An interventional study comparing skin hydration in nursing home residents using traditional versus disposable bed bath Katrin Gillis (RN, MSc) Inge Tency (RM, MSc, PhD) Ella Roelant (MSc, PhD) Dirk Lips (Msc, PhD)

Background Research on demand, in particular for a nursing home group, Curando Research on innovative washing method is relevant for clinical practice nursing education Dublin, 4-5 th November th Healthcare Interdisciplinary Research Conference 2

Introduction Growing population in nursing homes Modified barrier properties and skin hydration Skin tears and dry skin (or xerosis) are the most common problems Increased by agents containing soap Skin and soft tissues infections: 2 nd most common type of infection Dublin, 4-5 th November th Healthcare Interdisciplinary Research Conference 3

Introduction Skin care is essential for the wellbeing of elderly people Need for an evidence based approach on personal hygienic care Lack of high-quality studies as a framework for evidence based skin care practice Dublin, 4-5 th November th Healthcare Interdisciplinary Research Conference 4

Objective of the study To compare the effect of two washing methods (traditional versus disposable bed bath) on skin hydration at stratum cornea level in nursing home residents Dublin, 4-5 th November th Healthcare Interdisciplinary Research Conference 5

Study design and population A cluster randomized trial 166 residents from six wards of two nursing homes in Flanders I NTERVENTION GROUP : disposable glove bed bath Training session health care personnel 8 pre-moistened paraben free disposable wash gloves, 30 sec at 600W in microwave (exclusively used for the study) of which at least 4 gloves were used (SCA Hygiene products) C ONTROL GROUP : traditional washing method Dublin, 4-5 th November th Healthcare Interdisciplinary Research Conference 6

Study design and population All residents were eligible for participation Written informed consent of residents (or legal representatives) Approved by the EC of AZ Nikolaas hospital Dublin, 4-5 th November th Healthcare Interdisciplinary Research Conference 7

Dublin, 4-5 th November th Healthcare Interdisciplinary Research Conference 8 Control group n=46 Intervention group n= residents 45 observations 46 residents 45 observations 115 residents 110 observations 115 residents 110 observations 42 residents 40 observations 42 residents 40 observations 108 residents 105 observations 108 residents 105 observations Included at the baseline n=155 PRETEST Included at the baseline n=155 PRETEST Included after implementation n=155 POSTTEST Included after implementation n=155 POSTTEST 5 residents no informed consent 2 residents died 1 resident moved to another nursing home 1 resident hospitalized 2 residents died 1 resident moved to another nursing home 1 resident hospitalized 3 residents died 2 residents stopped the intervention 2 residents hospitalized 3 residents died 2 residents stopped the intervention 2 residents hospitalized

Measurements Dublin, 4-5 th November th Healthcare Interdisciplinary Research Conference 9 At the baseline After 12 weeks of implementation Stratum corneum hydration was measured using the MoistureMeter SC (Delfin Technologies Ltd) Mean score of two measurements (AU, arbitrary units) Registration of temperature (°C) and humidity (%) C HEEK H AND L EG

Measurements 16 th Healthcare Interdisciplinary Research Conference 10 Dublin, 4-5 th November

Residents’ baseline characteristics, bath practices and environmental factors Intervention group n=115 Control group n=46 P-value Gender (n, %)Male37 (31.6)10 (22.2)0.238 * Female80 (68.4)35 (77.8) Age (Me, IQR, y) 87 [82-91]86 [80-90]0.224 ** BMI (Mean, SE 23.8 ± ± *** Frequency bathing or showering (n,%) no bathing or showering 1 x/2 weeks 1x/week 15 (15.5) 3 (3.1) 79 (81.4) 0 (0) 39 (100) **** Soap (n,%)Bar of soap35 (92.1)14 (58.3)0.001 * Liquid soap/oil3 (7.9)10 (41.7) Environmental factors (Mean, SE, °C/%)Room temperature24.0± ±0.18<0.001 *** Humidity29.5± ±0.34<0.001 *** Dublin, 4-5 th November th Healthcare Interdisciplinary Research Conference 11

Skin hydration at the baseline Total skin Cheek: 22.8±15.2 AU Hand: 17.9±8.2 AU Leg: 18.7±8.8 AU No difference between intervention and control group nursing home and bathing practice Dublin, 4-5 th November th Healthcare Interdisciplinary Research Conference 12 C HEEK 19.7±12.3 AU H AND 17.7±7.6 AU L EG 18.9±9.5 AU C HEEK 24.1±16.1 AU H AND 18.0±8.5 AU L EG 18.7±8.5 AU (Mean±standard deviation)

Skin hydration after implementation Total skin Cheek: 36.5±23.9 AU Hand: 20.6±10.9 AU Leg: 23.1±10.8 AU Significantly higher in intervention versus control group 88% cheek 28% hand 38% leg Dublin, 4-5 th November th Healthcare Interdisciplinary Research Conference 13 C HEEK 22.2 ±19.7 AU H AND 17.1±6.6 AU L EG 18.1±6.3 AU C HEEK 41,8±23.3 AU H AND 21.9±11.8 AU L EG 24.9 ±11.5 AU (Mean±standard deviation)

Skin hydration post-minus-pre score 16 th Healthcare Interdisciplinary Research Conference 14 * significance at <0,05 level ** significance at ≤0,001 level Dublin, 4-5 th November 2015 Total ** * Leg Hand CheekHydration Post – Pre (AU) Control Intervention * p < 0,05; ** p < 0,001

Determinants of skin hydration Differed according to The skin site Prehydration status Gender Humidity Frequency of bathing Dublin, 4-5 th November th Healthcare Interdisciplinary Research Conference 15

Conclusion A significant increase in hydration score at all skin sites and total skin after implementation of disposable wash gloves The use of disposable wash gloves in nursing homes can improve quality of care, thereby reducing the risk of dry skin. Dublin, 4-5 th November th Healthcare Interdisciplinary Research Conference 16

Further research Further RCT’s in similar and other health care settings are needed Determinants of skin hydration in elderly (e.g. environmental factors) needs further consideration Further research to compare different wash gloves as well as cost-effectiveness of the innovative wash method Dublin, 4-5 th November th Healthcare Interdisciplinary Research Conference 17

Thank you for your attention! Dublin, 4-5 th November th Healthcare Interdisciplinary Research Conference 18