skin-care-5.matches: skin care
The chronic wound management decision tree: a tool for long-term care nurses.

Knight CL.

Skin care and wound management are integral components of practice for nurses who care for frail, elderly, and chronically ill persons. However, "knowing which dressing to use and when to use it can be a mystery for those who lack the opportunity and time to study wound care and thoroughly evaluate the products." In our long-term care facility in Edmonton, it was not uncommon to find that treatment decisions were inconsistent, fluctuating with individual nurses' and physicians' knowledge, experience, training, and preferences. Although the skin problems of residents in our long-term care facility were few in number, we believed that we could provide better wound care. Our goal was to develop a chronic wound care protocol to assist nursing staff in making consistent, correct wound care choices. The Chronic Wound Management Decision Tree is the result of our efforts. In this article we review the development, use, implementation and evaluation of this tool in our long-term care organization.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8845895&dopt=Abstract skin, skin care, skin care medicine skin-care-5.matches: skin care
Prevention of hand eczema in the metal-working industry: risk awareness and behaviour of metal worker apprentices.

Itschner L, Hinnen U, Elsner P.

Institute of Social and Preventive Medicine, University of Zurich, Switzerland.

BACKGROUND: In the metal-working industry, occupational hand eczema is very common and often due to contact with cutting fluids. Since it can be avoided by adequate protective measures, prevention plays an important role. However, the effectiveness of prevention depends heavily on the employees' awareness of this health risk. OBJECTIVE: The study aimed to collect information on the attitude of metal worker apprentices towards the risk of occupational skin disorders and skin protection since it is believed that their attitude at the beginning of the education will guide their future risk behaviour. METHODS: By means of a questionnaire, 79 metal worker apprentices were interviewed about their awareness of dermal risk factors and their risk behaviour at work. RESULTS: The apprentices are very badly informed about skin diseases and skin care. Most of them are not concerned about developing occupational skin problems, and they declared having obtained very little information about this subject. CONCLUSION: Considering this finding, it seems urgent to intensify health and safety education already at the beginning of the apprenticeship.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8944345&dopt=Abstract skin, skin care, skin care medicine skin-care-5.matches: skin care
Hexachlorophene emulsions and antiseptic skin care of newborn infants.

Plueckhahn VD, Collins RB.

This paper reviews 81,756 live births and 858 infant deaths occurring during the years 1959 to 1969. Sixty-three instances of central nervous system vacuolation are reported. Prematurity is shown to be a necessary prerequisite for central nervous system vacuolation to occur during routine antiseptic skin care of newborn infants with 3% hexachlorophene emulsions. Hyperbilirubinaemia is a contributory factor in such premature infants. Long-term clinical follow-up studies show that, should central nervous system vacuolation occur in premature infants, there is no resultant detriment to their immediate clinical progress and physical and neurological development. Normal newborn infants weighing more than 2,000 g do not develop such central nervous system vacuolation during routine antiseptic skin care. The writers conclude that there is no rationale for regulations to restrict the use of 3% hexachlorophene emulsions in routine antiseptic skin care of normal newborn infants and that the benefits of such use far outweigh any possible risks from central nervous system vacuolation.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=958085&dopt=Abstract skin, skin care, skin care medicine skin-care-5.matches: skin care
A sequential study of various modes of skin and umbilical care and the incidence of staphylococcal colonization and infection in the neonate.

Johnson JD, Malachowski NC, Vosti KL, Sunshine P.

The rates of colonization and infection of newborns with coagulase-positive staphylococci were studied during five sequential periods using various modes of skin care in the nursery. Colonization and infection were low during the baseline period when total body bathing with 3% hexachlorophene was employed (period 1), but increased dramatically (80% colonization, 9.5% infection) when hexachlorophene was discontinued and replaced by Ivory Soap baths (period 2). Reinstitution of hexachlorophene (period 3) reduced both colonization and infection, but not to the low levels seen during period 1. A second Ivory Soap period (period 4) resulted in a return to high colonization (77%) and infection (11.5%) rates. During period 5, daily Ivory Soap baths were continued and bacitracin ointment was applied to the umbilical area at least three times daily. Colonization was reduced to 10% and infection to 3.0%. Bacitracin could not be detected in serum in 15 infants studied. Colonization with gram-negative enteric bacilli was highest while using hexachlorophene or Ivory-bacitracin, but no increase in gram-negative infections was seen. Colonization of newborns with non-group A beta-hemolytic streptococci was not influenced predictably with various modes of skin care. The local application of bacitracin is a safe and effective method of controlling staphylococcal colonization and disease for infants in nurseries.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=958762&dopt=Abstract skin, skin care, skin care medicine skin-care-5.matches: skin care
[Microorganisms in drugs and cosmetics - occurrence, harms and consequences in hygienic manufacturing (author's transl)]

[Article in German]

Grigo J.

