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Background: The costs to healthcare systems of pressure ulcer (PU) prevention and management programmes remain high, and although PU risk assessment tools exist, they generally have poor predictive value. It has been demonstrated that PU are preceded by subtle tissue changes that are invisible to the naked eye before skin breakdown occurs. One such change is an increase in sub-epidermal moisture (SEM) which can be identified by biocapacitance. Aim: To investigate the effect of skin barrier cream on biocapacitance readings made with the SEM Scanner 200 (BBI LLC (CA, USA). Methods: SEM Scanner 200 delta readings were recorded on the heels and sacrums of healthy volunteers with and without barrier cream. This was a two part investigation. In part one participants had barrier cream applied to one heel (right) and not to the other (left). In part two participants were allocated into one of two groups-full application or partial application of barrier cream. Results: No difference in SEM delta values was observed in participants between the right and left heel. With sacral application there was a significant rise in SEM Scanner 200 readings when barrier cream was only applied to a small area compared to those with full coverage though this rapidly resolved with time and skin cleaning. Conclusions: Even distribution of barrier creams over scanned areas did not affect SEM readings though uneven application might adversely affect readings. [ABSTRACT FROM AUTHOR]

BACKGROUND: The use of noninvasive ventilation masks is known to cause damage to facial skin tissue, which affects both the efficacy of the intervention and the patient's quality of life. The use of humidification with noninvasive ventilation is a common practice, but its relative role in the development of facial pressure ulcers has not been fully studied. METHODS: A crossover cohort design was used in this study, with 15 healthy volunteers. Each volunteer randomly received both 10 cm H2O of CPAP with and without humidification through an oronasal mask. Skin integrity was evaluated by measuring transepidermal water loss, skin hydration, and skin pH at the bridge of the nose. Device-skin interface conditions (pressure and microclimate) were recorded at the bridge of the nose and both cheeks. The pro-inflammatory cytokine interleukin-1α was collected from the nose bridge before and after CPAP application by using a skin analysis tape. Nasal symptoms were collected by using a validated 6-point score. RESULTS: Humidified CPAP significantly increased transepidermal water loss (P < .001) and skin humidity (P = .02) compared with non-humidified CPAP. There were no significant differences in skin hydration, skin pH, skin temperature, and cytokine expression between both conditions. However, there was a trend of increased median ratios of interleukin-1α concentrations in the humidified CPAP. There was a significant increase in the interface pressure at the bridge of the nose after CPAP application (P = .02), with higher interface pressure values at the nose bridge compared with both left (P = .002) and right (P = .003) cheeks. The participants reported elevated nasal discomfort during non-humidified CPAP. CONCLUSIONS: These findings indicated that noninvasive ventilation with humidification had a potential disrupting effect on the barrier function of facial skin, associated with changes in skin microclimate and function. Further research is required to establish the cause of mask-related skin damage and to evaluate the effects of mask design, application techniques, and air flow and humidity settings. [ABSTRACT FROM AUTHOR]

David Voegeli, Associate Professor of Nursing, Skin Health Research Group, Faculty of Health Sciences, University of Southampton, discusses the care of patients with incontinence-associated dermatitis and how to distinguish this condition from pressure ulcers [ABSTRACT FROM AUTHOR]

Incontinence-associated dermatitis (IAD) is a common skin disorder seen in patients with incontinence. Typically IAD presents as inflammation of the skin surface characterised by redness, and in extreme cases, swelling and blister formation. If untreated this usually rapidly leads to excoriation and skin breakdown, which may subsequently become infected by the skin flora. While this is a common condition encountered in all areas of nursing practice, gaps remain in our understanding of the many contributing factors. A lack of standardised definitions of IAD, differences in terminology, and a bewildering increase in products available to prevent and manage IAD, makes it difficult for nurses to deliver evidence-based care. However, it is an area where nursing research has made a considerable contribution over the past few years. This article explores the current thinking on IAD and the implications for nursing practice. [ABSTRACT FROM AUTHOR]

The prevention and treatment of pressure ulcers continues to present a challenge across acute and long-term care settings, and costs the NHS up to £2.64 billion annually. As well as causing a reduced quality of life for sufferers, they can prove to be fatal. The complexity of the exact causes of skin breakdown and accurate risk assessment has proved problematic to fully understanding this common nursing problem, yet despite limited evidence clear guidelines on best practice exist, suggesting that prevention strategies should encompass interventions in three areas: risk assessment; relief of pressure, and education. Evidence exists that where these strategies are adopted at an organizational level, and strong leadership provided, the outcomes can be remarkable. This article outlines effective prevention and risk-reduction strategies, together with interventions that can promote healing. [ABSTRACT FROM AUTHOR]

Skin care is a fundamental aspect of basic nursing care, with the outcome of these interventions often used to gauge the quality of the care provided. However, possibly as a result of the 'basic' nature of this aspect of care, little attention has been paid to developing a firm evidence base to guide decision-making in this area. This is compounded by the wide variety of products now available, ranging from simple cleansers and moisturizers, to more complex agents that cleanse, moisturize and protect all in one, which adds to the confusion. This article explores the basic principles of skin care, and considers the evidence available to support the nursing interventions used, and the range of products available. Finally it suggests the adoption of clear skin care protocols, and recommends actions that should form part of these. [ABSTRACT FROM AUTHOR]

Presents a study that investigated whether smoking, known to be a risk factor in the development of pressure ulcers, has an effect on vascular responsiveness in the skin. Background on pressure ulcers in Great Britain; Methodology; Discussion on the effect of smoking on skin.

Background Individuals who have reduced mobility are at risk of developing pressure ulcers if they are subjected to sustained static postures. To reduce this risk, clinical guidelines advocate healthcare professionals reposition patients regularly. Automated tilting mechanisms have recently been introduced to provide periodic repositioning. This study compared the performance of such a prototype mattress to conventional manual repositioning. Methods Ten healthy participants (7 male and 3 female, aged 23–66 years) were recruited to compare the effects of an automated tilting mattress to standard manual repositioning, using the 30° tilt. Measures during the tilting protocols (supine, right and left tilt) included comfort and safety scores, interface pressures, inclinometer angles and transcutaneous gas tensions (sacrum and shoulder). Data from these outcomes were compared between each protocol. Findings Results indicated no significant differences for either interface pressures or transcutaneous gas responses between the two protocols ( P > 0.05 in both cases). Indeed a small proportion of participants (~ 30%) exhibited changes in transcutaneous oxygen and carbon dioxide values in the shoulder during a right tilt for both protocols. The tilt angles at the sternum and the pelvis were significantly less in the automated tilt compared to the manual tilt (mean difference = 9.4–11.5°, P < 0.001). Participants reported similar comfort scores for both protocols, although perceived safety was reduced on the prototype mattress. Interpretation Although further studies are required to assess its performance in maintaining tissue viability, an automated tilting mattress offers the ability to periodically reposition vulnerable individuals, with potential economic savings to health services. [ABSTRACT FROM AUTHOR]