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The almost quarter of a million people living in the UK with a stoma are likely to encounter damage to the skin around their stoma. Community nurses are well placed to assist in skin assessment and planning of interventions to improve skin integrity if damage does occur. As part of that skin assessment process, it is important to understand the terminology used to identify issues being observed as well as the potential causes. Although general wound healing is similar across different areas of the body, wound healing products used on peristomal skin need to be considered in terms of how they might adversely affect adhesion of the stoma appliance. Sometimes simple changes to diet or skin care routine, which community nurses can suggest, is enough to improve the peristomal skin condition. [ABSTRACT FROM AUTHOR]

Skin complications in ostomates are widely reported and can cause physical and emotional challenges in everyday life. Chronic parastomal skin complications can be difficult to heal and cause significant pain. Two patients presented to the stomal therapy clinic for treatment and were diagnosed with chronic parastomal skin ulceration. Following standard treatment of wound management, topical corticosteroid ointment and appliance review, the ulcers were either not improving or had reoccurred. Treatment with a combination cream consisting of 0.2% Hyal uronic acid (HA) and 1% Silver sulfadiazine (SSD) was initiated and both patients demonstrated complete healing. Treatment of parastomal skin ulceration with dual action cream 0.2% HA and 1% SSD was successful for these two patients, with a reduction in pain and purulent fluid noted throughout treatment, in addition to a reduced cost of treatment when compared with standard protocols. [ABSTRACT FROM AUTHOR]

Moisture associated skin damage is common in patients with a urinary or fecal stoma and can cause significant challenges in patient care and quality of life. Chronic moisture associated skin damage can be difficult to heal and expensive to treat. A patient with a stenosed ileal conduit was diagnosed with chronic moisture associated skin damage (MASD), caused by leaking of urine underneath the base plate. Following multiple stomal therapy reviews and appliance alternatives, the skin damage was not improving, and the patient reported consistent pain and itching. Treatment with a combination cream of 0.2% hyaluronic acid and 1% silver sulfadiazine was initiated and complete healing was observed. Treatment of MASD with dual action cream 0.2% hyaluronic acid and 1% silver sulfadiazine was successful for this patient, with a reduction in wound size, itch, dry skin and serous exudate noted throughout treatment, in addition to a reduced cost of treatment when compared with standard protocols. [ABSTRACT FROM AUTHOR]

The stoma care nurse (SCN) assesses peristomal skin during each patient intervention. Living in a diverse multicultural society, the SCN needs to consider dark skin tones and how these are documented. This article looks at how the literature on peristomal skin assessment and available tools discuss skin colour, and compare this with the tissue viability literature. Stoma care and peristomal skin literature features very little about skin colour. Registered nurses are often unaware of the differences when assessing light skin tones versus dark skin tones. The article discusses how to assess for, identify and document problems around peristomal skin with patients who have dark skin tones. The differences in skin breakdown between light skin tones and dark skin tones are highlighted. There needs to be further research and development of tools to assist clinicians in identification and documentation relating to skin tone, thus providing consistency in assessment. [ABSTRACT FROM AUTHOR]

Background. Peristomal skin complications (PSCs) pose a major challenge for people living with an ostomy. To avoid severe PSCs, it is important that people with an ostomy check their peristomal skin condition on a regular basis and seek professional help when needed. Aim. To validate a new ostomy skin tool (OST 2.0) that will make regular assessment of the peristomal skin easier. Methods. Seventy subjects participating in a clinical trial were eligible for the analysis and data used for the validation. Item-level correlation with anchors, inter-item correlations, convergent validity of domains, test-retest reliability, anchor- and distributionbased methods for assessment of meaningful change were all part of the psychometric validation of the tool. Results. A final tool was established including six patient reported outcome items and automatic assessment of the discolored peristomal area. Follow-up with cognitive debriefing interviews assured that the concepts were considered relevant for people with an ostomy. Conclusion. The OST 2.0 demonstrated evidence supporting its reliability and validity as an outcome measure to capture both visible and non-visible peristomal skin complications. [ABSTRACT FROM AUTHOR]

