Comparison Of Two Nursing Interventions On The Prevention Of Perianal Skin Lesions In ICU Patients With Enteric Nutrition Associated Diarrhea

Objective:To compare the clinical efficacies of two different nursing interventions of nappy rash barrier cream and Burnet oil in prevention of perianal skin lesions in ICU patients with enteric nutrition associated diarrhea, in order to effectively prevent perianal skin damages in ICU patients caused from enteric nutrition associated diarrhea.Materials and Methods:From June2008to June2010, there were80ICU patients with enteric nutrition associated diarrhea who met the enrollment criteria to. They were randomly divided into two groups, the nappy rash barrier cream care group and the Burnet oil care group in accordance with the hospitalization number in our institute, each group enrolled40cases, and there was no significant difference between the two groups in age, sex, etiology of disease, APACHE Ⅱ (P>0.05). Patients were subject to different nursing interventions on perianal skin lesions:In Nappy rash barrier cream group, once after defecation, perianal skin was washed with37-39℃warm water, gently wiped with baby wipes (Johnson&Johnson China Co, Ltd, Shanghai) and dried naturally, then dipped in baby Nappy rash barrier cream (Johnson&Johnson China Co., Ltd., Shanghai) with a cotton swab around the anus smoothly. Finally massage the perianual skin from the center to peripheral area for4-6times, extending to5-10cm around the anus. In the Burnet oil care group once after defecation, perianal skin was washed with37℃～39℃warm water, gently wiped with baby wipes (Johnson&Johnson China Co, Ltd, Shanghai) and dried naturally, then dipped in Burnet oil (hospital preparation of the First Affiliated Hospital of Tianjin Traditional Chinese Medicine University, batch No. Tianjin drug system Z20070681) with a cotton swab around the anus smoothly. Finally massage the perianual skin from the center to peripheral area for4-6times, extending to5-10cm around the anus. The date of skin damage and severity of perianal skin condition were observed and assessed daily in patients after onset of diarrhea. The incidences of perianal skin lesions, the time interval between occurrence of skin lesions and diarrhea and the severity of lesions (scored according to the severity of skin lesions, the higher the scores, the more severe the lesions) were compared among two groups.Results:The overall incidence of perianal lesions was27.5%(22/80) in two groups of ICU patients with diarrhea, the nappy rash barrier cream care patients had the skin damage rate of37.5%(15/40), while the Burnet oil care patients was17.5%(7/40), the incidence skin damage between the two groups was significant difference (x2-test, P <0.05). The time interval between occurrence of skin lesions and onset of diarrhea for nappy rash barrier cream care patients was2.47±1.959d, while in Burnet oil care patients, skin damage occurred at2.14±1.215d, there was no statistical differences in the skin damage occurrence time between the two groups by t-test (P>0.05). For nappy rash barrier cream care patients, average skin damage severity score was3.30±4.508, by skin damage assessment, and for Burnet oil care patients, skin damage severity score was1.38±3.160there was significant difference between the two group by t-test(P<0.05).Conclusion:The Burnet oil coating could effectively reduce both the incidence of skin damage and skin damage severity, it is an effective method of skin nursing method to prevent perianal skin damages caused by enteric nutrition associated diarrhea.