Minimize Risk of Skin Tears

Skin tears are associated with patient pain and suffering, increased morbidity and length of hospital stay, decreased quality of life, and increased costs of care.1 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.1 Interventions designed to eliminate nosocomial skin tears and Medical Adhesive-Related Skin Injury (MARSI) are essential for preventing unnecessary patient pain, as well as preventing the potential for infection and worsening of existing wounds.2

Common Skin Injury Related Questions

What is the definition of MARSI?

  • MARSI 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
  • Mechanical MARSI includes skin tears and epidermal stripping (skin stripping).2 Skin stripping can take place “when the tape is stronger than the skin layers, causing removal of superficial layers of the dermis upon tape removal.”3

What is the prevalence of MARSI?

  • A randomized controlled trial (RCT) reported a 7.3% MARSI prevalence in 300 patients undergoing knee and hip procedures.4
  • Another single-center pilot RCT (n=124 patients) reported 29% of patients experienced skin complications with vascular access devices (eg, skin tear, blister, rash, itching, or bruising.)5
  • A smaller study reported a 5.8% MARSI prevalence (n=120 patients) on a vascular unit.3

How often do skin tears occur?

  • Approximately 1.5 million skin tears occur each year in the US.1

What is the cost to treat a skin tear?

  • 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.1 The economic burden of treating 1.5 million skin tears by these estimates is significant (1.5 million x $21.96 = $32,940,000).1 Each patient heals differently; therefore, only estimates can be made for the actual economic burden.

What evidence-based recommendations exist to provide guidance minimizing risk of skin tears?

  • Multidisciplinary Consensus Panel recommends:2

Use proper application and removal techniques for adhesive-containing products.

Consider use of medical adhesive removers to minimize discomfort and skin damage associated with removal of adhesive products.

References

  1. 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.
  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: 10.1097/WON.0b013e3182995516.
  3. Ratliff CR. Descriptive study of the frequency of medical adhesive-related skin injuries in a vascular clinic. J Vasc Nurs. 2017 Jun; 35(2): 86-89.
  4. Ter N, Yavuz M, Aydoğdu S, Kaya Biçer E. The effect of 2 adhesive products on skin integrity used for fixation of hip and knee surgical dressings: a randomized controlled trial. J Wound Ostomy Continence Nurs. 2015; 42(2): 145-50.
  5. 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(1): 458. doi: 10.1186/s13063-017-2207-x. PubMed PMID: 28978332.