Background Peristomal skin complications (PSCs) pose a major challenge for people living with an ostomy. To avoid severe PSCs, it is important that people with an ostomy check their peristomal skin condition on a regular basis and seek professional help when needed. Aim To validate a new ostomy skin tool (OST 2.0) that will make regular assessment of the peristomal skin easier. Methods Seventy subjects participating in a clinical trial were eligible for the analysis and data used for the validation. Item-level correlation with anchors, inter-item correlations, convergent validity of domains, test-retest reliability, anchor- and distribution-based methods for assessment of meaningful change were all part of the psychometric validation of the tool. Results A final tool was established including six patient reported outcome items and automatic assessment of the discolored peristomal area. Follow-up with cognitive debriefing interviews assured that the concepts were considered relevant for people with an ostomy. Conclusion The OST 2.0 demonstrated evidence supporting its reliability and validity as an outcome measure to capture both visible and non-visible peristomal skin complications.

Aim: The aim of this study was to evaluate the effectiveness of a combined treatment strategy involving the use of a light convex ostomy appliance (Easifiex Confort Convex Light) and a fiexible ring (Brava moldable) in reducing the number of leak episodes and improving self-reported satisfaction in patients with digestive ostomies and early effiuent leakage. Methods: A multicenter prospective study was conducted across 54 stoma units in Spain, with 257 patients screened and 244 completing the study. Clinical data were collected at baseline (V1) and 2–3 weeks after discharge (V2) by specialist stoma care nurses. The primary outcome was a reduction in the mean number of leak episodes per day. The secondary outcome was a change in self-reported satisfaction on a scale of 0–10. A multivariate analysis was conducted to identify the patient profile that benefited the most from the treatment strategy. Results: The results showed a significant reduction in the mean number of leak episodes from 3.4±5.2 at baseline to 1.3±2.3 at the end of the study (P<0.0001). Additionally, the mean self-reported satisfaction with the device increased from 5.1±2 at baseline to 7.2±1.7 at the end of the study (P<.00001). A predictive model with an area under the curve of 0.74 was developed to identify the patient profile that benefited the most from the treatment strategy. Conclusions: The study confirmed that patients with ostomy and early effiuent leakage benefit from convex light ostomy appliances and fiexible rings. To improve satisfaction, those with worse outcomes and higher needs should be treated early with the CONAN strategy (convex system and a seal) if they exhibit leakage, longer hospital stays, emergency surgery and previous use of open system and single-piece appliances. This combined treatment strategy can improve outcomes and satisfaction in patients with digestive ostomies and early effiuent leakage. [ABSTRACT FROM AUTHOR]

Peristomal skin complications (PSCs) are relatively common in ostomy patients, particularly in those with ileostomies. Non-healing irritation presents a clinical challenge and leads to pain and impaired quality of life for patients. Methods: The cases of four ileostomy patients experiencing severe, challenging PSCs refractory to appliance changes, conventional dressings and barrier creams are discussed. Findings: The cases of one male and one female patient with an end ileostomy post-subtotal colectomy for ulcerative colitis, one female with a defunctioning ileostomy post-anterior resection for sigmoid carcinoma and one male with an end ileostomy with a complex Crohn's surgical history are described. Two puffs of a 250 mcg metered dose beclometasone inhaler were applied to the affected skin once or twice daily. Treatment ranged from 6 to 21 days. Complete resolution was seen in all cases. Conclusion: Topical use of a beclometasone inhaler was effective for severe peri-ileostomy PSC secondary to four different aetiologies. Further studies are warranted to determine the effectiveness of this treatment in a larger patient cohort. [ABSTRACT FROM AUTHOR]

In order to determine the perception of ostomized patients about the performance and safety of the new one-piece device Moderma Flex, as well as the evolution of peristomal skin health after its use. The pre- and post-experimental multicenter study after the use of the Moderma Flex one-piece ostomy device on 306 ostomized people from 68 hospitals in Spain. We used a self-made questionnaire on the usefulness of different parts of the device and the perception of peristomal skin improvement. The sample was composed of 54.6% (167) men and had an average age of 64.5 years (standard deviation = 15.43). The type of device most commonly used according to its opening was closed by 45.1% (138). In addition, for the type of barrier, the most frequently used is the flat one; 47.7% (146) and 38.9% (119) used a model of soft convexity. A total of 48% scored with the highest assessment in the perception of skin improvement. The percentage of patients with peristomal skin problems decreased from 35.9% at the first visit to less than 8% after the use of Moderma Flex. Further, 92.4% (257) had no skin problems, the most frequent being erythema. The use of the Moderma Flex device seems to be related to a reduction in peristomal skin complications and a perception of improvement. [ABSTRACT FROM AUTHOR]

