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Medical adhesive-related skin injury (MARSI) in intensive care: prevalence and associated factors
Solange Cortés Luengo1, Maria Fernanda Morales-Labarca2, Francisca Villagrán-Silva3
1Clinical Hospital of the University of Chile, Santiago, Chile.
Aims:
To determine the prevalence of medical adhesive-related skin injury (MARSI) and its association with relevant clinical factors and medical devices in intensive care.
Methods:
An observational, cross-sectional, analytical study was conducted on 84 adult patients admitted to intensive care at the Clinical Hospital of the University of Chile. Data collection included sociodemographic characteristics, MARSI occurrence and types, use of medical devices including adhesive fixation products, medical history, nutritional status, risk factors for skin lesions, biochemical and haematological parameters and skin characteristics. Standardisation training was conducted for data collection, and analysis was performed using STATA v18 (α=0.05).
Outcomes:
The mean patient age was 63.02±16.0 years, and 53.6% were male. Nine MARSIs were observed in 9.5% (n=8) of patients. Skin stripping (1.2%) occurred in the cervical region, while skin tears (6.0%) affected the cervical region (1.2%), thorax (1.2%) and upper limb (3.6%). Irritant contact dermatitis was found in 3.6% of cases in the upper limb. The most frequently used medical device was the peripheral venous device (76.2%, n=64), and the most common fixation products were acrylic-based adhesives: transparent polyurethane film (88.1%, n=74) and elastic polyester non-woven wide-area fixation (67.9%, n=57). Transparent polyurethane film with acrylic adhesive was the most common adhesive implicated in MARSI, in 4.8% (n=4) of cases. A multiple logistic regression model identified two independent predictors: the chance of MARSI was significantly increased in type 2 diabetes (odds ratio (OR): 8.28; p=0.024; 95% confidence interval (CI): 1.31, 52.14) and reduced with elastic polyester non-woven wide-area fixation (OR: 0.116; p=0.035; 95% CI: 0.01, 0.86).
Conclusions:
These findings confirm that intensive care patients, particularly those with type 2 diabetes, are at increased risk of developing MARSI. The findings also enhance the understanding of MARSI epidemiology, facilitating evidence-based preventive strategies including the choice of fixation products in intensive care settings. Moreover, they underscore the need for clinical protocols to incorporate education on MARSI identification, standardised documentation and preventive measures.
Insights
Intensive care patients, especially those with type 2 diabetes, face a higher risk of medical adhesive-related skin injury (MARSI). Choosing appropriate fixation products can help reduce MARSI occurrence.
Area of Science:
- Medical Research
- Dermatology
- Intensive Care Medicine
Background:
- Medical adhesive-related skin injury (MARSI) is a significant concern in healthcare settings.
- Understanding MARSI prevalence and associated factors is crucial for patient care.
Purpose of the Study:
- To determine the prevalence of MARSI in intensive care unit (ICU) patients.
- To identify clinical factors and medical devices associated with MARSI.
- To inform preventive strategies for MARSI in critical care.
Main Methods:
- An observational, cross-sectional study was conducted on 84 adult ICU patients.
- Data collected included patient demographics, MARSI occurrence, medical devices, and risk factors.
- Statistical analysis was performed using STATA v18.
Main Results:
- MARSI was observed in 9.5% of patients, with skin tears and stripping being common.
- Transparent polyurethane film with acrylic adhesive was frequently implicated in MARSI.
- Type 2 diabetes significantly increased MARSI risk (OR: 8.28), while elastic polyester fixation reduced it (OR: 0.116).
Conclusions:
- Intensive care patients, particularly those with type 2 diabetes, are at elevated risk for MARSI.
- Findings aid in understanding MARSI epidemiology and developing evidence-based preventive strategies.
- Clinical protocols should include MARSI education, documentation, and prevention measures.
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