Incidence and risk factors of medical adhesive-related skin injury among ICU patients: a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: Paediatric ICU highest incidence at 48% (95% CI: 35%, 60%)

• Primary Outcome: Pooled incidence of MARSI: 21% (95% CI: 14%, 28%)

• Nnt Or Sensitivity: Strongest risk factors: oedema (OR: 8.144), sedative use (OR: 6.022), hypoalbuminaemia (OR: 4.321)

• Confidence Interval: Adult ICU: 16% (95% CI: 11%, 22%); Neonatal ICU: 15% (95% CI: 6%, 26%)

Clinical Application

Risk assessment tools readily available in Australian ICUs; prevention strategies can be implemented with existing resources Findings applicable to Australian ICUs; aligns with NSQHS Standards for preventing healthcare-associated harm; relevant for ACQSHC clinical care standards All ICU patients, particularly those with identified risk factors including oedema, prolonged mechanical ventilation, sedation, and malnutrition

Abstract

OBJECTIVE: To summarise the evidence regarding the incidence and risk factors of medical adhesive-related skin injury (MARSI) among patients in the intensive care unit (ICU). METHOD: A systematic review and meta-analysis was undertaken using articles available in nine databases: PubMed; the Cochrane Library; Web of Science; Embase; CINAHL; Chinese Biomedical Literature Database; China National Knowledge Infrastructure Database; Wanfang Database; and Weipu Database, from inception until 30 June 2024. Additional studies were identified by examining the references of relevant articles. The Stata 16.0 statistical platform (StataCorp LLC, US) was used for analysis. Study quality was assessed using the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality standards. RESULTS: Of 14,743 titles screened, 19 studies involving 5218 patients were included in the systematic review. The pooled incidence of MARSI was 21% (95% confidence interval (CI): 14%, 28%), and the incidence of MARSI among neonatal ICU, paediatric ICU and adult ICU was 15% (95% CI: 6%, 26%), 48% (95% CI: 35%, 60%) and 16% (95% CI: 11%, 22%), respectively. Significant risk factors in adult ICUs included oedema (odds ratio (OR): 8.144; 95%CI: 3.267, 20.304), Braden scale score (OR: 0.733; 95%CI: 0.641, 0.837), length of ICU stay (OR: 1.072; 95%CI: 1.026, 1.120), mechanical ventilation (OR: 3.698; 95%CI: 1.900, 7.199), sedative use (OR: 6.022; 95%CI: 2.859, 12.687), Nutritional Risk Screening 2002 score (OR: 4.241; 95%CI: 1.984, 9.065) and hypoalbuminaemia (OR: 4.321; 95%CI: 1.967, 9.488). CONCLUSION: This study found that MARSI is prevalent among ICU patients and is associated with multiple risk factors. Improved strategies for identifying and clinically managing MARSI in ICU patients are needed. Nevertheless, large-sample and multicentre studies are still warranted to validate the present study's findings.

References

1. 1.Xu, Y., Yan, M., Pan, W., & Li, C. (2024). Incidence and risk factors of medical adhesive-related skin injury among ICU patients: a systematic review and meta-analysis. Journal of Wound Care, 33(5). https://doi.org/10.12968/jowc.2024.0404