Minimize Risk of Skin Tears


In 2011, the Centers for Disease Control and Prevention (CDC) published evidence-based guidelines regarding prevention of catheter-related bloodstream infections (CRBSIs).[1] The guidelines highlighted the fact that terminology associated with different
types of bloodstream infections can be confusing because the terms CRBSI and central line–associated bloodstream infections (CLABSI) have often been used interchangeably; however, their definitions are different.[1] A CRBSI is a clinical definition requiring confirmation by laboratory testing, whereas the definition associated with CLABSI is most often used for surveillance.[1]

The National Healthcare Safety Network (NHSN) defines an incidence of CLABSI as “a primary BSI in a patient that had a central line within the 48-hour period before the development of the BSI and is not bloodstream related to an infection at another site.”[1]

Medical adhesive–related skin injury is defined as follows: “A medical adhesive-related skin injury is an occurrence in which erythema and/or other manifestation of cutaneous abnormality (including, but not limited to, vesicle, bulla, erosion, or tear) persists 30 minutes or more after removal of the adhesive.”[2]

Detachol® Adhesive Remover

Detachol® Adhesive Remover is a nonirritating adhesive remover used to aid in the removal of dressings, tapes, and most sticky residue from the skin and other surfaces.

Detachol Adhesive Remover Product Family

The development of CRBSI takes place by contamination of the catheter in 1 of 4 separate ways either intraluminally or extraluminally.[1,9]

1. “Migration of skin organisms at the insertion site into the cutaneous catheter tract and along the surface of the catheter with colonization of the tip
2. Direct contamination of the catheter or hub by hand contact or contaminated fluids/devices
3. Hematogenous seeding from another focus of infection
4. Infusate contamination (rare)”

Published guidance for preventing CRBSIs recommends a bundled approach for eliminating known risks.[1,10,11] It has been well established that tape and residual adhesive material on the skin can serve as a reservoir for colonization of bacteria.12 The appropriate use of Detachol® Adhesive Remover completely removes all residual adhesive material, therefore reducing the risk of bloodstream infection or CRBSI. A recent consensus statement was published bringing attention to the problems associated with medical adhesive–related skin injury, stating, “Appropriate selection of adhesive products and the use of proper application and removal techniques can help minimize medical adhesive-related skin injury.”[2] Detachol® Adhesive Remover can be considered a safe and effective product as part of a well-defined removal technique.

The role of Detachol® Adhesive Remover is centered on the effective removal of dressings by completely removing residual adhesive material on the patient’s skin and decreasing the
amount of friction or shearing known to be associated with skin tears or medical adhesive-related skin injury.

Reducing Risk of Bacterial Colonization

Berkowitz and colleagues established the scientific foundation for the risk associated with adhesive tape and bacterial colonization.[12] Another study (N = 80) assessing tape applied to intravascular catheters revealed bacteria colonized in 74% of specimens (coagulase-negative Staphylococcus 72.5%; coagulase-positive Staphylococcus 2.5%; gram-negative bacilli 15%; alpha-hemolytic Streptococcus 17.5%).[13]

Evidence-based recommendations for the prevention of CRBSI include maintaining catheter dressing integrity for up to 7 days.[1] When an adhesive product has been present on the patient’s skin for 7 days, removal of the dressing can result in residual adhesive material on the skin. The appropriate use of Detachol® Adhesive Remover may reduce the risk of bacterial colonization around the catheter site by enabling the caregiver to easily remove residual adhesive materials underneath the dressing site.

Public Burden

The public health burden associated with hospital-acquired conditions is substantial and includes increased morbidity and mortality, increased length of hospital stay, and increased costs. It is well known that CRBSIs are associated with increased morbidity
and mortality. Raad et al published an attributable mortality rate of 12% to 25% in the critical care patient population that experiences catheter-related bacteremia,[3]
and the CDC has published estimates that >92,000 CLABSIs occur in the US
each year.[4] Another study reported that nearly 80,000 CLABSIs occur in the US annually, with approximately 25,000 CLABSI-related intensive care unit deaths.[5,6] The excess costs associated with each incidence of CLABSI ranges from $5734 to $29,156.4
Additional estimates place the total economic burden of CLABSIs in the US at approximately $2 billion.[5]

The public health burden associated with skin tears and medical adhesive–related skin injury is found in the evidence-based literature. Approximately 1.5 million skin tears occur each year in the US.[7] Skin tears are associated with patient pain and suffering,
increased morbidity and length of hospital stay, decreased quality of life, decreased nursing efficiency, and increased costs of care.[7] Skin tears occur as a result of friction or shearing, which results in separation of the epidermis from the dermis and can
occur with inappropriate removal of adhesive products such as dressings and tapes.[7]

Economic studies have reported that the cost to treat a skin tear from incidence to complete resolution (approximately 2 weeks) is $21.96 per week.[2,7] The economic burden of treating 1.5 million skin tears by these estimates is significant (1.5 million × $21.96/tear = $32,940,000).[2,7] Each patient heals differently; therefore,
only estimates can be made for the actual economic burden. In a before/after quality improvement study conducted by Bank and Nix in a 209-bed urban nursing and rehabilitation center, there were 10 fewer skin tears in the after period (18 before/8
after), and the authors estimated that the monthly cost savings associated with skin tear prevention was $1698, which included increased nursing time associated with treatment.[8]

Decreased Risk of Skin Tears

The friction and shear forces associated with tape or dressing removal may be minimized with the use of Detachol® Adhesive Remover. Research reports have demonstrated that the use of solvents to break the adhesive bond between the skin and an adhesive product is an effective method for preventing skin injury associated with adhesive removal.[2] The non–alcohol-based ingredients in Detachol® Adhesive Remover do not degrade sterile gloves, and irritancy testing has documented that it is safe and effective.[14]

Interventions designed to eliminate nosocomial skin tears and medical adhesive–related skin injury are essential for preventing unnecessary patient pain and suffering, as well as preventing the potential for infection and worsening of existing wounds.[2]

Interested in seeing if Detachol® Adhesive Remover is a good fit for your facility?

