Medical adhesive-related skin injury (MARSI) in intensive care: prevalence and associated factors

AIMS: To determine the prevalence of medical adhesive-related skin injury (MARSI) and its association with relevant clinical factors and medical devices in intensive care. METHODS: An observational, cross-sectional, analytical study was conducted on 84 adult patients admitted to intensive care at the Clinical Hospital of the University of Chile. Data collection included sociodemographic characteristics, MARSI occurrence and types, use of medical devices including adhesive fixation products, medical history, nutritional status, risk factors for skin lesions, biochemical and haematological parameters and skin characteristics. Standardisation training was conducted for data collection, and analysis was performed using STATA v18 (α=0.05). OUTCOMES: The mean patient age was 63.02±16.0 years, and 53.6% were male. Nine MARSIs were observed in 9.5% (n=8) of patients. Skin stripping (1.2%) occurred in the cervical region, while skin tears (6.0%) affected the cervical region (1.2%), thorax (1.2%) and upper limb (3.6%). Irritant contact dermatitis was found in 3.6% of cases in the upper limb. The most frequently used medical device was the peripheral venous device (76.2%, n=64), and the most common fixation products were acrylic-based adhesives: transparent polyurethane film (88.1%, n=74) and elastic polyester non-woven wide-area fixation (67.9%, n=57). Transparent polyurethane film with acrylic adhesive was the most common adhesive implicated in MARSI, in 4.8% (n=4) of cases. A multiple logistic regression model identified two independent predictors: the chance of MARSI was significantly increased in type 2 diabetes (odds ratio (OR): 8.28; p=0.024; 95% confidence interval (CI): 1.31, 52.14) and reduced with elastic polyester non-woven wide-area fixation (OR: 0.116; p=0.035; 95% CI: 0.01, 0.86). CONCLUSIONS: These findings confirm that intensive care patients, particularly those with type 2 diabetes, are at increased risk of developing MARSI. The findings also enhance the understanding of MARSI epidemiology, facilitating evidence-based preventive strategies including the choice of fixation products in intensive care settings. Moreover, they underscore the need for clinical protocols to incorporate education on MARSI identification, standardised documentation and preventive measures.