Healing of peristomal lesions through application of a hygiene protocol respecting the  skin’s physiological pH and natural moisturizing factor: a clinical study

Elena Toma; Filippo La Torre; Maria Sole Ercolani; Giuseppe La Torre; Paola Pocek

Elena Toma Registered Nurse, Clinical Specialist in Wound Care, Clinical Specialist in Ostomy Care, Independent tissue viability and Ostomy Care Consultant, Rome, Italy https://orcid.org/0000-0002-8844-0187
Filippo La Torre Professor in General Surgery, Department of Surgical Science, Director of I Level Master in Enterostomal Therapy, Director: U.O.C. Trauma and Emergency Surgery, “Sapienza” University of Rome, Italy
Maria Sole Ercolani Registered Nurse, Clinical Specialist in Wound Care and Clinical Specialist in Ostomy Care, Policlinico Umberto I , Rome, Italy
Giuseppe La Torre Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
Paola Pocek Clinical Translator and English Language Consultant, Lecco, Italy

Keywords: peristomal lesions, stoma complications, ostomy hygiene protocol, peristomal skin disorders, peristomal wound

Abstract

Background: Patients with ostomies, and at times also the specialty clinicians, can at times underestimate the importance of a correct peristomal hygiene (PHy). Awareness happens only when peristomal lesions (PSL) occur. The study had the objective to observe whether applying a suitable PHy protocol is a sufficient measure to heal L1-L3 PSL (SACS 2.0).
Methods: 64 patients requiring a specific consulting for managing PHy and the PSL present were enrolled in the study. They were all treated with the same PHy protocol, using a self-balancing pH soap to restore optimal pH and an isodermic cream to restore the skin’s natural moisturizing factor. The patient’s general condition and the peristomal skin condition were assessed using specific device to measure elasticity, pH, sebum, percentage of water contained in epidermis (PWCE) and derma (PWCD) at 3(T1), 7(T2), 15(T3) days and follow-up at 28 days(T4).
Results: Data from 50 patients were analysed (11 withdrew once the lesions were healed, and 3 needed treatment with advanced dressing). Sample composition: F50%, M50%; age ange 23-97 years; urostomy 20%, intestinal ostomy 80%; average BMI 25,09kg/m2, normal weight 48%; neoplasia 46%, 78% of patient population were self-sufficient in managing their stoma; 100% presence of PSL. Complete healing was achieved in 98%(49) of monitored patients, and specifically: 42% after 3 days, 80% after 7 days, and 96% at T3. From healing to the end of the monitoring
period, no other lesions occurred. At T4 we observed an improvement vs initial assessment of: PWCE in 46% of cases (PWCEAVG: T0=42.8%; T4=44.2%), PWCD in 40% of cases (PWCDAVG: T0-39.3%; T4-40.7%), elasticity in 24% of cases (peristomal elasticityAVG: T0-38.3N/m; T4-40.4N/m) and pH in 70% (pHAVG: T0–6.4; T4AVG -5.9). At follow-up we recorded a 96% compliance to the new protocol.

Conclusions: The combination of therapeutic education, applying a correct PHy, maintaining the peristomal skin hydrated and with a pH around 5.9 jointly contributed to ensure prevention and healing of L1-L2 peristomal lesions.