AIMS
OF STUDY:
Absorbent
pads are the main method of managing urinary incontinence in residential
settings. Improvements in technology have resulted in highly absorbent
products which may be worn all night, but the effects of prolonged pad
wearing on aged skin are unknown. Hydrated skin is known to be more
susceptible to dermatitis1, friction and abrasion2. The aim of this study
was to examine the effect of different pad changing regimes on skin
health.
METHODS:
A
cross-over design was used. Following a two week baseline period subjects
from residential settings were randomly allocated to one of two pad
changing regimes, a more frequent pad changing regime (whereby residents
were changed at 22.00, 02.00 and 06.00) or a less frequent pad changing regime (with residents
changed at 22.00 and 06.00 only). Each regime lasted four weeks and was followed by the alternative
regime. Skin measurements were taken from selected skin sites using
the following tools (i) the Diastron erythema meter (ii) visual rating
scale (iii) the Servomed evaporimeter (to measure trans-epidermal water
loss) (iv) a pH meter. The primary outcome variable
was measurement of erythema using the Diastron erythema meter.
RESULTS:
Eighty
five subjects from 20 nursing/residential homes for elderly people completed
the study. Continuous data were analysed using general linear modeling
and ordinal data using McNemar’s test. The table below shows results
from four of the skin sites. No significant differences were found in
the severity of erythema, or skin pH, between regimes. However, measurements
of trans-epidermal water loss were significantly higher in the less frequent pad changing regimes indicating that skin was ‘wetter’.
Five
subjects developed a stage 2 pressure ulcer (abrasions) during the less frequent pad changing regime, but none in
the more frequent pad changing regime,
this result was not significant 0.1>P>0.05.
| |
Less
frequent regime (mean/SD)
|
More
frequent regime (mean/SD)
|
P
value
|
Visual
rating scale
|
|
Erythema
meter: Groin R
|
89.6
(36.5)
|
93.3
(29.1)
|
0.311
(NS)
|
NS
|
|
Groin L
|
92.9
(33.7)
|
93.8
(35.1)
|
0.612
(NS)
|
NS
|
|
Buttock R
|
125.4
(41.2)
|
132.8
(44.2)
|
0.207
(NS)
|
NS
|
|
Buttock L
|
133
(41.6)
|
133
(42.6)
|
0.399
(NS)
|
NS
|
Trans-epidermal
water loss (g/m2/hr)
|
55.9
(31.8)
|
68.1
(33.8)
|
0.009
0.009
|
|
pH
|
6.8
(0.4)
|
6.7
(0.5)
|
0.140
(NS)
|
|
CONCLUSIONS:
We found no evidence
that a less frequent
pad changing regime has an effect on skin erythema, but there is evidence
that skin is wetter, which may make it more vulnerable to friction and
abrasion. The non-significant finding of greater incidence of stage
2 pressure ulcers merits further investigation. We cannot therefore
be confident that a less frequent pad changing regime has no effect
on skin health.
1 Berg, RW, Buckingham, KW, Steward, RL (1986) Etiological factors
in diaper dermatitis: the role of urine Pediatric Dermatology 3 2 102-6
2
Zimmerer, RE, Lawson, KD, Calvert, CJ (1986) The effects of wearing
diapers on skin Pediatric Dermatology 3 2 95-101.
