Importance of pH in Care for Stoma Patients

Skin pH and Stomas

Healthy and intact peristomal skin is a crucial element of the quality of life for patients with a stoma and significantly affects their overall health. The quality of the skin in the immediate vicinity of the stoma is influenced by many factors – from the choice of sufficiently adhesive and absorbent stoma appliances to the care of proper skin pH.

Under normal circumstances, healthy skin has a slightly acidic pH, usually ranging between 4 and 6. This pH primarily ensures antimicrobial protection, as at this level beneficial microorganisms thrive while conditions are not favorable for pathogen multiplication. Slightly acidic pH supports skin integrity, but when the pH rises to neutral values, processes that disrupt the skin occur.

The goal of stoma care is thus to maintain the correct skin pH despite the negative influences such as moisture, chemical irritation related to the leakage of intestinal contents or urine, and improperly chosen stoma appliances. These play an important role particularly concerning the action of digestive enzymes found in the intestinal contents, which can, with improperly selected or applied appliances, repeatedly and long-term reach the skin surface. Protease and lipase, due to their pH, usually around 8, can disrupt the stratum corneum, weaken the protective function of the skin, and lead to irritation and damage to the peristomal area.

Economic Aspects of Skin Complications in Stoma Patients

Peristomal skin complications negatively impact clinical outcomes, health-related quality of life, and the economic aspect of stoma care. An American retrospective study examining the clinical and economic impacts of skin complications affecting the stoma area observed various aspects of this issue. From the records of 128 patients with different types of stomas, 47 showed signs of skin complications within 90 days after stoma creation, and 81 had no peristomal skin problems, illustrating the burden these complications pose from a financial and organizational perspective.

The costs of health care for patients with peristomal skin complications were on average $50,000 higher in the 120-day period after surgery compared to those without skin complications. The hospitalization of patients with complications was on average 54% longer than for individuals with trouble-free skin condition. These patients were also not as frequently re-hospitalized. Findings from the study conducted in the USA demonstrate that complications affecting peristomal skin are a financial, organizational, and personnel burden for the healthcare system, and therefore significant attention needs to be paid to them in the postoperative period and in further stages of stoma patient treatment.

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Sources:
1. Taylor M. G. White Paper: Introducing Dansac TRE^TM Seal Technology. Dansac, 2018.
2. The evidence and costs associated with peristomal skin complications. Dansac.