Comparative evaluation of the effect of aloe vera gel, olive oil, and compound aloe vera gel-olive oil on prevention of pressure ulcer: A randomized controlled trial

Fallahi, Masoud; Soroush, Ali; Sadeghi, Narges; Mansouri, Feizollah; Mobaderi, Tofigh; Mahdavikian, Somayeh

Comparative evaluation of the effect of aloe vera gel, olive oil, and compound aloe vera gel-olive oil on prevention of pressure ulcer: A randomized controlled trial

Document Type : Original Article

Authors

¹ School of Nursing and Midwifery, Kermanshah University of Medical Sciences; Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran

² Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran

³ Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran

⁴ Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

⁵ School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran

Abstract

Background: One of the most common problems in the intensive care units (ICUs) is pressure ulcers (PUs). The present study aimed to evaluate the effectiveness of aloe vera gel, olive oil, and compound aloe vera gel-olive oil in the prevention of PUs. Materials and Methods: This randomized clinical trial was conducted on 240 patients. They were randomly divided into four groups, aloe vera gel (n = 60), olive oil (n = 60), aloe vera gel-olive oil combination (n = 60), and control (n = 60). Braden scale and National Pressure Ulcer Advisory Panel scale were used to collect data. The intervention was performed for 30 days. In the intervention and control groups, the patient received routine care. In each intervention group, 10–15 ml of olive oil or aloe vera gel or a combination of olive oil and aloe vera was rubbed into body areas under pressure. Results: There were no PUs detected in all groups before the intervention; after the intervention, 12 patients in the olive group, 20 patients in the aloe vera group, 10 patients in the aloe vera-olive combination group, and 22 patients in the control group developed PUs. The results reported 40% of the patients with stage 1 PU and 10% of them with stage 2. Conclusion: Due to the effectiveness of olive oil and aloe vera-olive oil combination in preventing PU, it is recommended to use these herbal compounds in preventing PU on ICU patients.

