Research of Stoma Bridges and Their Impact on Skin Integrity and Patiient Outcomes

Purpose: Clinical observation of skin insult related to post-operative loop ostomies with and without stoma bridges were observed, and led to a quality research initiative to improve patient care. The purpose of this study was to explore variables related to peristomal breakdown, including but not limited to, the use of plastic bridges or flexible catheters to secure a loop ostomy. Methodology: An IRB approved retrospective chart review was conducted on a non-random subset of hospitalized adult patients having had a surgical loop ileostomy (n=72) or loop colostomy (n=21) procedure, conducted between 2008 – 2015. Demographic and clinical variables for 93 adults were recorded and analyzed. Statistics: Descriptive and correlational statistical analyses were performed. The variables were: age, gender, length of stay (LOS), diagnosis, type of bridge, wound presence, skin integrity, and pouch leakage due to the bridge or catheter presence. Results: The study population had slightly more females (57%) than males (43%) and the ages of the patients ranges from 19 to 96 years, with a mean 59.6±16.47 (SD); median of 60 years. The average LOS for the initial surgery was 4.03 days. In this sample the primary reasons for surgical bowel diversion were cancer (60%), inflammatory disease (16%), non-cancerous bowel obstruction (10%), and other (14%). Flexible catheters were used most often (53.76%), followed by plastic bridges (40.86%). 21 patients (24.44%) had pouch leakage. Leakage occurred 3.55 times more often with plastic bridges compared with flexible catheters (p=0.002). The 23% (n=21) of pts that presented with leakage also developed erythema and rash. 11.8% (n=11) progressed to a fungal skin infection necessitating treatment with antifungal powder. Conclusion:  The use of plastic stoma bridges in loop ostomy patients increased peristomal leakage, inflammation and fungal infection rates. Findings provide a springboard for interprofessional collaboration between ostomy nurses and surgeons to improve patient outcomes.