Background: Prevention and treatment of peristomal skin problems should be a priority for nurses caring for ostomates, even when the assessment of lesions must be done remotely. Objective: To measure the level of agreement on assessment, diagnosis and care indications for peristomal skin lesions using remote imaging among nurses in Spain. Design: Prospective observational multicentre study to assess the diagnostic validity and inter‐ and intraobserver agreement between nurses in peristomal skin lesions. Data were collected between March and October 2019. Settings and Participants: The research sample consisted of a group of 39 nurses with expertise in the care of ostomates. Methods: A panel of experts established a list of 24 common signs/findings, 15 diagnostic options and 35 treatment approaches for peristomal skin lesions. Three expert stoma therapy nurses compiled the clinical cases, which they described thoroughly and documented with photographs. The 39 participating nurses evaluated the cases in two rounds to measure inter and intraobserver agreement. Results: A high or very high level of agreement (κ > 0.61) was observed for the following signs: encrustation, nodules, mucocutaneous separation and varicose veins; for the following diagnoses: mucocutaneous dehiscence, allergic contact dermatitis, encrustation and varicose veins (caput medusae); for the following treatments: recommending a diet rich in vitamin C/blueberries, applying acetic acid dressings, applying cold and topical tacrolimus treatment. Conclusions: The most easily identifiable lesions were those most prevalent and with visible signs. There was a lower level of agreement in identifying lesions for which photographs required additional information (laboratory data, description of signs and symptoms, type of diet and level of self‐care). It is important to train nurses caring for ostomates to correctly describe ostomy‐related lesions, which is important for nursing records, continuity of care and telehealth care. [ABSTRACT FROM AUTHOR]

Adjusting to life with a stoma can be difficult physically and emotionally. Preoperative counselling, where possible in cases of elective surgery, is fundamental to preparing those facing stoma formation, and a lack of support can be detrimental and can increase the risk of stoma patients experiencing complications. The stoma care nurse specialist (SCN) uses a range of clinical skills and specialist knowledge to support a patient through their surgical pathway; this is important for helping patients gain the skills and confidence to care for their stoma and reduce the risk of stoma-related complications. Complications are common and can reduce patient wellbeing and quality of life. As well as patient education and SCN support, using the appropriate stoma care appliances is important in achieving positive outcomes and preventing complications. Furthermore, the correct appliance for an individual patient can help to improve their confidence and wellbeing, leading to better stoma acceptance by meeting their needs and allowing them to carry out everyday life without feeling obstructed by having a stoma pouch. This article discusses the Aura Plus stoma pouch range, and highlights the features designed to prevent common complications and improve patient outcomes and confidence. A case study demonstrates how Aura Plus led to positive outcomes for a patient who had been experiencing significant leakage and peristomal skin complications when using a multitude of different pouches. The change to Aura Plus resolved these complications and led to improved wellbeing and quality of life. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to analyse the impact of using both a light convex appliance and mouldable ring in the early postoperative period on leakage frequency, peristomal skin health and quality of life after discharge. Methods: This prospective non-randomised study was performed in patients with a digestive stoma experiencing effluent leakage during the early postoperative period. Evaluation was performed at baseline (V1) during admission and at 2–3 weeks after discharge (V2). The outcomes measurements were: number of leaks per day; satisfaction (0 to 10 VAS scale); DET score evaluating discolouration (D); erosion/ulceration (E) and tissue overgrowth (T); stoma morphology and NANDA International nursing diagnosis, which measures anxiety, fear and image deterioration as well as insomnia. NANDA International diagnosis were evaluated as a percentage of cases with the diagnosis and categorically according to several dimension scores. Signed rank, McNemar, chi-squared and Bowker's tests were used for comparison. Results: Of 257 patients screened, 244 completed the study. The mean number of leak episodes using the light convex appliance and mouldable ring in the early postoperative period decreased from 3.4±5.2 (V1) to 1.3±2.3 (V2) (p<0.0001). Mean discolouration, erosion and tissue overgrowth (DET) score decreased from 3.3±3.3 (V1) to 1.6±2.3 (V2) (p<0.0001). Mean self-reported satisfaction with the appliance increased from 5.1±2 (V1) to 7.2±1.7 (V2) (p<0.0001). The proportion of patients with a retracted peristomal area changed from 27.9% to 21.7%, while that of patients with protruded stoma increased from 32.9% to 40% (p=0.025). Regarding NANDA International diagnosis, anxiety reduced from 36.5% to 9.5% (p<0.0001), fear from 40.6% to 4.9% (p<0.0001), image deterioration from 19.2% to 10.9% (p=0.002) and insomnia from 39.3% to 2.5% (p<0.0001). All the categorical dimensions evaluated for each NANDA International diagnosis improved (p<0.0001). Conclusion: Patients with an ostomy and effluent leakage in the early postoperative period clearly benefited from the use of both a light convex appliance and mouldable ring. This approach had a positive impact on number of leakages per day, peristomal skin status and patient satisfaction, as well as meeting several NANDA International nursing diagnosis criteria. [ABSTRACT FROM AUTHOR]

