失禁性皮膚炎和壓力性損傷之間的關係

訪談人： DEBRA M. THAYER，3M醫療產品解決方案應用工程師，護理碩士、護理師，傷造口護理師

編譯：劉芝伶

我們知道失禁和腹瀉是重症加護病房中常見的問題。然而，這些問題出現在所有的醫療院所中。接觸了液狀糞便，尤其是混合著尿液的糞便，是導致失禁性皮膚炎（Incontinence Associated Dermatitis, IAD）發生的重要危險因素。我們知道IAD會增加繼發性感染的風險，更會給患者帶來痛苦。但可能很少人知道，IAD已經被證明是形成壓力性損傷（Pressure Injuries, PIs）^1-3的獨立危險因素。

加強IAD的預防有助於解決日益嚴重的壓力性損傷問題；為了做到這一點，就必須瞭解IAD和壓力性損傷之間的關聯。

皮膚暴露在由尿液和液狀糞便構成的潮濕環境時，會降低皮膚的防護強度，損害皮膚的屏障功能，使皮膚更容易受到摩擦的傷害。摩擦力不僅會導致IAD，也是剪力形成的必要條件。

減少摩擦是預防壓力性損傷的一個重要措施，您可能已經嘗試過各種策略來減少摩擦，如減少表面摩擦，儘量減少床單的層數，藥物外塗或覆蓋敷料來保護脆弱部位。

由於剪力對壓力性損傷的進程存在潛在影響，請小心辨別您的IAD預防方法，確保它們不會增加皮膚摩擦，而是有助於降低壓力性損傷的風險。

參考文獻：

Demarre L, Verhaeghe S, Van Hecke A, Clays E, Grypdonck M, Beeckman D. Factors predicting the development of pressure ulcers in an at-risk population who receive standardized preventive care: secondary analyses of a multicentre randomised controlled trial. J Adv Nurs. 2015 Feb;71(2):391-403.
Park KH. The effect of a silicone border foam dressing for prevention of pressure ulcers and incontinence-associated dermatitis in intensive care unit patients. J Wound, Ostomy, Continence Nurs. 2014; 41(5):424-29
Gray M, Juliano KK. Incontinence-Associated Dermatitis, Characteristics and Relationship to Pressure Injury: A Multisite Epidemiologic Analysis J Wound Ostomy Continence Nurs 2018; 45(1): 63-67.
Zaratkiewicz, S., Whitney, J. D., Lowe, J. R., Taylor, S., O’Donnell, F., & Minton-Foltz, P. (2010). Development and Implementation of a Hospital-Acquired Pressure Ulcer Incidence Tracking System and Algorithm. J Healthc Qual. 2010 Nov–Dec; 32(6): 44–51. doi: 10.1111/j.1945-1474.2010.00076.x.
Declines in Hospital-Acquired Conditions. Content last reviewed May 2019. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/data/infographics/hac-rates_2019.html. Ulcer Incidence Tracking System and Algorithm. Journal for Healthcare Quality, 32(6), 44-51.
Asmus R, Bodkhe R, Ekholm B, Thayer D, and Bradley J. The Effect of a High Endurance Polymeric Skin Protectant on Friction and Shear Stress. Poster presentation at 2018 Symposium on Advanced Wound Care Las Vegas NV and 2019 National Pressure Ulcer Advisory Panel Annual Conference St Louis MO.
Grove G, Houser T, Grigoryan A, Damia J. Atwood N. A motorized sliding sled for measuring the coefficient of friction of human skin in vivo. Poster presentation at 2011 Symposium on Advanced Wound Care. Dallas TX, 2011 European Wound Management Association Conference. Brussels BE, and the 2011 Wound Ostomy and Continence Nursing Society Conference New Orleans LA.