Facilitating neonatal MARSI evidence into practice: Investigating multimedia resources with Australian Neonatal Nurses – A participatory action research project

August, Deanne; Chapple, Lynette; Flint, Anndrea; Macey, Judith; Ng, Linda; New, Karen

doi:10.1016/j.jnn.2020.12.001

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…According to existing literature, 16%–27% of hospitalised neonates are predisposed to developing at least one MARSI event during the routine application of adhesives to secure medical devices during hospital stay. 1 8 About 10%–15% of these injuries leave behind a scar, while approximately 5% are associated with functional and cosmetic damage. 2 Lund et al demonstrated significantly improved skin condition in NICU babies by application of AWHONN/NANN neonatal skin care research-based guidelines in routine practice.…”

Section: Discussionmentioning

confidence: 99%

“…The neonatal skin injury rate documented during NICU stay has been reported to be around 9.25%–41.5%. 1 Furthermore, the injury was around 57% in neonates with gestational age between 24–27 weeks as compared with a meagre 3% in term neonates. 2 With less functionality and underdeveloped anatomical integrity (thin stratum corneum and fragile dermo-epidermal junction), sick preterm neonates are most vulnerable to injury during adhesive removal.…”

Section: Introductionmentioning

confidence: 97%

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Quality improvement initiative to reduce Medical Adhesive Related Skin injury (MARSI) in very preterm babies admitted to neonatal intensive care unit

Kar,

Jarain,

Karmakar

et al. 2024

BMJ Open Qual

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IntroductionSick preterm neonates are most vulnerable to developing skin injuries. Despite sound knowledge and application of evidence-based practices for preventing medical adhesive-related skin injury (MARSI), the incidence of MARSI was 30 events per 1000 adhesive application days in our unit.Aims and objectivesWe aimed to reduce the median MARSI rate from the existing 30 per 1000 MARSI days to <5 per 1000 MARSI over 5 months from June 2023 to October 2023.Material & methodsWith the point-of-care quality improvement (QI) approach, a prospective study was planned to reduce the incidence of MARSI among sick very preterm newborns (<32 weeks gestational age) and eventually improve overall skin condition during hospital stay. Sequential Plan—Do—Study—Act cycles were implemented based on the identified risk factors recognised during recurring team discussions.ResultsWe demonstrated a reduction in the MARSI rate from 30 events per 1000 adhesive applications (during baseline assessment) to zero events per 1000 adhesive applications at the end of the study period. It was temporally related to the assessment of skin risk stratification at admission using a validated tool, regular assessment of neonatal skin condition score based on the skin risk stratification, and reinforcement of MARSI prevention bundle by application of barrier spray. Awareness regarding ‘skin injury prevention’ bundles was continually generated among healthcare professionals. The MARSI rate remained <5 events per adhesive application in the sustenance phase over 6 months.ConclusionImplementing evidence-based skin care practices resulted in a significant reduction in iatrogenic cutaneous injury events in very preterm neonates.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Quality improvement initiative to reduce Medical Adhesive Related Skin injury (MARSI) in very preterm babies admitted to neonatal intensive care unit

Kar,

Jarain,

Karmakar

et al. 2024

BMJ Open Qual

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“…Despite growing evidence of injury and risk for ELBW infants, there is limited evidence available for injury prevention and even less evidence for injury management in ULBW infants. Recommendations for skin injury prevention in extremely preterm infants include minimizing the use of adhesive tapes, opting for silicone adhesives, using correct adhesive application and removal techniques, rotating devices and offloading devices when possible [63,70,71]. Polyurethane adhesives (e.g., transparent films) allow easy inspection of the underlying skin.…”

Section: Current Evidencementioning

confidence: 99%

“…When removing adhesives, it is essential to adopt a gentle approach by pulling tapes horizontally after wetting the adhesive [63]. While there is some evidence to support adhesive remover wipes [mineral or petrolatum oil(s) or silicone], it is important to note that their safety in the first two weeks after birth has not been fully evaluated, and they can make readhesion of tapes to the skin difficult [63,71]. Therefore, it is advisable to use them with caution during this period.…”

