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For documents located in SharePoint Site (CA SJ Wound and Ostomy) look for the article and click it to open. June 2026 - MARSI in patients in NICU. Don't forget to write your name with each posting.
1) What are the advantages to the proposed recommendations in the article?
The proposed recommendations in the article provide several key advantages for improving neonatal skin integrity in the NICU. By emphasizing intensified structured skin assessments every 8 to 12 hours during the critical ICU days 3–7, standardizing the use of silicone-based adhesive removers, and optimizing fixation techniques for devices like gastric and endotracheal tubes, these strategies target the peak window of Medial Adhesive-Related Skin Injuries (MARSI) occurrence. This proactive, time-sensitive approach can substantially lower the incidence of medical adhesive-related skin injuries, reduce associated complications such as pain, infections, prolonged hospital stays, and neurodevelopmental impacts, while supporting better skin barrier maturation in premature infants. Furthermore, integrating electronic health record tools for documentation and delivering targeted nurse education promotes consistency, multidisciplinary collaboration, and efficient workflow without excessively increasing staff burden, ultimately enhancing patient outcomes, cost-effectiveness, and overall quality of neonatal care.
2) What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
Implementing these recommendations on a unit or hospital level offers notable advantages, including reduced MARSI rates, fewer secondary complications like electrolyte disturbances or delayed wound healing, and improved staff competency through focused education and training. It can foster a culture of preventive skin care, support quality improvement initiatives with measurable metrics, and streamline processes via EHR integration, leading to better neonatal comfort and potentially shorter lengths of stay. However, disadvantages include the upfront costs and time required for staff training, procurement of specialized silicone-based supplies, and possible temporary disruptions to existing workflows during the transition period. In high-acuity or resource-limited settings, increased documentation demands or resistance to practice changes could strain staffing, requiring strong leadership support, pilot testing, and ongoing monitoring to ensure sustainable adoption without compromising daily operations or overwhelming the care team.
1. Discuss the research question or main problem discussed in the study?
The study examined the problem of medical adhesive related skin injuries in newborns admitted to the neonatal intensive care unit (NICU). Because newborns have delicate and sensitive skin, especially those born prematurely, the medical adhesives used to secure tubes, catheters, and monitoring devices can easily cause skin damage.
The main research question was to determine how often medical adhesive related skin injuries occur in NICU patients and what factors increase the risk of developing these injuries. The researchers also wanted to identify the most common sites of injury and the medical devices that caused them.
Providing information that could help healthcare professionals prevent these injuries and improve skin care for newborns in the NICU is the goal of the study.
2.what are the advantages and disadvantages to the proposed recommendations in the article?
Advantages The study's recommendations can help reduce skin injuries, pain, and the risk of infection in newborns. Checking the skin regularly and using adhesives more carefully can improve the quality of care and keep babies safer. The recommendations also help healthcare providers identify babies who are at higher risk so they can take steps to prevent skin damage.
Disadvantages Following these recommendations may require more time, staff training, and hospital resources. Some hospitals may need to buy gentler adhesive products, which can increase costs. It may also be difficult to follow all of the recommendations during emergency situations when medical devices need to be secured quickly. Since the study was conducted in only one NICU, the recommendations may not apply to every hospital or healthcare setting.
June 2026 Discuss the sample size used in the study. This study was conducted at a level III NICU at the National University Hospital in Korea from September 1, 2023 to August 11, 2024. Inclusion criteria for the study were neonates who were admitted to the NICU for greater than 48 hours. Some exclusion criteria were neonates who already had a MARSI at the time of admission to the NICU and patients who more than 24 hours have passed since they were born. There was a total of 129 neonates that were included in the study out of the 172 neonates who were admitted to the NICU during the study trial timeframe. There were several reasons why the 43 neonates were not included, such as, parents who declined participation, those who did not meet eligibility since they were transferred out after 24 hours of age, transferred in after 24 hours of age, not having a legal guardian, communication barriers, or incomplete data.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias. The article suggests multiple limitations. One limitation that the study points out is that the study was only conducted at one hospital, which can limit the generalizability of the results. The results may not represent other neonates from different geographical areas or socioeconomic backgrounds. Another limitation that the study brings up is that there were two investigators that would monitor MARSI occurrences on a daily basis at a specific time and if the investigators were not there, they would request that the NICU nurses take photos of MARSIs while they were absent. Leaving it up to the nurses could have caused an underreporting of the MARSIs that actually occurred which could have affected the accuracy of the study. Also, there were not many extremely premature infants included in this study. This could mean that they cannot apply the findings to extremely premature infants since they are the population with the greater risk of skin injury due to their fragile skin. There was also a lack of data on whether or not skin products make a difference in the prevention of MARSIs.
