Objective To determine if a repurposed silicone-based dressing used underneath an N95 mask is a safe and beneficial option for facial skin injury prevention without compromising the mask’s seal.
Methods Since February 21, 2020, staff in high-risk areas such as the ED and ICU of King Hamad University Hospital have worn N95 masks when doing aerosol-generating procedures to protect against the novel coronavirus 2019. At that time, without education enablers or resources that could be directly translated into practice, the hospital’s Pressure Injury Prevention Committee explored and created a stepwise process to protect the skin under these masks. This procedure was developed over time and tested to make sure that it did not interfere with the effectiveness of the N95 mask seal.
Results Skin protection was achieved by repurposing a readily available silicone border dressing cut into strips. This was tested on 10 volunteer staff members of various skin types and both sexes who became part of this evidence generation project. Oxygen saturation values taken before and after the 4-hour wear test confirmed that well-fitted facial protection did not compromise the mask seal, but rather improved it. An added advantage was increased comfort with less friction as self-reported by the staff. An educational enabler to prevent medical device-related pressure injuries from N95 mask wear was an important additional resource for the staff.
Conclusions This creative and novel stepwise process of developing a safe skin protection method by which staff could apply a repurposed silicone border dressing beneath an N95 mask was largely effective and aided by the creation of the enabler.
Aim To present the management of a patient who developed a fistula from a uretero-ileostomy anastomosis of the ileal conduit by applying intra-conduit negative pressure through a dual tube.
Case report The patient was a 73-year-old man diagnosed with bladder cancer who underwent a radical cystectomy and formation of an ileal conduit in our centre. A fistula occurred in the ileal conduit less than 1 week after the surgery. Urineleakedcontinuously into the pelvic cavity which put the patient at risk of fluid and electrolyte imbalances. A further operation to suture the fistula to contain the leakage was suggested. To save the patient from a further operation, intra-conduit negative pressure through a dual tube was attempted to assist with management of the fistula. This conservative treatment promoted successful closure of the fistula.
Method It is clinically challenging to manage a urinary fistula associated with an ileal conduit in a conservative way. This is because the fistula is deep within the body cavity and it is almost impossible for the fistula to heal spontaneously. The literature reveals previous conservative treatment has been mostly unsuccessful. Surgical suturing of the fistula is the most used method but is not always an ideal choice. By applying intra-conduit negative pressure through a dual tube system to the ileal conduit, the aim was to facilitate closure of the fistula.
Conclusion In this case report the application of intra-conduit negative pressure through a dual tube to contain a fistula from a uretero-ileostomy anastomosis of an ileal conduit was found to be safe and effective. This method of conservative treatment is worth promoting.
Initiate and implement an appropriate risk assessment tool to identify high-risk prolonged surgery patients at risk of developing pressure injuries (PIs).
Initiate education and training regarding PI prevention and management in the operating theatre (OT).
Establish resource individuals in the OT.
Enable early identification of high-risk patients and implementation of preventative measures.
Methods A retrospective data analysis was conducted from Safety Intelligence (SI) 2016–2017 gathering baseline information of all skin injuries, particularly PIs reported in the OT. Upon completion of a needs analysis, a continuous quality improvement and learning model, Plan-Do-Check-Act (PDCA), was initiated. Comparative data from Quarter 1 (Q1) 2016 to Quarter 4 (Q4) 2018 pre- and post-implementation were analysed.
Results Within a period of 9 months from April to December 2018, 99 patients were referred to the wound care team, with an average operation time of 7 hours. Two cases of PI were reported in Q2 and Q4 2018. The contributing factors discovered upon review of the root cause analysis were related to poor nutrition, extended immobilisation, prolonged surgery time (more than 17 hours), presence of multiple comorbidities e.g. chronic renal failure, diabetes, hypoalbuminaemia and haemodynamic instability. Improvement outcomes were achieved by adhering to the new system and practices.
Conclusion Preventing PIs are part of patient safety and quality of care which needs collaborative and proactive teams with a sense of responsibility and accountability.
Background Incontinence-associated dermatitis (IAD) is a prevalent cause of skin damage in the clinical setting. IAD may cause a heat sensation, pruritus, pain and infection as well as prolong hospital stays and increase healthcare costs.
Objective The aim of this study was to develop a bundle care guideline for IAD based on an evidence-based framework.
Method Three steps were conducted: an IAD bundle care guideline was drafted, consensus among hospital nursing staff and clinical experts was obtained, and an evaluation was made by methodology experts.
Results The initial guideline was approved by 30 nurses and seven clinical experts (two runs) to achieve >80% agreement. Three methodology experts evaluated the quality of the development process as a use recommendation. The IAD bundle care guideline consisted of four aspects with 19 interventions – skin assessment, skin cleansing, skin protection and supportive care. The IAD bundle care guideline was standardised and evidence-based.
Conclusions The developed IAD bundle care guideline integrates information from a systematic literature review and the opinions of nurses, clinical experts and methodology experts, and is recommended for clinical application. Further studies will be implemented to verify its effectiveness.
The coronavirus disease 2019 (COVID-19) pandemic has brought uncertainty and opportunity to nurses and healthcare. As part of the nursing profession, enterostomal therapy (ET) / wound, ostomy, continence (WOC) nurses offer specialised care that is critical to the health of persons with wounds, ostomies and continence. ET/WOC nurses’ knowledge and practice have positioned these nurses as integral partners in leadership and the delivery of care during these challenging times. The aim of this paper is to highlight five leadership themes for ET/WOC nurses that have evolved during the pandemic, namely interprofessional practice, emotional intelligence, ethical practice, advocacy, and self-care.