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Medical Adhesive-Related Skin Injuries and Associated Risk Factors in a Pediatric Intensive Care Unit

Wang, Dan BS; Xu, Hongzhen BS; Chen, Shuohui BS; Lou, Xiaofang BS; Tan, Jiafei BS, RN; Xu, Ying BS, RN

Advances in Skin & Wound Care: April 2019 - Volume 32 - Issue 4 - p 176–182
doi: 10.1097/01.ASW.0000553601.05196.fb

OBJECTIVE: To investigate the prevalence of medical adhesive-related skin injuries (MARSIs) and associated risk factors in a pediatric ICU (PICU).

METHODS: A cross-sectional design was adopted in the PICU of a university-based children’s hospital in eastern China. A total of 232 patients were enrolled, and 611 person-days were analyzed.

MAIN OUTCOME MEASURES: Researchers assessed all patients daily for 2 weeks. The use of adhesives and prevalence of MARSIs were recorded. The patients’ clinical data were also collected. The prevalence of MARSIs was calculated daily, and the risk factors were examined statistically.

MAIN RESULTS: The MARSI prevalence ranged from 23.53% to 54.17% (mean, 37.15%). Multivariate analysis identified being female, age 2 years or younger, hospital stays longer than 5 days, infection, edema, and surgery as independent risk factors. Prevalence by product ranged from 19 to 53 per 1,000 product-days with a mean of 34 MARSIs per 1,000 product-days. The major MARSI types were epidermal stripping and skin tear. The face was the most common MARSI site, and tracheal intubation was the most common inciting condition. Implicated products were acrylate tapes with elastic cloth backings.

CONCLUSIONS: Researchers concluded that MARSI is common in the PICU. Skin stripping and skin tear were the most common types, and the face was the most vulnerable site for MARSI, typically attributable to the cloth tape used to affix tracheal intubation. Careful attention should be paid to children with identified risk factors (females, age 2 years or younger, longer hospital stays, edema, infection, or surgery).

At the Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China, Dan Wang, BS, is a master’s degree candidate; Hongzhen Xu, BS, is associate director of the nursing department; Shuohui Chen, BS, is director of the nursing department; Xiaofang Lou, BS, is nursing education manager; Jiafei Tan, BS, RN, is a registered nurse; and Ying Xu, BS, RN, is a registered nurse.

Acknowledgments: The authors thank the pediatric ICU staff, who answered questions patiently and helped gather patient information. They also appreciate Mr Liang’s help with statistics, the generous help of Ms Chen in data collection, and Mr Lin’s (Zhejiang University) help in photograph coding.

The authors have disclosed no financial relationships related to this article.

Submitted October 2, 2018; accepted in revised form December 11, 2018.

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