Objectives: To identify the physiological and appearance characteristics of skin maceration caused by urine and/or faeces and determine their suitability as risk indicators for incontinence-associated dermatitis.
Method: This cross-sectional, comparative study involved sixty-nine elderly women with urinary and/or faecal incontinence who provided informed consent to participate. Exclusion criteria included serious medical problems, acute illness and the presence of damaged skin on the buttocks. The physiological and appearance characteristics of macerated skin on the buttocks of the patients were examined. Stratum corneum and dermis hydration levels, transepidermal water loss and skin pH were used to assess skin condition. Skin morphology (sulcus cutis) was confirmed using images at x15 magnification. The erythema index and white index were used to evaluate colour in the macerated skin areas.

Results: Forty-four patients exhibited skin maceration. Stratum corneum and dermis hydration levels were significantly greater in the maceration group than in the non-maceration group, as were transepidermal water loss, skin pH and differences in sulcus cutis interval between the buttock of interest and the subumbilical region. Furthermore, differences in the erythema and white indices between these two regions were significantly higher and lower, respectively, in the maceration group than in the non-maceration group.

Conclusion: To our knowledge, this is the first report to note that there are interesting changes not only in the epidermal layer but also in the dermis layer in patients with skin maceration. This finding confirmed that skin maceration caused by incontinence is a severe condition. Moreover, the erythema index was the best index for identifying skin maceration caused by incontinence, indicating that it can be used for precise and easy identification of the condition in clinical practice.

The development of an enterostomal therapy nurse (ETN) clinic was a new system in the health care setting in Indonesia. This is a retrospective descriptive study conducted in Griya Afiat Makassar, an outpatient ETN clinic in eastern Indonesia, with data collected from medical records in 2012. There werre 73 patients (35 male and 38 female) with 47 acute wounds and 26 chronic wounds. Duration of wound care for acute wounds was (11.26 +/- 18.2 days) and for chronic wounds was (26.8 +/- 40.0 days) with frequency of visit (3.5 +/- 3.7 times) for acute wounds and (7.8 +/- 9.2 times) for chronic wounds. Our healing rate was 85.1% and 34.6% for acute and chronic wound respectively. The introduction of an ETN clinic in Indonesia has had a positive outcome in wound healing process, for both acute and chronic wounds in Indonesia.

     This study aims to evaluate the microclimate and development of pressure ulcers and superficial skin changes. A prospective cohort study was conducted in an acute care ward in Indonesia. Risk factors for pressure ulcers and superficial skin changes were identified based on the Bergstrom Braden conceptual model. Microclimate data were collected every 3 days for 15 days while the development of pressure ulcers and superficial skin changes was observed every day. Pressure ulcers and superficial skin changes were developed in 20 of the 71 participants. Total mean difference in skin temperature was higher for patients with pressure ulcers and superficial skin changes (0·9 ± 0·6°C) compared with controls (0·6 ± 0·8°C) (P = 0·071). Binary logistic regression predictor values for pressure ulcers and superficial skin changes were 0·111 for type of sheet and 0·347 for Braden Scale results. In conclusion, difference in skin temperature seems to be a predictor for pressure ulcer development and superficial skin changes, while synthetic fibre sheets are able to maintain a beneficial microclimate.

A nurse from Indonesia describes how receiving an NNGF scholarship enabled him to go to enterostomal therapy (ET) and change care for his patients.


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