Section: Current Evidencementioning

confidence: 99%

Thermoregulation, incubator humidity, and skincare practices in appropriate for gestational age ultra-low birth weight infants: need for more evidence

Mishra,

August,

Walker

et al. 2024

World J Pediatr

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Background Although not universal, active care is being offered to infants weighing < 500 g at birth, referred to as ultra-low birth weight (ULBW) infants appropriate for gestational age. These infants have the greatest risk of dying or developing major morbidities. ULBW infants face challenges related to fluid and heat loss as well as skin injury in the initial days of life from extreme anatomical and physiological immaturity of the skin. Although there is an emerging literature on the outcomes of ULBW infants, there is a paucity of evidence to inform practice guidelines for delivering optimal care to this cohort of infants. Data sources A comprehensive review of the literature was performed using the PubMed and Embase databases. Searched keywords included “thermoregulation or body temperature regulation”, “incubator humidity”, “skin care”, “infant, extremely low birth weight” and “ultra-low birth weight infants”. Results Evidences for thermoregulation, incubator humidity, and skincare practices are available for preterm infants weighing < 1500 g at birth but not specifically for ULBW infants. Studies on thermoregulation, incubator humidity, or skincare practices had a small sample size and did not include a sub-group analysis for ULBW infants. Current practice recommendations in ULBW infants are adopted from research in very and/or extremely low birth weight infants. Conclusions This narrative review focuses on challenges in thermoregulation, incubator humidity, and skincare practices in ULBW infants, highlights current research gaps and suggests potential developments for informing practices for improving health outcomes in ULBW infants.

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“…Zhang et al [15] emphasized the importance of providing training and education to healthcare workers on neonatal MARSI. Several studies have shown that the theoretical and operational knowledge of nurses regarding MARSI are at a relatively low level [19][20][21] . Most nurses have not received relevant training on skin care, are unaware of the importance of preventing MARSI, and have different methods for handling MARSI.…”

Section: Management Of Training Nodesmentioning

confidence: 99%

Risk Factors of Neonatal Medical Adhesive-Related Skin Injury and Management of High-Risk Nodes

Huang

Wang

2023

JCNR

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Objective: To analyze the risk factors of neonatal medical adhesive-related skin injury and put forward targeted preventive measures, so as to provide reference for the care and prevention of neonatal medical adhesive-related skin injuries. Methods: Using the convenience sampling method, 262 neonates admitted to the neonatal intensive care unit (NICU) of a tertiary general hospital in Wenzhou from April 2021 to May 2022 were selected as the study subjects. The incidence of medical adhesive-related skin injuries in these neonates was retrospectively analyzed. Results: Among the 262 children, 43 cases had skin injuries, with an incidence rate of 16.4%. Single factor analysis showed that the occurrence of medical adhesive-related skin injury was related to gestational age, weight, electrocardiogram (ECG) monitoring, venous access, ambient temperature, and mechanical ventilation (P < 0.05). Multivariate logistic regression showed that gestational age, ECG monitoring, and ambient temperature were independent risk factors of medical adhesive-related skin injury (OR values were 0.700, 0.431, and 6.365, respectively). Conclusion: The high incidence of neonatal medical adhesive-related skin injury may be caused by one or more factors. Clinical measures should be taken, such as selecting the appropriate type of adhesive according to gestational age and using skin-protecting membrane, minimizing ECG monitoring, etc., to prevent the occurrence of neonatal medical adhesive-related skin injury.

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Facilitating neonatal MARSI evidence into practice: Investigating multimedia resources with Australian Neonatal Nurses – A participatory action research project

Cited by 5 publications

References 16 publications

Quality improvement initiative to reduce Medical Adhesive Related Skin injury (MARSI) in very preterm babies admitted to neonatal intensive care unit

Quality improvement initiative to reduce Medical Adhesive Related Skin injury (MARSI) in very preterm babies admitted to neonatal intensive care unit

Thermoregulation, incubator humidity, and skincare practices in appropriate for gestational age ultra-low birth weight infants: need for more evidence

Risk Factors of Neonatal Medical Adhesive-Related Skin Injury and Management of High-Risk Nodes

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