Decrease Medical Adhesive Related Skin Injuries (MARSI) rate in ICU setting

In Our ICU setting, we found 31% patients suffered from Medical Adhesive Related Skin Injuries (MARSI) during January to March 2014. After researched, we found 86% of MARSI happened when securing the tube and 14% of MARSI were found on securing the dressing. Also, we found using elastic tape to secure the endotracheal tube is the most common cause of MARSI, account for 52%. And second cause of MARSI is using transparent dressing and surgical tape to secure central venous catheter and foley, account for 48%.Common occurrence body part of MARSI are cheek and jaw, account for 57%. Second are thigh (groin included), account for 38%. Third are neck (clavicle included), account for 10%.

We have done a root causes analysis, we found the causes of MARSI are choosing inappropriate tape, unrecognized at risk skin group, repeated taping and inappropriate apply and remove skill of nursing staff. In order to improve the quality of care and reduce the MARSI rate, we have done several interventions during April to October 2014. Including protocol of applying medical adhesive, created assessment tool and tape application guide, education for at-risk skin assessment and education for tape application and removal technique. After the intervention mentioned above, we found the MARSI rate decreased to 13.4%.