Keywords

References

1.	Ho C, Jiang J, Eastwood CA, Wong H, Weaver B, Quan H. Validation of two case definitions to identify pressure ulcers using hospital administrative data. BMJ Open 2017;7:e016438.
2.	Hekmatpou D, Mehrabi F, Rahzani K, Aminiyan A. The effect of aloe vera gel on prevention of pressure ulcers in patients hospitalized in the orthopedic wards: A randomized triple-blind clinical trial 11 Medical and Health Sciences 1103 Clinical Sciences. BMC Complement Altern Med 2018;18:1-11.
3.	Nicksic PJ, Sasor SE, Tholpady SS, Wooden WA, Gutwein LG. Management of the pressure injury patient with osteomyelitis: An algorithm. J Am Coll Surg. 2017;225:817-22.
4.	Etafa W, Argaw Z, Gemechu E, Melese B. Nurses' attitude and perceived barriers to pressure ulcer prevention. BMC Nurs. 2018;17:14.
5.	Moore Z, Avsar P, Conaty L, Moore DH, Patton D, O'Connor T. The prevalence of pressure ulcers in Europe, what does the European data tell us: A systematic review. J Wound Care. 2019;28:710-9.
6.	Cramer EM, Seneviratne MG, Sharifi H, Ozturk A, Hernandez-Boussard T. Predicting the incidence of pressure ulcers in the intensive care unit using machine learning. EGEMS (Wash DC) 2019;7:49.
7.	Han Y, Jin Y, Jin T, Lee SM, Lee JY. Impact of pressure injuries on patient outcomes in a Korean hospital: A case-control study. J Wound Ostomy Continence Nurs 2019;46:194-200.
8.	Díaz-Valenzuela A, García-Fernández FP, Carmona Fernández P, Valle Cañete MJ, Pancorbo-Hidalgo PL. Effectiveness and safety of olive oil preparation for topical use in pressure ulcer prevention: Multicentre, controlled, randomised, and double-blinded clinical trial. Int Wound J. 2019;16:1314-22.
9.	Hajhosseini B, Longaker MT, Gurtner GC. Pressure injury. Ann Surg 2020;271:671-9.
10.	Mervis JS, Phillips TJ. Pressure ulcers: Prevention and management. J Am Acad Dermatol. 2019;81:893-902.
11.	Miraj S, Pourafzali S, Ahmadabadi ZV, Rafiei Z. Effect of olive oil in preventing the development of pressure ulcer grade one in intensive care unit patients. Int J Prev Med 2020;11:23. [Full text]
12.	Lupiáñez-Pérez I, Herrera J, Kaknani S, Lupiañez-Perez Y, Fernández-Gallego M, Martín-Santos F, et al. A cost minimisation analysis of olive oil versus hyperoxygenated fatty acid treatment for the prevention of pressure ulcers in primary health care: A randomised controlled trial. Wound Repair Regen 2017;25:846-51.
13.	Padula WV, Delarmente BA. The national cost of hospital-acquired pressure injuries in the United States. Int Wound J 2019;16:634-40.
14.	Zarei E, Madarshahian E, Nikkhah A, Khodakarim S. Incidence of pressure ulcers in intensive care units and direct costs of treatment: Evidence from Iran. J Tissue Viability. 2019;28:70-4.
15.	Moghadari M, Rezvanipour M, Mehrabani M, Ahmadinejad M, Tajadini H, Hashempur MH. Efficacy of mummy on healing of pressure ulcers: A randomized controlled clinical trial on hospitalized patients in intensive care unit. Electron Physician. 2018;10:6140-7.
16.	Dehghani M, Azarpira N, Mohammad Karimi V, Mossayebi H, Esfandiari E. Grafting with cryopreserved amniotic membrane versus conservative wound care in treatment of pressure ulcers: A randomized clinical trial. Bull Emerg Trauma 2017;5:249-58.
17.	Babamohamadi H, Ansari Z, Nobahar M, Mirmohammadkhani M. The effects of peppermint gel on prevention of pressure injury in hospitalized patients with head trauma in neurosurgical ICU: A double-blind randomized controlled trial. Complement Ther Med 2019;47:102223.
18.	Pérez-Acevedo G, Torra-Bou JE, Manzano-Canillas ML, Bosch-Alcaraz A. Management of purpura fulminans skin lesions in a premature neonate with sepsis: A case study. J Wound Care. 2019;28:198-203.
19.	Shakib Z, Shahraki N, Razavi BM, Hosseinzadeh H. Aloe vera as an herbal medicine in the treatment of metabolic syndrome: A review. Phytother Res. 2019;33:2649-60.
20.	Salehi B, Albayrak S, Antolak H, Kręgiel D, Pawlikowska E, Sharifi-Rad M, Uprety Y, Tsouh Fokou PV, Yousef Z, Amiruddin Zakaria Z, Varoni EM, Sharopov F, Martins N, Iriti M, Sharifi-Rad J. Aloe genus plants: From farm to food applications and phytopharmacotherapy. Int J Mol Sci 2018;19:2843.
21.	Gao Y, Kuok KI, Jin Y, Wang R. Biomedical applications of aloe vera. Crit Rev Food Sci Nutr. 2019;59(Supp 1):S244-56.
22.	Baghdadi M, Rafiei H, Rashvand F, Oveisi S. Effect of aloe vera gel, Calendula officinalis ointment and simple prophylactic sacral dressings for pressure injury development. Chronic Wound Care Manag Res 2020;7:19-26.