The care of peristomal skin is a major challenge for people living with a stoma, as well as stoma care nurses. Peristomal skin complications include medical adhesive-related skin injuries/skin stripping, moisture-associated skin damage and contact dermatitis. There is also a limited choice of hydrocolloid adhesive stoma bags. This article reports on the introduction of Genii™, a new stoma bag that sticks with a unique breathable silicone adhesive. The study investigated the experiences of 61 colostomates over a 6-week period, examining the effect on their peristomal skin and their quality of life, in terms of sleep, self-image, social confidence and exercise, and overall product performance. The majority of study participants reported a positive experience when using the stoma bag. [ABSTRACT FROM AUTHOR]

Aim: The Convexity in Ostomy (ECOS) study measured the impact of soft convex ostomy appliances on leakage frequency, peristomal skin health, and patient satisfaction, as well as stomal protrusion and body profile. Methods: This prospective non-randomised controlled trial included people with a stoma, divided into a control group using a convex appliance throughout (Alterna Confort Convex or Easiflex Confort Convex Light, Coloplast A/S, Humlebæk, Denmark), and an intervention group who were using a flat appliance at baseline before switching to a convex appliance for the rest of the study. Leakage frequency was counted within the past 2 weeks; peristomal skin health was assessed using the discolouration, erosion and tissue overgrowth (DET) Ostomy Skin Tool; and patient satisfaction was measured with a 0-10 Likert scale of self-reported satisfaction with the appliance. Measurements were taken at three visits: baseline (V1), 2-8 weeks (V2) and 6 months (V3). The Kruskal-Wallis and analysis of variance (ANOVA) tests were used for comparison. Multiple regression analysis was used to evaluate the effect of independent variables on the change in leakage frequency and DET score between baseline and 6 months. Findings: Of 253 participants screened, 245 completed the follow-up, with 151 in the intervention group and 94 in the control group. Mean leakage frequency period went from 5.85 ± 5.55 (V1) to 0.63 ± 1.42 (V2) and 0.23 ± 0.75 (V3) (p<.0001). Mean DET score changed from 4.8 ± 3.47 (V1) to 1.41 ± 2.17 (V2) and 0.54 ± 1.57 (V3) (p<.0001). Mean satisfaction changed from 6.0 ± 2.25 (V1) to 8.6 ± 1.14 (V2) and 9.17 ± 0.93 (V3) (p<.0001). From V1 to V3, the proportion of patients with a depressed peristomal area went from 45.7% to 31.4%, a normal peristomal area went from 45.3% to 65.3%, stoma protrusion went from 31.4% to 47.3% and stoma retraction went from 28.6% to 15.5%. By group, mean leakage frequency decreased in the intervention group by 7.65, from 7.57 to 0.11, and in the control group by 2.37, from 2.94 to 0.46 (p<0.0001). Multiple ANOVA analysis confirmed independent variables in reducing leakage to be initiating convexity and appliance coupling. By group, mean DET score decreased in the intervention group by 4.82, from 5.24 to 0.42, and in the control group by 3.52, from 4.34 to 0.76. Multiple ANOVA analysis showed independent variables for DET score to be initiating convexity, emergency surgery and stoma siting. Conclusion: People with a stoma experiencing repeated leakage benefitted from shifting from a flat to a soft convex appliance in terms of leakage frequency, peristomal skin health, stomal protrusion and body profile. [ABSTRACT FROM AUTHOR]