1. Describe the method used by the author of the study
This study employed a prospective observational design to look into the frequency, severity, risk factors, and outcomes of medical adhesive-related skin injuries (MARSI) in neonates admitted to a Level III neonatal intensive care unit (NICU) at a South Korean university. The study included 129 hospitalized newborns and ran from September 2023 to August 2024. Data were obtained prospectively from admission until discharge, or 44 weeks of corrected age, by direct observations and electronic medical records. Overall skin condition was assessed daily using the Neonatal Skin Condition Scale (NSCS), and MARSI severity was quantified using the Three-Item Severity (TIS) score via direct observation and images taken by NICU nurses. The researchers used logistic regression analysis to identify risk factors linked with MARSI, allowing them to investigate the correlations between patient features and the development of skin injuries.
2. Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
Several limitations should be acknowledged when interpreting the results. First, because the study was carried out at a single university hospital's neonatal intensive care unit, the findings may not be applicable to other neonatal settings or patient demographics. Second, relying on NICU nurses to document and photograph medical adhesive-related skin injuries (MARSI) while investigators were not present may have resulted in underreporting, especially during periods of high workload and inadequate nurse-to-patient ratios (up to 1:3). Third, transitory cutaneous erythema that cleared before assessment may have resulted in missing MARSI instances and an underestimation of the true incidence. Additional limitations include a lack of data on skincare product use, the absence of standardized device fixation techniques and adhesive reapplication practices, and the observational study design, which makes it difficult to establish causal correlations between risk factors and MARSI. Finally, because most infants were moderately preterm rather than extremely premature, the findings may not be completely applicable to the highest-risk neonatal populations.
Discuss the main problem in the study. Neonates often need adhesives to secure life -support and monitoring devices, including endotracheal and gastric tubes, IV and arterial lines, ECG and pulse oximeter probes. Their thin, underdeveloped skin barrier and fragile dermal-epidermal connection make application and particularly removal of adhesives hazardous. The main problem is that medically necessary tapes, electrodes, and devices securements can damage neonates' fragile, immature skin-especially in preterm infants- causing medical adhesives-related injuries(MARSI) such as redness, skin stripping, tears, blisters, and erosions. These injuries are a major care- related skin injury issue in NICU.
Advantage/s and disadvantage/s to the proposed recommendations in the article. Advantage: The authors recommend prioritizing prevention strategies for infants receiving TPN and for those needing gastric or endotracheal tubes fixation. This can include frequent skin assessment, careful choice and removal of adhesive products, skin protection barriers when appropriate, and consistent staff adherence to a neonatal skin care protocol. A separate NICU quality-improvement project reduced MARSI from 30 events per 1,000 adhesive application days to zero during its intervention period through risk stratification, regular skin scoring, and reinforcements of a prevention bundle including barrier spray.
Disadvantage: In the NICU study, the available abstract reports the severity distribution of MARSI- 18.1% mild, 75% moderate, and 6.9% severe; but it does not identify specific adhesive type as causing the severe classification. It identifies gastric tube and endotracheal tubes fixation as the leading causes, rather than naming the tape or adhesive material used. In short; material chemistry such as viscoelastic behavior, backing and dressing design, skin moisture/oils, dwell time, and the mechanics of application and removal are clinically important and brand variation can influence those characteristics.
Discuss the research question or main problem discussed in the study? Neonates in the intensive care unit face unique challenges during their care related to their skin integrity, due to the fragileness of their skin. This study discusses medical adhesive related skin injuries in neonates from gastric tubes, endotracheal tubes, IV lines, and pulse oximeter probes are just a few examples of the devices needed to be anchored in place on a neonate. The study also looks at the significance, risk factors, and characteristics of said medical adhesive related skin injuries and discusses the results of this. Discuss the limitations of the article: limited sample size, design flaws, and/or author bias The study relays a few different limitations, such as the lack of data on lotions or other products on the skin that can impact skin integrity. Another limitation is when researchers were not present they relied on nursing staff to take photos of MARSI's, which may have been missed if staffing or time did not permit, leading to errors in reporting for the research study. Finally, because this study was done at a university hospital the generalizability of the findings are limited in this study.
The main problem is that NICU neonates are highly vulnerable to skin damage from the medical adhesives necessary for their care, while there is insufficient information about the frequency and specific risk factor for these injuries. Identifying these risk can help nurses develop more targeted prevention strategies particularly for infants requiring TPN and adhesive fixation around the head and face.
2. What are the advantages and disadvantages to the proposed recommendation in the article?
Advantages: - They target the highest-risk patients. - They can reduce preventable skin injury. - They support individualized nursing care. - They can improve patient safety and quality of care. - They are consistent with evidence-based neonatal care.
Disadvantages: - Additional nursing workload. - Additional costs. - Not all prevention strategies are appropriate for every neonate. - Requires staff education and consistency. - The study’s sample does not prove that the recommended strategies will prevent MARSI.
