Medical Adhesive-Related Skin Injury (MARSI) refers to damage caused to the skin by medical adhesives, such as tapes or device attachments. It can occur when adhesives are applied, worn, or removed, particularly in patients with fragile or sensitive skin.
MARSI has been reported to occur in up to 15% of patients in acute care settings according to Wounds International, 2017. MARSI is a recognised issue in healthcare, especially where wearable medical devices or wound care products are used. Reducing its occurrence depends on selecting appropriate materials and applying them correctly.
What is MARSI (Medical Adhesive-Related Skin Injury)?
MARSI occurs when the bond between the adhesive and the skin is stronger than the cohesion of the skin itself. This can lead to separation of the skin layers, irritation, or allergic reactions.
MARSI is clinically defined by the Journal of Wound, Ostomy and Continence Nursing as erythema and/or other skin abnormalities that persist for 30 minutes or more after adhesive removal.
It may present as:
- Skin stripping (removal of the outer skin layer)
- Redness or inflammation
- Blistering or tearing
- Allergic responses to adhesive materials
Adhesives used in medical settings must balance secure attachment with safe removal. If this balance is not achieved, skin damage can occur.
Types of Medical Adhesive-Related Skin Injury (MARSI)
MARSI can present in several forms:
- Irritant Contact Dermatitis (ICD): Caused by prolonged exposure to adhesive. Symptoms include redness, itching, or a burning sensation.
- Allergic Contact Dermatitis (ACD): An immune response to components within the adhesive. This may result in redness, swelling, itching, and blistering.
- Skin Stripping or Trauma: Occurs when adhesive removal damages the skin, leading to tearing or abrasions. This can result in open wounds and increased risk of complications.
How to Prevent Medical Adhesive-Related Skin Injuries (MARSI)
Preventing MARSI requires a combination of correct product selection and ongoing patient assessment.
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Assess the Patient’s Skin
Evaluate the patient’s skin condition before applying any adhesive.
Consider:
- Skin integrity and existing damage
- History of sensitivity or allergic reactions
- Age, as paediatric and elderly skin is more fragile
Where appropriate, test for sensitivity before full application.
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Choose the Right Adhesive
Different adhesives have different properties. Selection should be based on the patient’s skin condition and the intended use.
For example:
- Silicone adhesives are often used where skin is fragile, as they can provide secure adhesion with less trauma on removal
Adhesive choice should also consider:
- How the adhesive interacts with the device
- Any additional adhesive components within the device itself
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Monitor&Reassess Regularly
Adhesive suitability can change over time. Regular checks help identify early signs of irritation or damage.
Reassess based on:
- Changes in skin condition or wound status
- Duration of adhesive use
- Any visible or reported discomfort
Adjust the approach if adverse reactions occur.
Choosing Skin-Friendly Medical Adhesives
Selecting appropriate materials and monitoring their performance can help reduce the likelihood of skin damage.
During product development, adhesive performance and suitability should be evaluated against the intended use. This includes assessing adhesion strength and how the product interacts with different skin types.
Adapting materials and formats, such as through perforation or design adjustments, can support better compatibility with skin and device requirements.
FAQs
- What does MARSI stand for in medical terms?
- MARSI stands for Medical Adhesive-Related Skin Injury.
- What causes medical adhesive-related skin injury?
- It is caused when adhesives damage the skin during application, wear, or removal, often due to excessive adhesion or sensitivity.
- What are the types of MARSI?
- The main types are irritant contact dermatitis, allergic contact dermatitis, and skin stripping or trauma.
- How can MARSI be prevented?
- By assessing the skin, selecting appropriate adhesives, and regularly monitoring for signs of irritation or damage.