Colostomy irrigation (CI) involves instillation of water via the stoma into the colon, where it stimulates peristalsis, causing expulsion of stool and water from the stoma. CI allows colostomates to regain controlled evacuation and faecal continence. A review of the literature suggests that CI is safe and can have a positive impact on key factors affecting quality of life, including flatus, odour and peristomal skin health. CI is also convenient in avoiding the need for frequent disposal of used appliances. All of this has also been shown to improve psychological wellbeing. However, use of CI in the UK remains relatively low. This first article considers the impact of CI on colostomates' quality of life, and the second will explore the barriers to uptake. [ABSTRACT FROM AUTHOR]

Introduction The COVID-19 pandemic has changed our world. It has impacted all healthcare professionals (HCPs), organisations and the people they serve in multiple ways. This includes the specialty area of nursing in ostomy and continence care. During this time, it is important to know what can be done to support clinicians and patients (end users) through understanding what they are experiencing and how they are adapting to this pandemic. Objective To gather research which describes the impact COVID-19 has had on clinicians and people with an ostomy or intermittent catheterisation requirements. Methods The research was conducted virtually to keep patients, clinicians and researchers safe but enable important learnings. Research modalities utilised were surveys and an observational study. Results This COVID-19 research shows that 57% of ostomy end users in the US and UK report peristomal skin issues in the past month. What has caused more concern is that 84% of ostomy end users report NOT contacting a HCP about their skin issues. In continence care, 49% of intermittent catheter (IC) users are more concerned about urinary tract infections (UTIs). Despite these challenges, many ostomy end users (52%) and IC end users (37%) report not knowing if telehealth is an option for their care. Instead, this research shows that end users are accessing more information online -- ostomy end users increased their online usage by 34% and IC end users by 50%. Both groups report the information they are seeking the most are tips for troubleshooting issues and information about the availability of their ostomy and continence products. This matches the ostomy nurse survey results that indicate clinicians are seeking information on ostomy education and product availability. Conclusion Early research suggests that ostomy and continence care patients alike are being negatively impacted by the COVID-19 pandemic. As this is only the beginning of the global pandemic, much more research is needed. [ABSTRACT FROM AUTHOR]

Abstract Koebner phenomenon regards the formation of a psoriatic lesion after a trauma, including tattoo, insect bite or other injuries. Although this manifestation is not specific for psoriasis, physicians should be aware because early recognition may be helpful in making the diagnosis when present.

Peristomal skin complications (PSCs) are reported by 77% of people with a stoma, with a serious impact on their quality of life, as well as on healthcare resources. PSCs are usually caused by irritant contact dermatitis from stoma effluent or skin stripping from mechanical trauma to the stratum corneum caused by removal of the ostomy appliance. The risk of mechanical trauma is higher in neonates, young infants and older adults, who have more fragile, friable skin. The incidence and impact of PSCs can be reduced with an appropriate appliance change routine. Mechanical trauma is reduced by minimising the frequency of appliance changes and using an adhesive remover wipe or spray. In adults with a stoma, silicone-based solvents are considered the first choice, as they are skin-friendly and sting-free, and they release the adhesive from the skin quickly and evaporate within seconds, without leaving a residue. However, for neonates, wipes and specialist paediatric oil-based adhesive removers are advised instead. The efficacy of adhesive removers, and silicone-based solvents in particular, at maintaining skin integrity and reducing discomfort has been reported by both stoma care nurses and people with a stoma. [ABSTRACT FROM AUTHOR]

Written for nurses who are not ostomy specialists, this article provides information about the care of stomas, including the normal stoma, with a focus on early and late complications of the stoma and peristomal skin. Nursing students who don't specialize in ostomy care typically gain limited experience in the care of patients with fecal or urinary stomas. This lack of experience often leads to a lack of confidence when nurses care for these patients. Also, stoma care resources are not always readily available to the nurse, and not all hospitals employ nurses who specialize in wound, ostomy, and continence (WOC) nursing. Those that do employ WOC nurses usually don't schedule them 24 hours a day, seven days a week. The aim of this article is to provide information about stomas and their complications to nurses who are not ostomy specialists. This article covers the appearance of a normal stoma, early postoperative stoma complications, and later complications of the stoma and peristomal skin. [ABSTRACT FROM AUTHOR]

