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Beware of the toilet: The risk for a deep tissue injury during toilet sitting
Author links open overlay panelMaayanLustigaAyeletLevyaKaraKopplinbZehavaOvadia-BlechmancAmitGefenPh.D.(Professor in Biomedical Engineering)a
Highlights
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- Prolonged sitting on toilet seats involves a potential risk for pressure injuries.
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- The potential risk for pressure injuries is affected by the toilet seat design.
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- Specialized toilet seat cushions are able to reduce the tissue injury risk.
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- Narrow/inclined seats increase tissue loads based on simulations and hemodynamics.
Abstract
A
pressure injury (PrI) compromises quality of life and can be
life-threatening. The fundamental cause of PrIs is sustained
deformations in weight-bearing soft tissues, e.g., during prolonged
sitting on inadequate surfaces such as a toilet seat. In nursing homes
and geriatric facilities, patients need assistance using the restroom,
and patients being left on the toilet for tens-of-minutes is a
real-world scenario, unfortunately. Nevertheless, there are no published
studies regarding sustained tissue loads during toilet sitting and
their effects on tissue physiology. Here, the biomechanical and
microcirculatory responses of the buttock tissues to toilet sitting were
investigated using finite element modeling and cutaneous hemodynamic
measurements, to explore the potential etiology of PrIs occurring on the
toilet. We found that prolonged sitting on toilet seats involves a
potential risk for PrI development, the extent of which is affected by
the seat design. Additionally, we found that specialized toilet seat
cushions are able to reduce this risk, by lowering instantaneous tissue
exposures to internal stresses (by up to 88%) and maintaining reduced
interface pressures. Furthermore, hemodynamic variables were altered
during the toilet sitting; in particular, tcPO2 was decreased
by 49% ± 7% (44 ± 2[mmHg] to 22 ± 4[mmHg]) during sitting. The current
study confirms that investing in expensive PrI prevention (PIP) products
is likely to be ineffective for an immobilized patient who is left to
sit on a bare toilet seat for long times. This argument highlights the
need for a holistic-care approach, employing PIP devices that span
across the entire environment where bodyweight forces apply to tissues.
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