact skin condition. METHODS: A retrospective review was conducted among 130 NICU patients. Skin regions were evaluated for erythema, rash, integrity and function. The effects of gestational age, time from birth, stool exposure, nutrition and diagnosis were examined. RESULTS: Three groups emerged: (i) premature and <38 weeks adjusted age; (ii) premature and >38 weeks adjusted age; and (iii) full term. Surprisingly, the premature infants exhibited lower perineal irritation and greater SC integrity (lower transepidermal water loss) than full terms (P < 0.05). Group 2 had a longer time before the first skin-stool contact. Chest skin pH showed maturational changes for Group 1 (P < 0.05) but did not change for premature Group 2 who was older at enrollment. Erythema was lower for infants using elemental formulas or total parenteral nutrition. CONCLUSIONS: Premature infants with early stool contact and high exposure, full term infants, and patients with congenital diaphragmatic hernia or trisomy 21 are at high risk for skin compromise and may benefit from prophylactic interventions to minimize compromise. Low stool exposure and greater time before the first stool contact appear to be protective against skin compromise.

Beginning at the bottom: evidence-based care of diaper dermatitis.

Diaper dermatitis (DD), an acute inflammatory reaction of skin in the perineal area, is an extremely common pediatric condition. Nurses' practice of preventing and treating DD is inconsistent and often not evidence-based. In addition, a 2008 Skin Injury Prevalence Study at our hospital revealed that 24% of inpatients had DD. The authors developed a project to determine a consistent and evidence-based approach to DD prevention and treatment including the availability of products. A complete literature review was conducted in addition to benchmarking with other pediatric hospitals, consultation with topic experts, and evaluation of current nursing practice prior to revising the existing perineal skin care nursing standard. The evidence supports frequent diaper changes, use of super absorbent diapers, and protection of perineal skin with a product containing petrolatum and/or zinc oxide. As supported by the literature, we revised the standard to include improvements in practice as well as product updates for prevention and treatment. Hospital-wide implementation of the revised standard included training "Skin Care Champions" to educate staff and support practice improvements. Ongoing education and monitoring by the Skin Care Champions is necessary to further improve the prevention and treatment of DD for our patients.

Adesão das mãe às condutas de enfermagem na dermatite irritativa de fraldas: estudo exploratório / Mothers adhesion to nursing plan for irritant diaper dermatitis: an exploratory study

This exploratory, descriptive, transversal, study, which takes a quantitative approach, was carried out at a Family Health Unit in the municipal district of Francisco Morato, with the following objectives: to determine the knowledge, care actions and adhesion of mothers to nursing conducts to deal with irritant diaper dermatitis in their children; to identify the facilities and difficulties reported by the mother when carrying out the prescribed nursing conducts. The study population consisted of 29 mothers, and 29 children with irritant diaper dermatitis. The adhesion was classified as total, partial or non-existent. The results show that the majority of the mothers (58.8%) had no knowledge of irritant diaper dermatitis. As for the care actions to deal with their children's dermatitis, 93.1% of the mothers opted to use disposable diapers and 58.7% used a moist tissue when carrying out perineal hygiene, during diaper changes. In relation to the conditions of the child, the majority presented inadequate hygiene and hyperemia with skin peeling in the diaper region. It was determined that 65.6% of the mothers adhered to all the prescribed nursing conducts, 17.2% adhered only partially, and 17.2% did not adhere at all to the nursing conducts.

Estudo exploratório, descritivo, transversal, de campo, com abordagem quantitativa, realizado em uma Unidade de Saúde da Família do município de Francisco Morato, que teve como objetivos: verificar o conhecimento, as ações de cuidado e a adesão das mães às condutas de enfermagem na dermatite irritativa de fraldas do filho; identificar as facilidades e dificuldades referidas pela mãe na execução das condutas de enfermagem prescritas. A população foi constituída de 29 mães e 29 crianças com dermatite irritativa de fraldas. Os dados foram coletados durante a consulta de enfermagem e a visita domiciliária. A adesão foi classificada em total, parcial e não adesão. Os resultados mostraram que a maioria (58,8%) das mães não possui conhecimentos a respeito da dermatite irritativa de fraldas. Quanto às ações de cuidado com a dermatite do filho 93,1% das mães optavam pelo uso da fralda descartável e 58,7% usavam lenço umedecido na higiene do períneo durante a troca das fraldas. Em relação às condições da criança, a maioria apresentava higiene inadequada e hiperemia com descamação na região das fraldas. Verificou-se que 65,6% das mães aderiram a todas as condutas de enfermagem prescritas, 17,2% apresentaram uma adesão parcial e que a não adesão foi de 17,2%.

An overview of neonatal and pediatric wound care knowledge and considerations.

Despite significant technological advances in the care of premature neonates and chronically ill children, the knowledge and evidence base for the management of this population's wound care lag far behind its adult counterpart. Updating antiquated care regimens is an uphill battle. This review of the literature seeks to illuminate key anatomical/structural differences in neonatal skin with particular attention paid to percutaneous absorption and tolerance of adhesives. The article also presents anatomically and physiologically based recommendations for the selection of prevention and treatment modalities, including specific dressing types, appropriate dressing change and securement procedures, and pain management. Commonly encountered wound types (epidermal stripping; surgical wounds; extravasation and thermal injuries; chemical burns; pressure ulcers; diaper dermatitis; and wounds secondary to congenital conditions) are discussed. Opportunities for research abound and are considered.