1) What are the advantages to the proposed recommendations in the article?
ReplyDeleteThe proposed recommendations in the article provide several key advantages for improving neonatal skin integrity in the NICU. By emphasizing intensified structured skin assessments every 8 to 12 hours during the critical ICU days 3–7, standardizing the use of silicone-based adhesive removers, and optimizing fixation techniques for devices like gastric and endotracheal tubes, these strategies target the peak window of Medial Adhesive-Related Skin Injuries (MARSI) occurrence. This proactive, time-sensitive approach can substantially lower the incidence of medical adhesive-related skin injuries, reduce associated complications such as pain, infections, prolonged hospital stays, and neurodevelopmental impacts, while supporting better skin barrier maturation in premature infants. Furthermore, integrating electronic health record tools for documentation and delivering targeted nurse education promotes consistency, multidisciplinary collaboration, and efficient workflow without excessively increasing staff burden, ultimately enhancing patient outcomes, cost-effectiveness, and overall quality of neonatal care.
2) What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
Implementing these recommendations on a unit or hospital level offers notable advantages, including reduced MARSI rates, fewer secondary complications like electrolyte disturbances or delayed wound healing, and improved staff competency through focused education and training. It can foster a culture of preventive skin care, support quality improvement initiatives with measurable metrics, and streamline processes via EHR integration, leading to better neonatal comfort and potentially shorter lengths of stay. However, disadvantages include the upfront costs and time required for staff training, procurement of specialized silicone-based supplies, and possible temporary disruptions to existing workflows during the transition period. In high-acuity or resource-limited settings, increased documentation demands or resistance to practice changes could strain staffing, requiring strong leadership support, pilot testing, and ongoing monitoring to ensure sustainable adoption without compromising daily operations or overwhelming the care team.
1. Discuss the research question or main problem discussed in the study?
ReplyDeleteThe study examined the problem of medical adhesive related skin injuries in newborns admitted to the neonatal intensive care unit (NICU). Because newborns have delicate and sensitive skin, especially those born prematurely, the medical adhesives used to secure tubes, catheters, and monitoring devices can easily cause skin damage.
The main research question was to determine how often medical adhesive related skin injuries occur in NICU patients and what factors increase the risk of developing these injuries. The researchers also wanted to identify the most common sites of injury and the medical devices that caused them.
Providing information that could help healthcare professionals prevent these injuries and improve skin care for newborns in the NICU is the goal of the study.
2.what are the advantages and disadvantages to the proposed recommendations in the article?
Advantages
The study's recommendations can help reduce skin injuries, pain, and the risk of infection in newborns. Checking the skin regularly and using adhesives more carefully can improve the quality of care and keep babies safer. The recommendations also help healthcare providers identify babies who are at higher risk so they can take steps to prevent skin damage.
Disadvantages
Following these recommendations may require more time, staff training, and hospital resources. Some hospitals may need to buy gentler adhesive products, which can increase costs. It may also be difficult to follow all of the recommendations during emergency situations when medical devices need to be secured quickly. Since the study was conducted in only one NICU, the recommendations may not apply to every hospital or healthcare setting.
June 2026
ReplyDeleteDiscuss the sample size used in the study.
This study was conducted at a level III NICU at the National University Hospital in Korea from September 1, 2023 to August 11, 2024. Inclusion criteria for the study were neonates who were admitted to the NICU for greater than 48 hours. Some exclusion criteria were neonates who already had a MARSI at the time of admission to the NICU and patients who more than 24 hours have passed since they were born. There was a total of 129 neonates that were included in the study out of the 172 neonates who were admitted to the NICU during the study trial timeframe. There were several reasons why the 43 neonates were not included, such as, parents who declined participation, those who did not meet eligibility since they were transferred out after 24 hours of age, transferred in after 24 hours of age, not having a legal guardian, communication barriers, or incomplete data.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
The article suggests multiple limitations. One limitation that the study points out is that the study was only conducted at one hospital, which can limit the generalizability of the results. The results may not represent other neonates from different geographical areas or socioeconomic backgrounds. Another limitation that the study brings up is that there were two investigators that would monitor MARSI occurrences on a daily basis at a specific time and if the investigators were not there, they would request that the NICU nurses take photos of MARSIs while they were absent. Leaving it up to the nurses could have caused an underreporting of the MARSIs that actually occurred which could have affected the accuracy of the study. Also, there were not many extremely premature infants included in this study. This could mean that they cannot apply the findings to extremely premature infants since they are the population with the greater risk of skin injury due to their fragile skin. There was also a lack of data on whether or not skin products make a difference in the prevention of MARSIs.