Use of an ostomy skin barrier can place the skin at risk of injury due to mechanical, chemical and biological factors. Repeated application and removal of the ostomy skin barrier can be associated with skin stripping and damage to the skin barrier function. Measurement of transepidermal water loss (TEWL) is a way to assess the effect of ostomy barrier use on the skin. The objective of this study was to determine the effect of a ceramide-infused ostomy skin barrier compared to other infused skin barriers when changed once daily. The study was a randomised, prospective, repeated measures trial involving healthy volunteers. Twenty-four subjects were randomised to wear a ceramide-infused ostomy barrier and either Manuka honey barrier or aloe-infused barrier for five subsequent days. Barriers were changed daily and the skin was evaluated by visual examination and measurement of TEWL. We found the ceramide ostomy barrier minimised the effects of skin stripping when compared with aloe or Manuka honey skin barrier. Ceramide-infused skin barriers should be considered as part of an overall peristomal skin care strategy aimed at preserving peristomal skin integrity. [ABSTRACT FROM AUTHOR]

The majority of ostomates experience peristomal complications, the most common of which is skin damage. Healthy peristomal skin is essential for pouch adherence, which prevents effluent from seeping onto the skin. The aim of good stoma management is to prevent peristomal skin soreness and, if this arises, to minimise its effects. Practitioners need to have a good understanding of the causes of skin breakdown and how to treat and prevent it. Appliances and accessories need to be assessed to ensure they are appropriate for each individual stoma to prevent leakage of effluent and maintain healthy peristomal skin. Several strategies and products can be used to protect and treat the skin, including barrier creams and films, powders, pastes, seals, cleansers, lotions and stoma accessories. Misuse of products can affect patient care and clinical outcomes, and increase costs. Good-quality stoma care patient education improves outcomes, is part of good-quality care and boosts efficiency in nursing services. This article focuses on good skin care regimens, preventing skin damage, particularly peristomal damage, assessing and treating specific peristomal skin conditions, and patient education. [ABSTRACT FROM AUTHOR]

Moisture-associated skin damage from stoma effluent is the most common cause of peristomal skin problems. It is important to identify the causes for any treatment to be effective. A comprehensive assessment should be undertaken using an assessment tool to document the extent of the damage in an accurate and reliable way, and to assist with developing and evaluating a management plan. This article discusses the different types of appliances and accessories that can be used to treat moisture-associated skin damage. As some are costly they should be used wisely. Management of the peristomal skin should be proactive, with the goal being prevention by identifying and managing the causes effectively, thus preventing skin breakdown occurring. [ABSTRACT FROM AUTHOR]

There are many stoma complications that can impact an ostomate's quality of life, particularly those affecting the surrounding skin, which is essential for maintaining appliance integrity to prevent leakage of effluent. Peristomal skin conditions affect up to half of new ostomates and can make psychological adaptation more difficult. Among the most common of these conditions is mucocutaneous separation, which affects up to a quarter of new ostomates. Reported incidence is highly inconsistent, likely due to disparate assessment criteria, poor recognition and/or underreporting. Mucocutaneous separation occurs in the first month following surgery and is caused by a breakdown in the wound healing process. The resulting cavity between the stoma and peristomal skin causes pain and discomfort, as well as impeding appliance adherence, increasing the potential of leaks. Although there is no standardised system of categorisation for assessment, nurses can use the Ostomy Skin Tool or the mild–severe system of Herlufsen et al along with management guidelines. Wound care principles should be applied to promote healing by secondary intention. In superficial mucocutaneous separation, pectin-based stoma powder can aid adherence. A moist environment can be cultivated with wound dressings, such as hydrogel, hydrocolloid or alginates. Slough can be treated with irrigation or a desloughing agent. Any wound exudate suggests the cavity should be filled with paste or absorptive dressing. Hydrocolloid wafers, pastes, mouldable rings and seals may have helpful healing properties and can create a smooth surface. Nutrition should also be addressed. Nurses must rely on experiential learning for treatment strategies and product selection. However, empirical evidence on the efficacy of these therapies in mucocutaneous separation would be invaluable in guiding evidence-based clinical decisions. Stoma care nurses have an essential role in assessing and treating this common and challenging condition. [ABSTRACT FROM AUTHOR]

