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 :
- Catheter‐related bloodstream infection (CRBSI) and central line‐associated bloodstream infection (CLABSI)
- 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 :
“…an occurrence in which erythema and/or other manifestations of cutaneous abnormality (including, but not limited to, vesicle, bulla, erosion, or tear) persists 30 minutes or more after removal of the adhesive.”
Types of mechanical skin injury that are attributable to medical adhesives include :
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.
Results from a study published in 2015 showed that in one acute care setting, the mean MARSI prevalence rate was 13%. 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. And, a smaller study reported a 5.8% MARSI prevalence on a vascular unit.
1.5 million skin tears per year in institutionalized adults in the US.
A MARSI consensus panel convened in 2012 highlighted both patient‐related and environment‐related risk factors for MARSI :
Patient‐related factors included:
- Extremes of age (both neonate and elderly)
- Race/ethnicity (African American skin may be at higher risk)
- Pre‐existing dermatological conditions, like eczema or dermatitis
- Underlying medical conditions, like diabetes or infection
Environment‐related risk factors included:
- Excessively dry skin
- Prolonged exposure to moisture
- Certain medications
- Radiation therapy
- Tape/dressing device removal
- Repeated taping
MARSI not only results in pain and anxiety for patients, but also increases the risk of infection and increases morbidity.
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. 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.
While a serious complication, MARSI is potentially avoidable. The 2013 Consensus Panel states :
“The appropriate selection of adhesive products and the use of proper application and removal techniques can help minimize MARSI.”
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.
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.
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.
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