Medical Adhesive Related Skin Injuries (MARSI), as the name itself suggests, is the result of the use of products available in the market that lack a skin friendly composition in their formula and provoke skin injuries upon appliance or removal of the dressings with these products incorporated in them. Despite being a problem that goes almost unnoticeable, all care settings have patients that go through the undeniable and, oftentimes, unbearable pain of MARSI and is highly prevalent. However, just as it is highly prevalent, it is also highly preventable if the adequate instruction on the technique of both appliance and removal is provided to nurses, patients and their caregivers.
MARSI can cause tissue trauma and, therefore, negatively impacts patients’ quality of life and causes an increase in unnecessary healthcare costs. MARSI usually is an occurrence in which erythema and/or other cutaneous reaction of the skin persists 30 minutes or more after removing the adhesive and skin tears can occur as a result. MARSI can include three categories: mechanical (blistering, skin tears, skin stripping, etc.), dermatitis (irritation, allergic dermatitis, moisture-associated skin damage relating to stoma) and other (maceration, folliculitis).
Regarding risk assessment, even if a patient does not check to any of the categories above, it is important not to forget that MARSI can affect any patient that has a medical adhesive attached to their skin. This underlies the urgency of preventing MARSI from occurring because of its impact on patients and the pain they experience, as it increases the possibility for wound healing complications and infection. Parallel to the painful experience of MARSI that many patients undergo is the use of already scarce resources, costs and clinical time that could be spared.
Since the purpose here is to emphasize that MARSI is, in fact, highly avoidable, it is crucial that resources are channeled to come up with solutions that prevent such pain from even beginning and to understand what products are more skin friendly and less aggressive on the skin. Nevertheless, it is also important to instruct and educate healthcare professionals, patients and their caregivers on how to better provide for patients in terms of dressings and their application and removal. Assessing these key factors is pivotal to reduce risk and to help guide decision-making in order to efficiently assist patients and their needs.
The approach to dressing removal comes with understanding not only patients and their needs and concerns, but also the exigence the wound carries and the dressing’s characteristics. There needs to be mindful care regarding patients’ anxieties and how to better manage their potential uneasiness, due to the fact that this influences the process of removing a dressing. Additionally, to fully comprehend the management of application and removal of a dressing is to be aware of its size and position. Combining these steps with a product already in place that ensures moisture balance and overall medical efficacy to care for the wound, patients could possibly turn the tables and experience comfort while having a wound, instead of pain.
These influencing practices can help prevent MARSI. When a patient addresses healthcare professionals with their experiences with medical adhesives, it is important to listen and find ways to respond. By providing a patient centric care and allowing access to education on the matter, medical resources don’t go to waste and time is saved, for both the patient and other caregivers in the picture. Providing detailed care based on evidence allows a continuity in care that anticipates risks and diminishes the possibility of putting a patient in danger of infection.