Efficacy of a Protective Hand Cream versus a Conventional Cream to Improve Skin Barrier Function among Pediatric Intensive Care Unit Healthcare Workers: A Pilot Study

Background: Hand hygiene is one of the most effective procedures for preventing health care-associated infection. Barrier creams are used to prevent the irritant effect caused by occupational exposure. Objective: To compare an aluminum chlorohydrate-containing hand cream and a conventional cream in health-care workers (HCWs) by using clinical assessment score and quantitative measurement of transepidermal water loss (TEWL). Materials and Methods: A double-blinded, randomized, placebo-controlled trial was performed in pediatric intensive care unit HCWs. The subjects were assigned to regularly use the given cream (one fingertip unit per time, equal to 0.5 gram) after washing their hands with either 4% chlorhexidine gluconate or alcohol hand rub, which is 70% alcohol, glycerin, D-panthenol. The clinical assessment score, ranging from 0 to 3 points per item, were performed by the investigator evaluating for erythema, dryness, scaling, vesicles, fissuring and lichenification, and by the subject evaluating the redness, itching, tightness, dryness and sweating, together with TEWL assessment in a controlled environmental condition at day 0, 7, and 14. Results: Sixty HCWs were equally divided for each product. Barrier cream and conventional cream, amount used were 32.20 g and 26.43 g, respectively. At day 14, the clinical assessment score by the investigator and by the subject were reduced by 40.02% and 43.38% in the barrier cream group, and 35.5% and 47.83% in the conventional cream group (p<0.001. However, the TEWL in both groups was not significantly different from the baseline. Both products were well tolerated. Conclusion: The amount of cream applied by HCWs was lower than assigned. Both barrier cream and conventional cream can clinically improve the clinical score. Frequent and regular use of hand creams should be encouraged to decrease or prevent skin irritation and hand dermatitis. Keywords: Protective hand cream, Transepidermal water loss, Healthcare workers, Hand hygiene practices, Pediatric intensive care unit

Factors Influencing Diaper Dermatitis Among Jordanian Children Younger Than 24 Months

Background: Diaper dermatitis (DD) is a highly common condition among neonates, infants, and toddlers. The current study aims to explore the factors influencing DD among children aged between 0-24 months in Jordan. Methods: This study utilized a descriptive cross-sectional design with a convenient sample of 140 children diagnosed with DD. Structured face-to face interviews were used to collect data from the parents of the children included in the study. Univariate and multivariate logistic regression analyses were used to test the association between diaper dermatitis and its related medical factors. Results: The prevalence of DD was found to be 98.6% among the participants. The median of the duration of the most recent DD episode in days was 3 days (Inter Quartile Range= 2 to 4 days). The factors influencing DD were the use of barrier cream (OR=.35, 95% CI = .18-.72, p=.004), and bathing frequency of ≤ 1 time per week (OR=1.15, 95% CI = .65-2.10, p=.002). Conclusion: The identified factors should be paid significant attention in order to reduce the prevalence of DD among children aged 24 months or under. Prevention-focused programs which encourage the frequent application of appropriate barrier creams and frequent bathing of more than once a week are needed.

Five-Month Follow-up Shows No Improvement in Dermatological Complications in Children With Type 1 Diabetes Using Continuous Glucose Monitoring Systems and Insulin Pumps

Background: A Danish study showed that 90% of the pediatric patients who participated had some time experienced dermatological complications due to treatment with continuous subcutaneous insulin infusion (CSII). This follow-up study describes dermatological complications due to CSII and/or continuous glucose monitoring (CGM) between the two study periods and includes health-related quality of life (HrQoL) measurements. Methods: A total of 138 patients (95%) out of 145 patients from the initial study answered an online questionnaire regarding dermatological complications related to CSII and/or CGM, five months later. A second questionnaire (DISABKIDS) regarding HrQoL was sent out to those 138 of which 111 patients completed it. The patients were aged from 2 to 20 years. Descriptive statistics, χ2 tests, and univariate and multivariate analyses were used to analyze the data. Results: In total, 81% of the 138 patients continued to have dermatological complications at follow-up. Itching was the most frequently reported complication. Patients using Enlite reported more dermatological complications than those using Libre. In total, 79% of the patients who used barrier cream in the initial study still had dermatological complications five months later. Age, gender, Body Mass Index (BMI), or HbA1c levels showed no significant association with dermatological complications. Patients who perceived dermatological complications as a greater problem had lower HrQoL scores. Conclusion: Once dermatological complications start to appear, they become chronic, indicating that the treatments currently available are inadequate. Patients perceiving dermatological complications as a greater problem were associated with lower HrQoL. These findings highlight the need for additional preventive studies.