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Evaluation of The Pressure Ulcers after Using Barrier Cream in Intensive Care Unit
*Corresponding author: Banu Otlar Can, Bursa Inegol State Hospital, Department of Anaesthesiology and Reanimation, Burhaniye Mahallesi Mimar Sinan Cad. No: 54, Inegol/Bursa, Turkey
Received: May 28, 2020; Published: June 23, 2020
A pressure ulcer (PU) is specified by National Pressure Ulcer Advisory Panel (NPUAP) as localized cutaneous or subcutaneous tissue damage that occurs on bone protrusions whether alone or in combination with shear stress .
Clinicians often use a four-grade system as defined by NPUAP for consistency in diagnosing and treatment; Grade 1 non-blanchable erythema with intact skin, Grade 2 partial skin loss of the dermis, Grade 3 full thickness skin loss with exposed dermis and Grade 4 deep tissue loss and injury exposure of bone, tendon and muscle .
Pressure ulcers are caused by multiple factors such as immobilization, malnutrition, advanced age, urine and/or faeces contamination, overhydration and friction . In intensive care units (ICUs) because of mechanical ventilation, limited immobilization, widespread use of anesthetic, sedative and muscle relexant drugs and circulatory ventilation disorders related to vasoactive drugs causes higher rate of pressure ulcers.
The prevelance of PU in adult ICU was 16.9-23.8% higher than the prevelance of 12-18% for all hospitalized patients . The prevelance of pressure ulcers in Europe is 7.9-22.9% in hospitals . Although many negative factors effect mortality in ICU, Kelle et al.’s study showed that the mortality rate was 15% without pressure ulcer and 63% with pressure ulcer .
As pressure ulcers are painful, they discomfort the patient and increase the complicants, stay of the hospital and cost of the treatment . Therefore, most important step in the treatment of pressure ulcers is to prevent the formation. For this purpose, various barrier creams are used to keep the skin intact an nourished . Our aim is to share our pressure ulcer data in ICU after using a barrier cream (Cavillon Durable Barrier Cream, 3M Health Care).
Material and Method
Bursa Inegol State Hospital’s ICU is a 36- bed unit with over 1200 admissions per year. Patients were observed by Norton Scale acceptance to ICU and daily about pressure ulcer area and graded by physicians and nurses. Pressure ulcers were classified according to the four grades of NPUAP. The barrier cream applied all over the body as a skin protector twice a day.
We observed that after using barrier cream three months ratio of PU was decreased from 6.6% to 4.5% (Table 1). Seventy five percent of the 17 PU were first grade and 25% were second. 90% of PU at sacral region. Eight patients were 10 risk score, 6 were 8 and 3 were 6 risk scores. Mean duration of stay in ICU was 13 days of patients with ICU. The ratio of PU did not exceed 6% during a year.
Management of skin damage is hard because skin is the body’s largest organ with a surface of around 2 m2. Skin barriers also called moisture barriers help to form a barrier between stratum corneum and any exposures . They are form of creams, pastes lotions and films. 3M Cavilon Durable Barrier Cream consist of dimethicone for skin protection ; acrylate terpolymer for durability and tape adhesion; coconut oil, mineral oil and paraffin for skin moisturizing; dicapryl adipate, isopropyl palmitate and PPG-15 stearyl ether for skin conditioning for skin conditioning and replenishing . Campbell et al. reported skin’s appearence ımprovement after using barrier cream between 88% and 100% of affected patients .
Zena EH Moore et al. five trials (940 participants) of unclear or high risk bias compared a topical agent with placebo. They reported no overall beneficial effect of the topical agents but the cluster randomised trial from the analysis indicated use of topical agents reduced the pressure ulcer incidence by 36% .
Kerr et al. İn a prospective cohort descriptive study of 10 patients over 14 days measured low echogenic pixel (LEP) imaging of affected skin and compared with the LEP of normal skin adjacent to the affected area using high-frequency ultrasound. After using barrier cream the mean LEP measures dropped. These suggests durable barrier cream effective for the treatment of incontinence associated dermatitis .
It is not possible to conclude with our results because of the small number of patients, the short duration time and effection of other multifactors in intensive care unit. However, barrier creams are easy to apply and cheap they can support the consideration of alternative treatment.
Evaluation of barrier creams or topical agents on the prevention of pressure ulcers needs well-designed studies. Prevention of pressure ulcers is important both in terms of public health and country economy.
- National Pressure Ulcer Advisory Panel. NPUAP Pressure Injury Stages.
- Beeckman D, Lancker A, Hecke A, Verhaeghe S (2014) A systematic review and meta‐analysis of incontinence‐associated dermatitis, incontinence, and moisture as risk factors for pressure ulcer development. Nursing in Research & Health 37(3):204‐218.
- Chaboyer WP, Thalib L, Harbeck EL, Coyer FM, Blot S, et al. (2018) Incidence and Prevalence of Pressure Injuries in Adult Intensive Care Patients. Critical Care Medicine 5(2).
- Vanderwee K, Clark M, Dealey C, Gunningberg L, Defloor T (2007) Pressure ulcer prevalence in Europe: a pilot study. Journal of Evaluation in Clinical Practice 13(2).
- Keller P, Wille J, van Ramshorst B, van der Werken C (2002) Pressure ulcers in intensive care patients: a review of risks and prevention. Intensive Care Medicine 28(10): 1379-1388.
- Pachá HHP, Faria JIL, Oliveira KA de, Beccaria LM (2018) Pressure Ulcer in Intensive Care Units: a case-control study. Revista Brasileira de Enfermagem 71(6): 3027-3034.
- Collier M, Simon D (2016) Protecting vulnerable skin from moisture-associated skin damage. British Journal of Nursing 25(20): S26-S32.
- Williams C (2001) 3M Cavilon Durable Barrier Cream in skin problem management. British Journal of Nursing 10(7): 469-472.
- Campbell K, Woodbury MG, Bray J, Bretschneider J, Gobel C, et al. (2000) Optimal skin care solutions: a clinical product evaluation. Poster. Parkwood Site, St Joseph’s Health Centre, Ontario, Canada, The University of Western Ontario, London, Ontario, Canada.
- Moore ZE, Webster J (2018) Dressings and topical agents for preventing pressure ulcers. Cochrane Database of Systematic Reviews.
- Kerr A, Arrowsmith M, Young S, Jaimes H (2014) Evaluation of a skin barrier cream for managing IAD in elderly patients using high-frequency ultrasound. British Journal of Community Nursing 19(12): 585-591.