The approach to ostomy care has changed drastically over time, with the most significant advances in the last 50 years. It took many years to overcome a range of challenges so that people could not only have lifesaving procedures resulting in an ostomy, but also have solutions that enabled them to truly live their lives after the surgery.
Living with Leaks
The first challenge facing healthcare professionals was developing and refining techniques to create stomas. In the early days stoma construction appears to have been rare, with the first known account in 1706 (a battlefield wound resulting in a colostomy). Records suggest that surgeons were able to create stomas, but did not have adequate solutions for stoma management. For example, a mid-1700s surgical textbook features an etching of a woman with a colostomy using rags and moss to absorb the output. Other accounts suggest a sponge held tightly with an elastic band or leather pouches with drawstrings as early solutions for ostomy appliances. One can imagine that, while the people wearing these products were alive because of having the surgical procedure, their quality of life after surgery was likely poor. During this time period, leaks would be a constant challenge due to poor output containment and exposure to stoma output combined with other challenges in hygiene management could present health risks.
Containment and Confinement
Little changed for those with ostomies until the early twentieth century, when progress was made to address the next major challenge: more secure methods of containing stoma output. In the first half of the twentieth century, many filed patents for ostomy appliances. One early example is a patent granted in 1913 to Mary Manney of Chicago, IL for a surgical appliance which attached to the abdomen of patient and drained stoma output into a container. In the 1920s, Dr. Alfred Strauss (also of Chicago) came up with the idea of a rubber pouch that could be held in place by adhesives and belts.
While appliances such as these were superior to previous alternatives, such as rags and sponges, they were cumbersome and poor solutions for managing odor or skin health. Some products used adhesives similar to rubber cement. They were intended to stay on as long as possible and could be very painful and damaging to the skin when it was time to change the system. Rubber pouches were heavy – putting weight and stress on the skin around the stoma – and bulky. The rubber itself might smell and did little to nothing to manage odors of stoma output. These pouches would need to be washed out by hand and reworn, which could build up more odor over time.
Safe and Effective Care
In the 1950s and 60s, healthcare professionals and product manufacturers made progress towards the next major challenge: making ostomy care and products more safe and effective for patients. Among healthcare professionals this included refinement of new surgical techniques and the emergence of a new profession: a registered nurse who specialized in treating patients with ostomies, known today as a WOC (Wound, Ostomy, Continence) or ET (Enterostomal Therapy) nurse.
At the same time, manufacturers of ostomy products started to experiment with and introduce other materials such as plastic films that were lighter, less bulky, and better contained odors than rubber bags. During this decade the Karaya 5™ hydrocolloid skin barrier called was introduced by Hollister Incorporated as safe and effective solution compared to alternatives that used cement-like adhesives or a required belt. The Karaya 5™ barrier is made of natural ingredients and is a gum substance produced from a specific type of trees that was originally used as a denture adhesive due to its ability to absorb liquid (the defining characteristic of a “hydrocolloid”) while maintaining its ability to stick in place. As the story goes, Dr. Rupert Turnbull accidentally spilled some Karaya denture powder on his wet hands while cleaning a colleague’s lab. He thought its ability to swell and cling to his wet skin might help meet the needs of his ileostomy patients. This product became the standard use skin adhesive and protective barrier of its time.
Getting Back to Life
In the early 1970s, ostomy care began to focus beyond the functionality of the products and started to consider factors on the quality of life of the person wearing the product. WOC and ET nurses played a significant role in this shift, as they began to closely observe their patients and advocate for their broader care needs to manufacturers. This 'quality of life' approach continues to drive product development today.
The pouching system we know today is designed to be discreet, comfortable and disposable. The most important part of the pouching system remains the hydrocolloid skin barrier. Now, different types are available to serve different needs — some with gentle adhesion for delicate skin or for more frequent changes, and some with the ability to absorb liquid quickly to help improve wear time for people with more liquid stoma output. Other advancements include odor-masking films, cover materials that minimize pouch noise and add discretion, filters to help reduce pouch ballooning, integrated closures, and more. These features are contained within a system that can weigh less than an ounce and help people with a stoma get back into everyday life.
Skin health continues to be an important area of focus for improving quality of life for people with a stoma. With this in mind, Hollister Incorporated looks to the science of skin care for ostomy solutions. Ceramide naturally occurs in the skin and acts like the mortar between the “bricks” of cells in the upper layer of the skin, helping to prevent water loss that may lead to damage and dryness. We have further evolved skin barrier technology by introducing products infused with ceramide to help protect the skin’s own moisture barrier. The CeraPlus™ skin barrier is infused with ceramide to help maintain healthy skin around the stoma. In a global user evaluation on file at Hollister Incorporated, people who have tried the CeraPlus skin barrier have reported visible improvement in the appearance of their skin and that it provides good adhesion, ease of removal and good wear time.
The CeraPlus skin barrier comes in a range of options including one-piece, two-piece, flat, firm convex, soft convex, tape border, and tapeless. To request a sample of the CeraPlus skin barrier, click here.
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