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Skin Care Protocols for Pressure Ulcers and Incontinence in Long-Term Care: A Quasi-Experimental Study

Thompson, Patricia MS, RN; Langemo, Diane PhD, RN, FAAN; Anderson, Julie PhD, RN, CCRC; Hanson, Darlene MS, RN; Hunter, Susan MSN, RN

Advances in Skin & Wound Care: October 2005 - Volume 18 - Issue 8 - p 422-429
FEATURES: ORIGINAL INVESTIGATIONS
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OBJECTIVE: To evaluate the effect on pressure ulcer prevalence, incidence, and healing time of incorporating use of a specific body wash and a skin protectant into skin care protocols that are based on guidelines from the Agency for Health Care Policy and Research.

DESIGN: Quasi-experimental intervention study.

SETTING: 2 rural long-term-care facilities.

PARTICIPANTS: A convenience sample of 136 residents at 2 rural long-term-care facilities during a 3-month preintervention and a 3-month postintervention period.

INTERVENTIONS: A 3-month preintervention observation period (baseline) was followed by a staff in-service session, in which the use of a body wash and a skin protectant was introduced into skin care protocols, and a 3-month postintervention observation period. The skin care protocols included skin assessment techniques, prevention and treatment strategies for Stage I and Stage II pressure ulcers, and management of incontinence.

MAIN OUTCOME MEASURES: Differences in the occurrence and healing time of Stage I and Stage II pressure ulcers before and after introduction of use of a body wash and a skin protectant into skin care protocols and the occurrence rate of urinary and fecal incontinence.

RESULTS: Stage I and Stage II pressure ulcers significantly decreased from 35 preintervention to 14 postintervention (t = 19.48, df = 47, P = .05). The prevalence of pressure ulcers preintervention was 11.3%, compared with 4.8% postintervention (t = 2.47, df = 1.0, P = .24), The change in the incidence of pressure ulcers was significant (t = 8.48, df = -2.0, P = .01), with 32.7% preintervention and 8.9% postintervention. Healing time for pressure ulcers ranged from 4 to 70 days preintervention (mean [M] = 22.72 ± 18.25) to 6 to 49 days postintervention (M = 16.0 ± 12.93). The decrease in pressure ulcer healing time (rapid, medium, and long) preintervention to postintervention was statistically significant (χ2 = 14.9, P = .001). The presence of fecal and urinary incontinence was significantly associated with the development of Stage I and Stage II pressure ulcers (χ2= 44.8, P = .000).

CONCLUSIONS: Implementation of skin care protocols that included use of a body wash and a skin protectant reduced the incidence of Stage I and Stage II pressure ulcers and decreased healing time. The skin protectant and body wash used in the protocols were found to be effective in preventing and treating Stage I and Stage II pressure ulcers.

The incidence of Stage I and Stage II pressure ulcers decreased significantly, as did time to healing of these types of pressure ulcers, when use of a body wash and a skin protectant was added to existing skin care protocols at 2 long-term-care facilities.

Patricia Thompson, MS, RN, is Clinical Assistant Professor

Diane Langemo, PhD, RN, FAAN, is Distinguished Professor Emeritus and Nurse Consultant

Julie Anderson, PhD, RN, CCRC, is Assistant Professor

Darlene Hanson, MS, RN, is Clinical Associate Professor

Susan Hunter, MSN, RN, is Associate Professor at the University of North Dakota College of Nursing, Grand Forks, ND.

The authors have disclosed that this research was supported by a grant from Summit Industries, Inc, Marietta, GA.

Submitted January 19, 2005; accepted in revised form June 22, 2005.

© 2005 Lippincott Williams & Wilkins, Inc.