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PubMed1994

Nipple candidiasis among breastfeeding mothers. Case-control study of predisposing factors.

OBJECTIVE: To investigate factors that predispose breastfeeding mothers to nipple candidiasis. DESIGN: A retrospective case-control study of women attending the Calgary Breastfeeding Clinic. SETTING: Ambulatory breastfeeding referral centre. PARTICIPANTS: All women (105) who attended the clinic during a 3.5-month study period. All were referred for problems with breastfeeding; 27 (the case group) had positive diagnostic criteria for nipple candidiasis. The other 78 formed a control group. MAIN OUTCOME MEASURE: A patient information sheet, completed while taking a medical history, recorded the presence or absence of four possible predisposing factors. Two infant variables were also noted on physical examination. Patients were diagnosed as having or not having nipple candidiasis on the basis of specific clinical criteria, and statistics on other variables were compared for those with positive and with negative diagnoses. RESULTS: A statistically significant correlation (P < 0.05) was found between nipple candidiasis and three factors: vaginal candidiasis (P = 0.001), previous antibiotic use (P = 0.036), and nipple trauma (P = 0.001). CONCLUSIONS: Further research is required to establish clear causality. However, we recommend that physicians be suspicious of nipple candidiasis; avoid antibiotics or use the shortest effective course; treat yeast vaginitis during the third trimester and after delivery aggressively; and treat mothers for nipple yeast if babies have oral or diaper candidiasis. Breastfeeding mothers can also be counseled in preventive measures.

Anti-Bacterial Agents↗
PubMed1993

[Diaper dermatitis. Classification, occurrence, causes, prevention and treatment].

Diaper dermatitis is a multifactorial dermatological disorder characterized by inflammation in the diaper area. About half of all babies and old people in need of care experience light dermatitis, while 20% have moderate and 5% severe dermatitis. Friction from the diaper, occlusion, irritation from faeces, ammonia, detergents, candida albicans, proteolytic and lipolytic enzymes and moisture deposited on the epidermis cause damage at the stratum corneum layer of the epidermis. Diaper dermatitis is caused by a combination of mostly irritant effects. Compounds that infiltrate the skin can aggravate the reaction to the damaged epidermis. The barrier function of epidermis must be restored in order to prevent and treat diaper dermatitis.

Aged↗
PubMedDate not supplied

Standardizing skin care across settings.

While healthcare providers are struggling to provide optimum patient care and health outcomes in a cost efficient manner, patients are demanding assurance that the care they receive offers the best chance for health improvement. The way to achieve the most effective and efficient treatments is through knowledge of current research and treatment options and standardized care. Resources are the AHCPR's Clinical Practice Guidelines on urinary incontinence and pressure ulcers in adults. Kaiser Permanente's Northern California Region created a Task Force to demonstrate nursing's contribution to positive patient outcomes, investigate and capture opportunities to participate in an interdisciplinary approach to measuring the effectiveness of patient care, and focus efforts on measurement, improvement, research, and development. Part of this effort was the conductance of a study which demonstrated that the absorbent product with the least expensive purchase price that had traditionally been used for incontinent patients was the most expensive product to use. The results of that study have been used, not only to improve purchase decisions, but also to teach nurses how theory, research, and practice are related to issues that concern caring for their patients.

Diaper Rash↗
PubMedDate not supplied

Perineal dermatitis risk factors: clinical validation of a conceptual framework.

As part of a larger study previously published in December of 1994, the question was asked whether commonly used pressure ulcer assessment tools (the Braden and Medley) were applicable to a broader definition of "skin risk assessment" and altered skin integrity related to perineal dermatitis (PD), and, if so, which risk factors were actually related to PD. The three site randomized clinical trial compared the use of diapers and underpads for 166 adult patients hospitalized on medical and surgical floors who were incontinent of urine and/or feces. Variables related to skin breakdown were the number of incontinence episodes, fecal incontinence, poor skin condition, pain, poor oxygenation, fevers, and mobility problems. Results also suggest that older patients may not have the sensory perception to experience discomfort in the same intensity as younger patients. Based on the findings of this study, pressure ulcer risk assessment tools are not good risk assessment tools for PD. The previously published conceptual framework for PD was modified and validated to form a basis for preventive measures.

