Professor Hans Smola is the director of the Medical Center of Excellence at HARTMANN, and is an adjunct professor in the Department of Dermatology at the University of Cologne. For many years, he has been researching the effects of urine on ageing skin and ways to reduce or eliminate the levels of infection from incontinence.
Five years ago Professor Smola co-wrote a paper on ways to optimise the design of adult incontinence briefs, so that the associated dermatitis was reduced or even resolved.
In Melbourne he will be outlining his further research on the topic.
"One source of confusion has been between pressure sores and dermatitis from moisture caused by incontinence, as the two are very difficult to tell apart. In the nursing sector it's very important that you avoid excessive pressure on bony prominences, for instance, as the patient can develop wounds.
"For the clinicians, it is difficult to distinguish between lesions due to exposed urine and moisture, or due to pressure."
Professor Smola says that in the five years since his previous paper was published, this field has developed more.
"There are guidelines now on how to distinguish between the two [types of wounds] and we have continued our research into what we can do to keep the skin healthier and more robust," he says.
Some of the subsequent data will be presented at the conference in Melbourne, including research into specific fibres that will exclude harmful bacteria in the zone close to the skin. These fibres are intended to be included in the superficial layers of the briefs HARTMANN has developed.
His latest research has therefore taken a more in-depth look at the environment between the fabric of incontinence briefs and the skin surface, and how to normalise the integrity of the skin – or at least make the skin more robust so a patient has fewer, or less severe, effects from incontinence.
"You can wick away the majority of the moisture but you cannot wick away all of it so the top layer – that is, the one closest to the skin – always stays moist," he says.
"This moisture is a little reservoir in which bacteria can multiply under normal conditions. Our aim has been to inhibit this growth of bacteria, so we will end up with moisture but no bacteria."
"What we have found is that when bacteria that are usually found in the urinary tract of patients are incubated in this fibre we have developed, they stopped growing," Professor Smola says.
"The only exception was candida, which was slowed but not stopped. All the other bacteria were growth inhibited."
This has not been tested on skin of patients so far but has been tested in the lab, where Professor Smola has collated further data – which are not yet ready to be presented – on whether the cellulose fibre that his team at HARTMANN have developed will modify the pH balance of the wearer's skin surface.
In essence, Professor Smola says, the effort is really about improving skin integrity.
"It's a situation that's not perfect, from the start," he says. "So it's about what you can do so the skin becomes more robust with fewer or, let's say, less severe effects of incontinence."
Professor Smola will be presenting the breakfast symposium at the 24th National Continence Foundation of Australia conference on 26 November. His address is titled ‘Causes and preventative strategies to maintain skin integrity’.