1. O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp
ME, Saint S; Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheter-related infections.
Am J Infect Control. 2011 May; 39(4 Suppl 1): S1-34. doi: 10.1016/j.ajic.2011.01.003.
2. McNichol L, Lund C, Rosen T, Gray M. Medical adhesives and patient safety: state of the science: consensus statements for the assessment,
prevention, and treatment of adhesive-related skin injuries. J Wound Ostomy Continence Nurs. 2013 Jul-Aug; 40(4): 365-80; quiz E1-2. doi:
3. Raad I, Hanna H, Maki D. Intravascular catheter-related infections: advances in diagnosis, prevention, and management. Lancet Infect Dis.
2007 Oct; 7(10): 645-57. PMID: 17897607.
4. Scott RD Jr. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Centers for Disease
Control and Prevention. March 2009. Available at: Accessed February 12, 2015.
5. Herzer KR, Niessen L, Constenla DO, Ward WJ Jr, Pronovost PJ. Cost-effectiveness of a quality improvement programme to reduce
central line-associated bloodstream infections in intensive care units in the USA. BMJ Open. 2014 Sep 25; 4(9): e006065. doi:
6. Klevens RM, Edwards JR, Richards CL Jr, Horan TC, Gaynes RP, Pollock DA, Cardo DM. Estimating health care-associated infections and deaths
in U.S. hospitals, 2002. Public Health Rep. 2007 Mar-Apr; 122(2): 160-6. PMID: 17357358.
7. Groom M, Shannon RJ, Chakravarthy D, Fleck CA. An evaluation of costs and effects of a nutrient-based skin care program as a component of
prevention of skin tears in an extended convalescent center. J Wound Ostomy Continence Nurs. 2010 Jan-Feb; 37(1): 46-51. doi: 10.1097/
WON.0b013e3181c68c89. Erratum in: J Wound Ostomy Continence Nurs. 2010 Mar-Apr; 37(2): 128.
8. Bank D, Nix D. Preventing skin tears in a nursing and rehabilitation center: an interdisciplinary effort. Ostomy Wound Manage. 2006 Sep; 52(9):
38-40, 44, 46. PMID: 16980728.
9. Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive
Care Med. 2004 Jan; 30(1): 62-7. PMID: 14647886.
10. Marschall J, Mermel LA, Fakih M, Hadaway L, Kallen A, O’Grady NP, Pettis AM, Rupp ME, Sandora T, Maragakis LL, Yokoe DS. Strategies to
prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014 Sep;
35 Suppl 2: S89-107. PMID: 25376071.
11. Marschall J, Mermel LA, Classen D, Arias KM, Podgorny K, Anderson DJ, Burstin H, Calfee DP, Coffin SE, Dubberke ER, Fraser V, Gerding DN,
Griffin FA, Gross P, Kaye KS, Klompas M, Lo E, Nicolle L, Pegues DA, Perl TM, Saint S, Salgado CD, Weinstein RA, Wise R, Yokoe DS. Strategies to
prevent central line-associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008 Oct; 29 Suppl 1: S22-30.
doi: 10.1086/591059. Erratum in: Infect Control Hosp Epidemiol. 2009 Aug; 30(8): 815. PMID: 18840085.
12. Berkowitz DM, Lee WS, Pazin GJ, Yee RB, Ho M. Adhesive tape: potential source of nosocomial bacteria. Appl Microbiol. 1974 Oct; 28(4): 651-4.
PMID: 4214373.
13. Redelmeier DA, Livesley NJ. Adhesive tape and intravascular-catheter-associated infections. J Gen Intern Med. 1999 Jun; 14(6): 373-5. PMID:
14. Data on file: Irritancy testing results.
15. Deneau J, Craig A. Nursing Survey Reveals Novel Strategy in Assisting Adherence to Best Practices of CVC Dressing Management. Poster
presented at: Institute for Healthcare Improvement National Forum, December 8-11, 2013.
16. Cummings EA, Reid GJ, Finley GA, McGrath PJ, Ritchie JA. Prevalence and source of pain in pediatric inpatients. Pain. 1996 Nov; 68(1): 25-31.
PMID: 9251995.
17. Broome ME, Bates TA, Lillis PP, McGahee TW. Children’s medical fears, coping behaviors, and pain perceptions during a lumbar puncture.
Oncol Nurs Forum. 1990 May-Jun; 17(3): 361-7. PMID: 2342970.
18. Nir Y, Paz A, Sabo E, Potasman I. Fear of injections in young adults: prevalence and associations. Am J Trop Med Hyg. 2003 Mar; 68(3): 341-4.
PMID: 12685642.
19. Centers for Medicare and Medicaid Services. Hospital Value-Based Purchasing. Available at:

Accessed February 12, 2015.
20. Data on file: Chlorhexidine gluconate compatibility testing.