23.	Panahi Y, Davoudi SM, Sahebkar A, Beiraghdar F, Dadjo Y, Feizi I, Amirchoopani G, Zamani A. Efficacy of aloe vera/olive oil cream versus betamethasone cream for chronic skin lesions following sulfur mustard exposure: A randomized double-blind clinical trial. Cutan Ocul Toxicol 2012;31:95-103.
24.	Panahi Y, Izadi M, Sayyadi N, Rezaee R, Jonaidi-Jafari N, Beiraghdar F, Zamani A, Saebkar A. Comparative trial of aloe vera/olive oil combination cream versus phenytoin cream in the treatment of chronic wounds. J Wound Care 2015;24:459-60, 462-5.
25.	Hekmatpou D, Mehrabi F, Rahzani K, Aminiyan A. The effect of aloe vera clinical trials on prevention and healing of skin wound: A systematic review. Iran J Med Sci 2019;44:1-9.
26.	Panahi Y, Rastgar N, Zamani A, Sahebkar A. Comparing the therapeutic effects of aloe vera and olive oil combination cream versus topical betamethasone for atopic dermatitis: A randomized double-blind clinical trial. J Pharmacopuncture. 2020;23:173-8.
27.	Lima-Serrano M, González-Méndez MI, Martín-Castaño C, Alonso-Araujo I, Lima-Rodríguez JS. Predictive validity and reliability of the Braden scale for risk assessment of pressure ulcers in an intensive care unit. Med Intensiva (Engl Ed). 2018;42:82–91.
28.	Chen HL, Cao YJ, Zhang W, Wang J, Huai BS. Braden scale (ALB) for assessing pressure ulcer risk in hospital patients: A validity and reliability study. Appl Nurs Res 2017;33:169-74.
29.	Aloweni F, Lim ML, Chua TL, Tan SB, Lian SB, Ang SY. A randomised controlled trial to evaluate the incremental effectiveness of a prophylactic dressing and fatty acids oil in the prevention of pressure injuries. Wound Pract Res 2017;25:24-34.
30.	Laryea EA. An Online Mixed-Methods Study Assessing Nurses' Training, Attitudes, Knowledge, Skill/Ability, and Perceived Barriers with Regard to Adherence to the National Pressure Ulcer Advisory Panel's Clinical Practice Guidelines. Teachers College, Columbia University; 2019.
31.	Kottner J, Cuddigan J, Carville K, Balzer K, Berlowitz D, Law S, Litchford M, Mitchell P, Moore Z, Pittman J, Sigaudo-Roussel D, Yee CY, Haesler E. Pressure ulcer/injury classification today: An international perspective. J Tissue Viability 2020;29:197-203.
32.	Borzou SR, Amiri S, Azizi A, Tapak L, Rahimi Bashar F, Moradkhani S. Topical almond oil for prevention of pressure injuries: A single-blinded comparison study. J Wound Ostomy Continence Nurs 2020;47:336-42.
33.	Mervis JS, Phillips TJ. Pressure ulcers: Pathophysiology, epidemiology, risk factors, and presentation. J Am Acad Dermatol. 2019;81:881-90.
34.	Karimi Z, Behnammoghadam M, Rafiei H, Abdi N, Zoladl M, Talebianpoor MS, Arya A, Khastavaneh M. Impact of olive oil and honey on healing of diabetic foot: A randomized controlled trial. Clin Cosmet Investig Dermatol 2019;12:347-54.
35.	Karimi Z, Mousavizadeh A, Rafiei H, Abdi N, Behnammoghadam M, Khastavaneh M, Shahini S. The effect of using olive oil and fish oil prophylactic dressings on heel pressure injury development in critically ill patients. Clin Cosmet Investig Dermatol. 2020;13:59-65.
36.	Madadi Z, Zeighami R, Azimian J, Javadi A. The effect of topical olive oil on prevention of bedsore in intensive care units patients. Int J Res Med Sci 2015;3:2342-7.
37.	Paymard A, Salehian T, Behnammoghadam M, Abbas Ali Madadi Z, Shahnavazi A, Allahyari E, Bakhshi F, Ghaffarian Shirazi HR. The effect of local olive oil on prevention of pressure ulcers in patients hospitalized in the intensive care unit of Shahid Beheshti Hospital, Yasuj: A double-blind randomized clinical trial. JAP 2017;7:54-61.
38.	Poursadra E, Anvari-Tafti M, Dehghani A, Eghbali-Babadi M, Rafiei Z. Comparing the effect of henna oil and olive oil on pressure ulcer grade one in intensive care units patients. Adv Biomed Res 2019;8:68. [PUBMED] [Full text]
39.	Gurfinkel R, Palivatkel-Naim M, Gleisinger R, Rosenberg L, Singer AJ. Comparison of purified olive oil and silver sulfadiazine in the treatment of partial thickness porcine burns. Am J Emerg Med 2012;30:79-83.
40.	Sharifi-Heris Z, Farahani LA, Haghani H, Abdoli-Oskouee S, Hasanpoor-Azghady SB. Comparison the effects of topical application of olive and calendula ointments on Children's diaper dermatitis: A triple-blind randomized clinical trial. Dermatol Ther 2018;31:e12731.

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