Background: Moisture-associated skin damage (MASD) to peristomal skin causes significant discomfort and is expensive to treat. It can be avoided by wicking moisture away from skin and controlling the source of excessive moisture with an absorbent seal. Method: In vitro testing determined the capacity for moisture absorption and combined faecal enzyme (elastase and lipase) inhibition of seven comparable leading UK ostomy seals. Ostomates using Eakin Cohesive® Seals were sent a postal questionnaire to rank the efficacy of this seal, while a different questionnaire was sent to stoma care nurses to rank the relative efficacy of different ostomy seals. Results: Eakin Cohesive Seals had the highest absorption capacity (4.0 g/g), while the range of absorption capacities for other seals was 1.0-2.9 g/g. The enzyme inhibition capacities of Coloplast Brava® Protective Seals and Eakin Cohesive Seals were 94.35% and 72.39% respectively, with other seals ranging from 39.45% to 59.96%. Users (n=2801) found Eakin Cohesive Seals helped prevent leakage (92.5%) and skin problems (73.3%), as well as treating sore skin (68.5%). Of nurses (n=194), 90.2% rated Eakin Cohesive Seal as good or excellent for treating denuded or excoriated skin. Conclusion: Eakin Cohesive Seals were highly absorptive, and this provided tangible clinical benefits. [ABSTRACT FROM AUTHOR]

Background: Body-altering surgery may affect perceptions of one's self. For those with abdominal stoma surgeries, altered perceptions amplified by peristomal skin condition can increase health burdens.Objectives: To assess health utility and health-related quality of life in an adult US ostomy sample in the presence of three levels of peristomal skin condition: intact, moderately compromised, and severely compromised.Methods: The short form 36 health survey version 2, a generic health survey incorporating the six-dimensional health state short form preference-based utility index, was chosen to assess the sample. Analysis of covariance adjusted for age and time from surgery was used.Results: The six-dimensional health state short form utilities for those with intact skin and physical component summary (PCS) levels indicating no physical limitations varied significantly from those with severely compromised skin and indicating the greatest degree of physical limitation (0.833 vs. 0.527). Peristomal skin condition decreases were associated with health utility decreases across all levels of the PCS. Because peristomal skin conditions are intermittent, the analysis presents quality-adjusted life-days (QALDs) per month. Ostomates with intact skin and PCS levels indicating no physical limitations demonstrated significant differences from those with severe skin condition and indicating the greatest degree of physical limitations (26.5 d/mo vs. 15.8 d/mo). As peristomal skin condition worsened, QALDs decreased across all levels of the PCS. A minimally important expected value of health was estimated to be an increase of 2.18 QALDs/mo.Conclusions: Successful treatment from a clinical perspective is more than the elimination of conditions-it is also a return of quality time to an individual. [ABSTRACT FROM AUTHOR]

Most stoma flanges are made of hydrocolloid material. Hydrocolloid is a hydrophilic material that attracts water, potentially resulting in moisture becoming trapped between the flange and skin. Also, as hydrocolloids are absorbent, the material breaks down over time, and there is a risk that some of the adhesive can remain on the skin on removal. Unlike hydrocolloids, silicone comprises fully cross-linked silicone polymers whose properties have been engineered to manage moisture without breaking down (i.e. manage the transepidermal water loss (TEWL)). A questionnaire survey was undertaken to determine ostomates’ perceptions of silicone versus hydrocolloid stoma care products (both flanges and seals). The survey was sent to 229 ostomates who had used silicone seals, of whom 78 returned it (a response rate of 34%). The results suggest that use of the silicone seals resulted in a improvement in the condition of the peristomal skin condition, reduced leakage and increased wear time. Further research into this area is required. [ABSTRACT FROM AUTHOR]

A new mouldable seal, Brava® Protective Seal, was evaluated by patients on aspects related to residue, durability, and preference. A total of 135 patients from four countries participated (Denmark, Germany, Japan and the USA) and the new product was compared to the patients’ usual pouching systems. Less residue and easier skin cleansing was observed, which may benefit patient quality of life. The possible benefits of less residue for peristomal skin health need further investigation. [ABSTRACT FROM AUTHOR]