The quantity of pharmaceutical and cosmetic products with different composition and the diversity of contaminating microorganisms set up special problems for each product with its specific field of application. It is not exact to generalize the hazard of contaminating microorganisms to product cathegories. Some product cathegories however are more imperilled to be contaminated with microorganisms and they are more hazardous than other ones. The most important component of the living matter is water that decides on growth, multiplication and survival of microorganisms in drugs and cosmetics. Products with a high content of available water are the most problematic ones. The consequences of survival and multiplication of microorganisms in relation to metabolic activity, pathogenicity and route of administration can be harmless or fatal. The nutritive wants of many microorganisms are very small, even simple salt solutions do not exclude microbial growth. There scarcely exist substrates not used as energy source by any microorganism and so it does not wonder that desinfectants are also used. Added preservatives may be absorbed or inactivated by suspended anorganic components, swelling agents, solubilizers etc., the containers or its closing. In the water phase of emulsions, in which under special conditions smaller amounts of the preservative are available, microorganisms sometimes can multiply. Skin care products neither belonging to pharmaceuticals nor to cosmetics present special clinical problems. Many times creams and lotions contain ingredients metabolized by microorganisms. Ointments and oils can be overgrown only by highly specialized organisms but if there is condensed water as a film at boundary surfaces much more microorganism species can grow. When using cosmetics it must be considered that parts of them will get into the eye. The eye is really endangered by Pseudomonads, which can according to the composition multiply in shampoos and whose contact to the eye can not be excluded. Syrups and solutions contain sugar concentrations, which suppress growth of most microorganisms except osmotolerant germs. Because of their low water content powders normally are protected against microbial growth but they should be free from clostridial spores for a mixture of powder and sweat is a good nutrient medium to Clostridia and fungi. Powders for surgical use must be sterile. Tablets and dragees do not allow microbial multiplication because of their low water activity. Under bad storage conditions a local increase of water content may permit microbial growth at the surface, especially in hygroscopicity. Fortunately there is seen a trend of not using multi-dose-containers for injections because of the high risk of contamination. It is to develop single-dose-containers also for other groups of preparations especially for eye-preparations. Many products microbiologically unobjectionable produced are contaminated in use, they contain the spectrum of microorganisms of the area of application...

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=983538&dopt=Abstract skin, skin care, skin care medicine skin-care-2.matches: skin care
The development and pilot testing of a teaching booklet for oncology patients' self-assessment and perineal skin care.

Haisfield-Wolfe ME, Rund C.

The Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA. MHaisfield-Wolfe jhmi.edu

Oncology patients often experience skin breakdown as a result of chemotherapy. Often the loss of skin integrity is neither identified nor treated until it becomes severe and painful. If patients were taught to identify early signs of breakdown and to report these symptoms to a health care provider, treatment for these conditions could begin at an early stage. Nursing staff identified the need to develop a booklet that would both instruct adult oncology patients concerning necessary perineal care following therapy and encourage them to partner with the nursing staff to provide this care through self-assessment and reporting. The focus of this article is the process of developing and pilot testing such a booklet by 27 female oncology patients undergoing peripheral stem cell transplantation. Participants were given a handheld mirror as an aid to assess perineal skin changes. Feedback from both staff and patients was very positive. As patients identified and reported perineal skin changes to the nursing staff, both patients and nurses implemented established perineal skin care protocols. This teaching booklet, The Perineal Skin Self-Assessment Guide, focuses on the partnering of nurses and patients to promote the involvement of patients in their own care.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11901417&dopt=Abstract skin, skin care, skin care medicine skin-care-2.matches: skin care
Maintenance of skin integrity as a clinical indicator of nursing care.

Meraviglia M, Becker H, Grobe SJ, King M.

University of Texas at Austin School of Nursing, USA.

OBJECTIVE: To assess maintenance of skin integrity in hospitalized patients as a clinical indicator of quality nursing care. DESIGN: Descriptive correlational study. SETTING: 17 acute care urban and rural hospitals in Texas. PARTICIPANTS: 723 hospitalized patients from 33 medical-surgical units. MAIN OUTCOME MEASURES: Pressure ulcers since admission and nursing care practices per unit. MAIN RESULTS: Overall prevalence of pressure ulcers since admission (4.7%) was lower than previously reported for acute care settings. Prevalence of pressure ulcers in hospitalized patients (10%) was higher than found in the Texas Nurses Association feasibility study (3.7%). The skin integrity ratio was strongly correlated for several unit variables, including number of beds per unit (r = 0.623) and average daily census per unit (r = 0.909). Benchmarking data across units showed that units with subjects that maintained skin integrity had a lower percentage of patients assessed on admission and performed daily assessments less frequently than did the units with subjects that did not maintain skin integrity. In addition, the units with subjects that maintained skin integrity classified fewer patients as at risk for pressure ulcer development and did not implement a skin care protocol for these patients. CONCLUSION: Patients who developed a pressure ulcer after admission were older and had more risk for pressure ulcers than those who maintained skin integrity. Benchmarking data detected various differences in nursing care. Significant relationships between study variables demonstrate the importance of assessing clinical indicators to monitor nursing care. Outcomes such as skin integrity, pressure ulcer since admission, and nosocomial ratio represent the quality of nursing care.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11902357&dopt=Abstract skin, skin care, skin care medicine