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Reducing the risk of Medical Adhesive-Related Skin Injury (MARSI).


What is MARSI?

  • Image of a baby’s hand holding an elderly person’s hand with MARSI logo lock-up.

    Skin tears, skin stripping and tension blisters are common but avoidable examples of Medical Adhesive-Related Skin Injury (MARSI). MARSI is damage to the skin that may occur when medical adhesives are not selected, applied and/or removed properly. When you better understand MARSI, you're better equipped to protect your patients.


Recognizing the different types of MARSI.

  • Dramatic image of a red wound where there are separated skin layers
    Skin Tear

    Wound caused by shear, friction and/or blunt force resulting in separation of skin layers. Can be partial- or full-thickness.10

    Dec 1, 1901
  • Dramatic image of an arm with bumps and lesions around the IV site
    Skin Stripping

    Removal of one or more layers of the stratum corneum following adhesive removal. Lesions are frequently shallow and irregular in shape. Skin may appear shiny.2,3,4

    Dec 1, 1901
  • Dramatic image of a red, blister like bumps on the surface of the skin
    Tension Injury or Blister

    Separation of the epidermis from the dermis caused by shear force as a result of distension of skin under an unyielding tape or dressing.3,5,6

    Dec 1, 1901
  • Dramatic image of a heel with a layer of skin missing, with the rest of skin appearing wrinkled and gray and white in color
    Maceration

    Changes in the skin resulting from moisture being trapped against the skin for a prolonged period. Skin appears wrinkled and white/gray in color.

    Dec 1, 1901
  • Dramatic image of elevated and irritated skin surrounding the hair follicle
    Folliculitis

    Inflammatory reaction in the hair follicle caused by shaving or entrapment of bacteria. Appears as small, inflamed elevations of skin surrounding the hair follicle.7,8,9

    Dec 1, 1901
  • Dramatic image of red, raw and irritated skin
    Allergic Contact Dermatitis

    Cell-mediated immunologic response to a component of tape adhesive or backing. Typically appears as an area of erythematous, vesicular, pruritic dermatitis.7,8,9

    Dec 1, 1901
  • Dramatic image of a swollen foot with red, and irritated skin
    Irritant Contact Dermatitis

    Non-allergic contact dermatitis that results from a chemical irritant. May appear reddened and swollen, and vesicles may be present. Typically of shorter duration.7,8

    Dec 1, 1901

Who's at risk for MARSI?

  • Blue teddy bear icon
  • Blue long-term care facility icon

3 steps to reduce the risk of MARSI

  • Click red dots for more information
    Click red dots for more information
Assess

Assess the skin for signs of damage at regular intervals, noting color, texture, uniformity of appearance, and integrity. Be sure to also note contextual factors and underlying health conditions before selecting and using any adhesive products.

Assess

Assess the skin for signs of damage at regular intervals, noting color, texture, uniformity of appearance, and integrity. Be sure to also note contextual factors and underlying health conditions before selecting and using any adhesive products.

Select

When selecting an adhesive product, consider the assessment criteria in addition to the intended use of the product, anticipated wear time, anatomical location and ambient conditions present at the site.1

Select

When selecting an adhesive product, consider the assessment criteria in addition to the intended use of the product, anticipated wear time, anatomical location and ambient conditions present at the site.1

Use

Proper application and removal of adhesive products is key to minimizing skin damage and reducing the risk of MARSI.1 Medical tape should be applied without stretching or tension and should be removed “low and slow” to avoid pulling at the epidermis.

Use

Proper application and removal of adhesive products is key to minimizing skin damage and reducing the risk of MARSI.1 Medical tape should be applied without stretching or tension and should be removed “low and slow” to avoid pulling at the epidermis.

Get the comprehensive MARSI guide.

Sign up to download the MARSI prevention guide for more information on the 3 steps to risk reduction, plus a comprehensive look at:

    • What MARSI is
    • Why it occurs
    • Who's most at risk
    • Why MARSI is relevant to your practice
    • How you can reduce the risk

Proven products for every patient application.

Selecting the right product for the right patient and application is an important part of MARSI risk reduction. At 3M, we have a wide variety of products designed for a variety of conditions and patient skin types, plus product selection information that makes it easy to make the right choice.

Challenging common medical adhesives myths

Watch as we address and fact-check commonly held beliefs (and misbeliefs) about medical adhesives.

Resources

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  • 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 WOCN. 2013;40(4):365-380.
    2. Smith MA, et.al. Pressure-sensitive tape and techniques for its removal from paper. Journal of the American Institute for Conservation. 1984;23(2):101-113.
    3. Farris MK, et. al. Medical adhesive-related skin injury prevalence. Journal of Wound Ostomy and Continence Nursing. 2015;42(6):589-598.
    4. Resnick B. Wound care for the elderly. Geriatr. Nurs. (Lond.). 1993;14:26-29.
    5. Gerhardt LC, et. al. Skin-textile friction and skin elasticity. Skin research and technology: official journal of International Society for Bioengineering and the Skin. 2009;15(3):288-298.
    6. Shannon ML, Lehman CA. Protecting the skin of the elderly patient in the intensive care unit. Crit. Care Nurs. Clin. North Am. 1996;8(1):17-28.
    7. 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 WOCN. 2013;40(4):365-380.
    8. Lund C. Medical Adhesives in the NICU. Newborn Infant. Nurs. Rev. 2014;14(4):160-165.
    9. Holbrook KA. A histological comparison of infant and adult skin. In: Maibach HI, Boisits EK, eds. Neonatal skin: structure and function. 1982.
    10. Lund CH, Tucker JA. Adhesion and newborn skin In: Hoath SB, Maibach HI eds. Neonatal skin: Structure and Function. 2nd ed. New York, NY: Marcel Dekker:2003:200-324.


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