Adult↗
PubMed1996

Breaking the cycle: the etiology of incontinence dermatitis and evaluating and using skin care products.

Dermatitis is a common problem for incontinent patients; a cycle of moisture, friction, bacteria and breakdown can be established. To break this cycle, the clinician must understand the etiology of incontinence dermatitis and choose appropriate skin care products. Healthy skin has a mean acid mantle of 5.5 pH. This natural acidity discourages bacterial colonization and provides a moisture barrier. Aging skin experiences increased dryness (allowing cracks in which bacteria colonizes) and slower recovery from the effects of alkaline substances. Incontinence results in elevated friction coefficient, exposure to moisture, bacteria and ammonia (leading to alkaline conditions), and increased enzymatic activity. When choosing products to protect the skin, clinicians should check that the product's pH level is within the desirable range (4 to 7), that ingredients are appropriate and not contraindicated for particular patients, and that the product has been tested for dermal irritation and antimicrobial efficacy. Three basic product types are cleansers, moisturizers and barriers. Skin should be cleansed gently without high alkalinity (as in some bar soaps) or rubbing (which denudes fragile skin), patted or air dried, moisturized after bathing, and protected with a barrier. Using the appropriate products can reduce the risk for breakdown and enhance the skin health of your patients.

Diaper Rash↗
PubMed1996

Perineal skin injury: extrinsic environmental risk factors.

Little research has been performed to evaluate factors that may exacerbate perineal skin injury in the adult population. But extensive research has been done and knowledge has been gained from studies with diaper dermatitis in infants. Our objectives in writing this article are to define the anatomical area affected, the terms used, and to review the available literature for diaper dermatitis in infants, elucidating the similarities and differences between diaper dermatitis in infants and perineal dermatitis in adults. The six extrinsic environmental factors that have been identified and extensively studied in diaper dermatitis are skin wetness, urine, ammonia, feces, local skin pH and microorganisms. Although the complex interactions of the six factors are still not totally defined, we do know that to prevent perineal skin injury, it is helpful to prevent excessive skin hydration, minimize the interaction of urine and feces, minimize local microorganisms, and maintain skin near its physiologic pH. In general, the six extrinsic factors can be extrapolated and applied to the care of adults. Further research in adult fecal enzymes and pH is still necessary.

Adult↗
PubMed1996

Protocol for changing condom catheters in males with spinal cord injury.

A five year study was conducted to determine the appropriate frequency for routine changing of condom catheters in males with spinal cord injury. One hundred and thirteen outpatient subjects participated in a non-randomized study. Eighty subjects changed their condom catheters on a daily basis, and 33 changed their condom catheters every other day. The subjects were questioned and the clinic record was reviewed by a nurse clinician about the incidence of skin and urinary complications occurring in the previous year. The most common skin complication found in both groups was redness, followed by excoriation. The most common urinary complication reported by both groups was urinary tract infection, followed by bladder and renal stones. There was no significant difference found in the incidence of skin or urinary complications between the subjects who changed their condom catheters daily and those who changed their condom catheters every other day. It is recommended that selected patients can change their condom catheters every other day as long as appropriate guidelines are followed.

Adult↗
PubMed1997

Pediatric dermatoses: three common skin disruptions in infancy.

Skin disruptions account for 20% to 30% of pediatric primary care visits [1]. These disruptions may result from skin infections, inflammatory responses, insect bites, and infestations. This article focuses on the identification and management of skin disruptions related to inflammatory dermatoses. The most common dermatoses in infancy are seborrheic dermatitis, (also known as cradle cap); diaper or primary contact dermatitis; and atopic dermatitis, more commonly referred to as eczema, an entity that has yet to be clearly defined. Recognition and appropriate treatment of these common pediatric dermatoses must not just focus on the skin disruptions; it is important that the infant be assessed within the context of the family. The primary care provider must be aware that these conditions have the potential to affect the developing relationship between the infant, parent(s), and family. The practitioner within the provider-family relationship, through education and support, can empower the parent(s) to provide the necessary care for their infant.

Dermatitis, Atopic↗