This document summarizes a pilot study conducted to audit the frequency and pattern of occurrence of Medical Adhesive Related Skin Injuries (MARSI). The study was conducted across two orthopedic units in the UK for one week. Unit A reported no MARSI cases while Unit B reported 5 MARSI cases in patients over 60 years old, with only one having previously fragile skin. The data collection forms were found to be easy to use and effective for capturing information. The audit will now be expanded to additional specialties to further assess MARSI frequency and patterns across different clinical settings.

1. A pilot audit of the frequency and pattern of occurrence of Medical
Adhesive Related Skin Injuries (MARSI)
Jacqui Fletcher Clinical Strategy Director*
Welsh Wound Innovation Centre, Wales, United Kingdom
*Author details:
jacqui.fletcher@welshwoundinnovationcentre.com
Co authors: Andra Jones2 and John McRobert3
1 Welsh Wound Innovation Centre 2 Salford Royal
NHS Foundation Trust 3Brighton and Sussex
University Hospitals
This work was supported by the Welsh Wound
Innovation Centre and 3M Healthcare
Introduction
Anecdotally it appears patients suffer considerably from Medical Adhesive Related Skin Injuries (MARSI), a recent consensus ( McNichol et al 2013) suggest that
MARSI is under recognised across all care settings. Whilst the consensus document sets out guidance on how to prevent MARSI it is difficult to make them a
priority when it is not possible to state the frequency of occurrence.
Aim
The aim of this audit was to test the data collection form which would be used to determine the frequency and pattern of occurrence of MARSI.
Conclusion
It appears that MARSI do occur in patients with both healthy and fragile skin and that the data
collection method is an appropriate way to capture the data. The data collection will now be
repeated in a broader range of specialities (ITU, Vascular, Hospice, Care Homes, Paediatrics) .
Methodology.
Prior to an audit across multiple settings a small pilot study was designed and
carried out across 2 orthopaedic units in the UK for 1 week. The settings
differed only in that unit A had recently introduced a ‘kind’ adhesive tape. Data
collection forms were distributed to the 2 units by a central audit
coordinator, they visited the units on a daily basis to remind staff of the data
collection.
Forms were distributed to a single orthopaedic ward by the audit co-ordinator.
Each ward was given an overview form (see figure 1) which identified the
characteristics of the area and the overall numbers of patients who were
inpatients during the week long period over which data were collected. The
wards were also given a supply of forms (see figure 2) on which to record the
details of occurrence of any MARSI which occurred). To ensure forms were
not duplicated the top section of the form was a patient identifier, this was
removed by the co-ordinator prior to the forms being submitted at the end of
the week, thereby ensure anonymity. Any patient who developed a MARSI
was asked if they would consent to a photograph and if they would be
prepared to briefly describe how the wound felt and had impacted on their
care.
At the end of the data collection period, following removal of the identifying
information forms were returned to the central co ordinator.
Fig 1 Overview form
Patient 1 2 3 4 5
Male /
Female
F Male F M F
Age
range
61 – 70 71 – 80 61 – 70 71 – 80 71 – 80
Skin is Healthy Not
complet
ed
Fragile Healthy Healthy
Type of
wound /
device
Surgical Surgical Surgical Surgical IV Cannula
Where Knee Left Hip Right Knee Hand
Describe
d as
Blister Blister Superfici
al
damage
Superficial
damage
Redness
Why Swelling Tape
difficult
to
remove
Dressing
removed
too soon
Adhesive
dressing
applied –
patient has
allergy to
adhesives
Image courtesy
of John
McRobert
Image courtesy
of John
McRobert
Image courtesy
of Jacqui
Fletcher
Results
Unit A reported no instances of MARSI during the audit week. Unit B reported
5 patients with MARSI (see table 1). Staff reported the data collection form
easy to use and forms were well completed.
Table 1 MARSI identified
Examples
of MARSI
Fig 2 Individual patient
form
Discussion
All the patients who developed MARSI were over 60 years of age, however this reflects the
typical age range of the patients on the elective orthopaedic ward. Of more interest is the
fact that only 1 patients was identified as having previously fragile skin, 3 were deemed to be
healthy – and in 1 instance this information had been omitted.
Reference: McNichol L, Lund C, Rosen T and Gray M (2013) Medical Adhesives and Patient Safety: State of the Science
Consensus Statements for the Assessment, Prevention, and Treatment of Adhesive-Related Skin Injuries JWOCN 40 (4) 1 - 15