Improving diaper design to address incontinence associated dermatitis

<p>Abstract</p> <p>Background</p> <p>Incontinence associated dermatitis (IAD) is an inflammatory skin disease mainly triggered by prolonged skin contact with urine, feces but also liberal detergent use when cleansing the skin. To minimize the epidermal barrier challenge we optimized the design of adult incontinence briefs. In the fluid absorption area we interposed a special type of acidic, curled-type of cellulose between the top sheet in contact with the skin and the absorption core beneath containing the polyacrylate superabsorber. The intention was to minimize disturbance of the already weak acid mantle of aged skin. We also employed air-permeable side panels to minimize skin occlusion and swelling of the stratum corneum.</p> <p>Methods</p> <p>The surface pH of diapers was measured after repeated wetting with a urine substitute fluid at the level of the top sheet. Occlusive effects and hydration of the stratum corneum were measured after a 4 hour application of different side panel materials by corneometry on human volunteers. Finally, we evaluated skin symptoms in 12 patients with preexisting IAD for 21 days following the institutional switch to the optimized diaper design. Local skin care protocols remained in place unchanged.</p> <p>Results</p> <p>The improved design created a surface pH of 4.6 which was stable even after repeated wetting throughout a 5 hour period. The "standard design" briefs had values of 7.1, which is alkaline compared to the acidic surface of normal skin. Side panels made from non-woven material with an air-permeability of more than 1200 l/m²/s avoided excessive hydration of the stratum corneum when compared to the commonly employed air-impermeable plastic films. Resolution of pre-existing IAD skin lesions was noted in 8 out of 12 patients after the switch to the optimized brief design.</p> <p>Conclusions</p> <p>An improved design of adult-type briefs can create an acidic pH on the surface and breathable side panels avoid over-hydration of the stratum corneum and occlusion. This may support the epidermal barrier function and may help to reduce the occurrence of IAD.</p

L'intégrité scientifique confrontée aux pratiques infirmières et aux recherches interdisciplinaires

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Les fonctions sensorielles et la maladie d'Alzheimer : une approche multidisciplinaire

Relations between sensory functions and Alzheimer's disease are still under explored.To understand them better, theFondation MédfJricAlzheimer has brought together a multi-disciplinary expert group. Aristote's five senses must be enhanced by today's know ledge of proprioception, motor cognition and pain perception. When cognition breaks dawn, the persan with dementia perceives the world around her with her sensory experience, yet is unable to intagratB all this information to understand the contaxt.The trBBtment of mul tiple sensory inputs by the brain is closely linked to cognitive processes. Sensory deficits reduce considerably the autonomy of people with dementia in their daily fife and their rela tions with others, increase their social isolation and the risk of accidents. Professionals involved with neurodegenerative diseases remain poorly aware of sensory deficits, which can bias the results of cognitive tests. However. there are simple tools to detect these deficits, notably for vision, hearing and balance disorders, which can be corrected. Many interventions for cognitive rehabilitation or quality of fife improvement are based on sen sory functions. The environment of people with dementia must be adapted to become understandable, comfortable, safe and eventually therapeutic.Afin de mieux comprendre les relations, encore insuffisamment étudiées, entre les fonctions sensorielles et la maladie d'Alzheimer, la Fondation Médéric Alzheimer a réuni un groupe d'experts multi-disciplinaire. Aux cinq sens d'Aristote, il faut aujourd'hui ajouter la proprioception, la cognition motrice et la perception de la douleur. Lorsque la cognition se détériore, la personne atteinte de la maladie d'Alzheimer voit le monde qui l'entoure avec son expérience sensorielle, sans qu'elle puisse toutefois intégrer toutes ces informations pour comprendre le contexte. Le traitement des multiples informations sensorielles par le cerveau est étroitement lié à des processus cognitifs. Les déficits sensoriels réduisent considérablement l'autonomie des personnes malades dans la vie quotidienne, leurs relations avec autrui, augmentent leur isolement social et le risque d'accidents. Les professionnels impliqués dans les maladies neurodégénératives restent insuffisamment sensibilisés aux déficits sensoriels, qui peuvent fausser l'évaluation de la cognition. Il existe pourtant des outils de repérage simples de ces déficits, notamment pour les troubles de la vision, de l'audition et de l'équilibre qui peuvent être corrigés. De nombreuses interventions pour la réhabilitation cognitive ou l'amélioration de la qualité de vie s'appuient sur les fonctions sensorielles. L'environnement des personnes malades doit être adapté pour le rendre compréhensible, confortable, sûr et si possible thérapeutique