Since the “pay for performance” era began, hospital acquired conditions (HAC) have deservedly received a great deal of attention from hospitals, healthcare providers, payors, patients and families.

For critical medical devices that pose danger to patients if they are dislodged [like vascular access devices, (VADs)], safety requires proper securement. Poor securement of VADs increases the risks of [1]:

• Catheter‐related bloodstream infection (CRBSI) and central line‐associated bloodstream infection (CLABSI)
• Phlebitis
• Catheter migration or displacement

While patient safety has required focused attention to proper device securement, one often overlooked HAC is medical adhesive related skin injury (or MARSI). Its prevention should be on every institution’s radar.

Because medical adhesives are virtually ubiquitous in the healthcare system, skin injury related to their use occurs across all healthcare settings. MARSI is defined as follows [1]:

Types of mechanical skin injury that are attributable to medical adhesives include [1]:

Caused by shear forces when the skin is distorted under an unyielding adhesive tape or dressing.

Removal of one or more layers of stratum corneum that can occur when an adhesive tape or dressing is removed. These lesions are often irregularly shaped and the skin may be shiny. Open lesions can appear red and exhibit blister formation.

The most serious of the mechanical skin injuries, a skin tear is a wound caused by shear, friction, or blunt force that causes separation of the epidermis from the dermis. It can occur with inappropriate removal of dressings and tapes.

MARSI may be under‐recognized, but recent studies demonstrate it is prevalent. It is estimated that approximately 1.5 million skin tears occur in in the US each year in institutionalized adults.[2]

Results from a study published in 2015 showed that in one acute care setting, the mean MARSI prevalence rate was 13%.[3] In a single center pilot randomized controlled trial (n=124 patients), 29% of patients with VADs experienced skin complications, including skin tears, blisters, rash, itching and bruising.[4] And, a smaller study reported a 5.8% MARSI prevalence on a vascular unit.[5]

A MARSI consensus panel convened in 2012 highlighted both patient‐related and environment‐related risk factors for MARSI [1]:

MARSI not only results in pain and anxiety for patients, but also increases the risk of infection and increases morbidity.[1]

For healthcare providers, the costs are significant. Studies have shown that the cost to treat a skin tear from incidence to complete resolution (approximately 2 weeks) is approximately $21.96 per week.[2] The economic burden of treating just the 1.5 million skin tears noted above using this estimate results in a cost of nearly $33 million per year.

Additionally, patient satisfaction scores have risen in importance as value‐based performance measures are now essential for hospital reimbursement. Patient experience criteria like pain management and overall perception of care affect total performance scores, which can impact hospitals’ bottom line.[6]

While a serious complication, MARSI is potentially avoidable. The 2013 Consensus Panel states [1]:

Importantly, the guidelines also state that the use of medical adhesive removers to minimize the discomfort and skin damage associated with the removal of adhesive products should be considered.[1]

Interventions with the goal of eliminating MARSI can improve patient safety and reduce costs. As an example, in a 2006 before/after quality improvement study in a 209‐bed urban nursing and rehabilitation center, there were approximately 10 fewer skin tears in the period after the intervention. The authors estimated a monthly cost savings associated with skin tear prevention of $1698, which included increased nursing time associated with treatment.[7]

MARSI is an under‐recognized yet serious healthcare‐acquired condition. What steps can your facility take to reduce the risk of MARSI for your most susceptible patients?

Eloquest Healthcare is committed to providing solutions that can help you reduce the risk of conditions like MARSI. For more information about Detachol®, please contact your sales consultant or Eloquest Healthcare®, Inc., call 1‐877‐433‐7626 or visit www.eloquesthealthcare.com.

1. 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. 2. 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; 37: 46‐51. doi: 10.1097/WON.0b013e3181c68c89. Erratum in: J Wound Ostomy Continence Nurs. 2010 Mar‐Apr; 37(2): 128. 3. Farris MK, Petty M, Hamilton J, et al. Medical adhesive‐related skin injury prevalence among adult acute care patients: A Single‐Center Observational Study. J Wound Ostomy Continence Nurs. 2015;42:589‐98. 4. Chan RJ, Northfield S, Larsen E, et al. Central venous access device securement and dressing effectiveness for peripherally inserted central catheters in adult acute hospital patients (CASCADE): a pilot randomised controlled trial. Trials. 2017;18:458. doi: 10.1186/s13063‐017‐ 2207‐x. PubMed PMID: 28978332. 5. Ratliff CR. Descriptive study of the frequency of medical adhesive‐related skin injuries in a vascular clinic. J Vasc Nurs. 2017;35:86‐89. 6. Centers for Medicare and Medicaid Services. The Hospital Value‐Based Purchasing (VBP) Program. Available at: https://www.cms.gov/Medicare/Quality‐Initiatives‐Patient‐Assessment‐Instruments/Value‐Based‐ Programs/HVBP/Hospital‐Value‐Based‐Purchasing.html. Accessed April 18, 2019. 7. Bank D, Nix D. Preventing skin tears in a nursing and rehabilitation center: an interdisciplinary effort. Ostomy Wound Manage. 2006;52:38‐40, 44, 46. PMID: 16980728.