1. Describe the method used by the author of the study
ReplyDeleteThis study employed a prospective observational design to look into the frequency, severity, risk factors, and outcomes of medical adhesive-related skin injuries (MARSI) in neonates admitted to a Level III neonatal intensive care unit (NICU) at a South Korean university. The study included 129 hospitalized newborns and ran from September 2023 to August 2024. Data were obtained prospectively from admission until discharge, or 44 weeks of corrected age, by direct observations and electronic medical records. Overall skin condition was assessed daily using the Neonatal Skin Condition Scale (NSCS), and MARSI severity was quantified using the Three-Item Severity (TIS) score via direct observation and images taken by NICU nurses. The researchers used logistic regression analysis to identify risk factors linked with MARSI, allowing them to investigate the correlations between patient features and the development of skin injuries.
2. Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
Several limitations should be acknowledged when interpreting the results. First, because the study was carried out at a single university hospital's neonatal intensive care unit, the findings may not be applicable to other neonatal settings or patient demographics. Second, relying on NICU nurses to document and photograph medical adhesive-related skin injuries (MARSI) while investigators were not present may have resulted in underreporting, especially during periods of high workload and inadequate nurse-to-patient ratios (up to 1:3). Third, transitory cutaneous erythema that cleared before assessment may have resulted in missing MARSI instances and an underestimation of the true incidence. Additional limitations include a lack of data on skincare product use, the absence of standardized device fixation techniques and adhesive reapplication practices, and the observational study design, which makes it difficult to establish causal correlations between risk factors and MARSI. Finally, because most infants were moderately preterm rather than extremely premature, the findings may not be completely applicable to the highest-risk neonatal populations.
Ronit Malamud
Discuss the main problem in the study.
ReplyDeleteNeonates often need adhesives to secure life -support and monitoring devices, including endotracheal and gastric tubes, IV and arterial lines, ECG and pulse oximeter probes. Their thin, underdeveloped skin barrier and fragile dermal-epidermal connection make application and particularly removal of adhesives hazardous.
The main problem is that medically necessary tapes, electrodes, and devices securements can damage neonates' fragile, immature skin-especially in preterm infants- causing medical adhesives-related injuries(MARSI) such as redness, skin stripping, tears, blisters, and erosions. These injuries are a major care- related skin injury issue in NICU.
Advantage/s and disadvantage/s to the proposed recommendations in the article.
Advantage: The authors recommend prioritizing prevention strategies for infants receiving TPN and for those needing gastric or endotracheal tubes fixation. This can include frequent skin assessment, careful choice and removal of adhesive products, skin protection barriers when appropriate, and consistent staff adherence to a neonatal skin care protocol. A separate NICU quality-improvement project reduced MARSI from 30 events per 1,000 adhesive application days to zero during its intervention period through risk stratification, regular skin scoring, and reinforcements of a prevention bundle including barrier spray.
Disadvantage: In the NICU study, the available abstract reports the severity distribution of MARSI- 18.1% mild, 75% moderate, and 6.9% severe; but it does not identify specific adhesive type as causing the severe classification. It identifies gastric tube and endotracheal tubes fixation as the leading causes, rather than naming the tape or adhesive material used. In short; material chemistry such as viscoelastic behavior, backing and dressing design, skin moisture/oils, dwell time, and the mechanics of application and removal are clinically important and brand variation can influence those characteristics.
Discuss the research question or main problem discussed in the study?
ReplyDeleteNeonates in the intensive care unit face unique challenges during their care related to their skin integrity, due to the fragileness of their skin. This study discusses medical adhesive related skin injuries in neonates from gastric tubes, endotracheal tubes, IV lines, and pulse oximeter probes are just a few examples of the devices needed to be anchored in place on a neonate. The study also looks at the significance, risk factors, and characteristics of said medical adhesive related skin injuries and discusses the results of this.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
The study relays a few different limitations, such as the lack of data on lotions or other products on the skin that can impact skin integrity. Another limitation is when researchers were not present they relied on nursing staff to take photos of MARSI's, which may have been missed if staffing or time did not permit, leading to errors in reporting for the research study. Finally, because this study was done at a university hospital the generalizability of the findings are limited in this study.
1. Discuss the main problem in the study.
ReplyDeleteThe main problem is that NICU neonates are highly vulnerable to skin damage from the medical adhesives necessary for their care, while there is insufficient information about the frequency and specific risk factor for these injuries. Identifying these risk can help nurses develop more targeted prevention strategies particularly for infants requiring TPN and adhesive fixation around the head and face.
2. What are the advantages and disadvantages to the proposed recommendation in the article?
Advantages:
- They target the highest-risk patients.
- They can reduce preventable skin injury.
- They support individualized nursing care.
- They can improve patient safety and quality of care.
- They are consistent with evidence-based neonatal care.
Disadvantages:
- Additional nursing workload.
- Additional costs.
- Not all prevention strategies are appropriate for every neonate.
- Requires staff education and consistency.
- The study’s sample does not prove that the recommended strategies will prevent MARSI.