What Makes Paediatric Patients So Much at Risk of Medical Adhesive-Related Skin Injury in Intensive Care Unit?

BACKGROUND

Medical adhesives are frequently used during hospitalization to secure medical devices to the skin. Compared to adults, children are at a higher risk of developing medical adhesive-related skin injuries (MARSI).

AIM

The aim of this study is to determine the incidence, characteristics and associated risk factors of MARSI in a Paediatric Intensive Care Unit (PICU).

STUDY DESIGN

This prospective cohort study included 72 children who were followed from November 10, 2023, to February 10, 2024, from admission until the onset of MARSI or discharge. The risk of skin injury was assessed using the Glamorgan Scale, and patients' sociodemographic and clinical data were obtained from medical records.

RESULTS

The incidence of MARSI was 61.1%, with 44 out of 72 patients developing MARSI, resulting in a total of 140 cases. The majority of cases were skin stripping (72.1%). The median time to MARSI occurrence was 2.78 days. Being 12 months old or younger (OR: 5.3, 95% CI: 1.6-17.6, p = 0.006), an increasing number of medical devices (OR: 2.4, 95% CI: 1.1-5.2, p = 0.026) and sedation use for more than 24 h (OR: 5.4, 95% CI: 1.7-16.8; p = 0.003) were identified as independent risk factors.

CONCLUSIONS

This study revealed a high incidence of MARSI in the PICU. MARSI develops rapidly in the early days of hospitalization. Critically ill patients aged 12 months or younger, with a greater number of medical devices and prolonged sedation, are at a higher risk of developing MARSI.

RELEVANCE TO CLINICAL PRACTICE

The high incidence of MARSI underscores the need for proactive prevention strategies. Skin assessment for MARSI should be conducted before, during and at each change of medical adhesive applications. Patients aged 12 months or younger, patients with an increased number of medical devices, and patients undergoing prolonged sedation require greater attention to MARSI prevention.