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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.
The study found that medical adhesive-related skin injuries were very common in newborns in the NICU. About 51.9% of the newborns developed this type of skin injury. The head and face were the areas most often affected, mainly because of adhesives used to secure gastric and endotracheal tubes. The study also found that newborns receiving total parenteral nutrition (TPN) had a higher risk of developing these injuries. Overall, the findings show that NICU patients need careful and frequent skin assessments.
2. How can the findings of this study be applied to patient care?
These findings can help NICU nurses identify babies who may be at higher risk for skin injuries from medical adhesives. Nurses should closely monitor areas where tubes, tape, and other adhesive devices are attached, especially around the head and face. Extra attention should also be given to babies receiving TPN because the study found they had a higher risk. Using gentle adhesive removal techniques and checking the skin regularly may help prevent injuries. Early identification can allow nurses to make changes before the skin damage becomes more serious.
1). Discuss the research question or main problem discussed in the study.
The main problem is this study is neonates in the neonatal intensive care unit (NICU) frequently require medical adhesives for device fixation; yet, their immature skin makes them vulnerable to medical adhesive-related skin injuries. Research on the incidence of medical adhesive-related skin injuries and clinical risk factors in this population is very limited. The research question is to investigate the incidence, characteristics, and clinical risk factors of medical adhesive-related skin injuries in neonates admitted to the NICU. According to this study, medical adhesive-related skin injury is defined as a skin integrity disorder caused by the use of adhesives that persists for greater than 30 minutes after tape removal and presents as erythema, blisters, erosion, vesicles, or tears. The study states that the skin of neonates is 20% to 30% thinner than skin of adults, leading to increased moisture loss, compromised barrier function, and more prone to skin damage.
2). Discuss the sample size used in the study.
The study was conducted from September 1, 2023 to August 11, 2024, in the Level III NICU of the National University Hospital in Korea. This hospital has a 20 bed capacity and serves as a referral center for premature and high-risk newborns, with an average annual admission of approximately 280 infants. During the study period, 172 infants were admitted to the NICU. After all was said and done, the exclusion criteria ended up resulting in a final sample of 129 neonates.
The main problem is that NICU neonates are highly vulnerable to skin damage from the medical adhesives necessary for their care. Neonates have immature, fragile skin, yet they frequently require adhesives to secure medical devices such as gastric and endotracheal tubes. It was significant because the study found that 51.9% of the 129 neonates developed MARSI. 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 to the proposed recommendation were, 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, and they are consistent with evidence-based neonatal care. Disadvantages were, additional nursing workload, additional costs, not all prevention strategies are appropriate for every neonate. Also, it requires staff education and consistency and the study’s sample does not prove that the recommended strategies will prevent MARSI.
1. Discuss the research question or main problem discussed in the study.
- The study's main problem is medical adhesive-related skin injury (MARSI) in NICU patients. Because premature and critically ill newborns have fragile, immature skin and frequently require adhesive medical devices, they are particularly vulnerable to skin damage. The research focuses on determining how often MARSI occurs in newborn patients, where and how the injuries occur, and what factors increase the risk of developing MARSI. The goal is to better identify at-risk infants and help nurses and other healthcare professionals develop strategies to prevent adhesive-related skin injuries.
2. Discuss the limitations in the article: limited sample size, design flaws, and/or author bias.
- One limitation of this study is the relatively small sample size of 129 neonates and that the research was conducted in only one university hospital NICU. This limits how well the findings can be generalized to other NICUs with different patient populations, adhesive products, or nursing practices. In addition, the study used a prospective observational design, so it can identify associations between risk factors and MARSI, but cannot prove that a specific factor caused the injury. For example, TPN was identified as a significant risk factor, but infants receiving TPN may also be more critically ill and require more devices and adhesives. There is also potential for observer bias when assessing and grading skin injuries, although the researchers used standardized skin assessment tools to help reduce this. The authors reported no conflicts of interest, so there is no clear evidence of significant author bias. Overall, larger multicenter studies would help confirm the findings and make them more applicable to a broader NICU population.
1. Discuss the research question or main problem discussed in the study. The main problem discussed in the study is medical adhesive-related skin injuries (MARSI) in newborns admitted to the neonatal intensive care unit (NICU). Medical adhesives are commonly needed to secure devices such as gastric tubes, endotracheal tubes, and other lines. Still, a newborn’s skin is very thin and sensitive, making it more likely to become damaged. The researchers wanted to find out how often these skin injuries occur, where they commonly develop, how severe they are, and what factors increase the risk.
The study also focused on identifying clinical factors that could help nurses recognize babies who are at higher risk for MARSI. By understanding these risks, nurses can provide better skin care and take preventive measures before an injury develops.
2. Discuss the sample size used in the study. The study included 129 newborns who were admitted to the NICU. The researchers originally determined that they needed at least 117 participants, but they increased the number to 129 in case some participants dropped out. A total of 172 babies were considered for the study, but some were excluded because they did not meet the requirements or their parents did not agree to participate. In the end, 129 newborns were included, giving the researchers a sufficient sample size to analyze the results.
1. Describe the method used by the author of the study. The method used in this article was an observational study conducted in the neonatal ICU unit at a university hospital. The study was conducted on 129 admitted NICU patients. The neonatal condition scale was used to assess the overall skin condition. However, the severity of medical adhesive related skin injuries (MARSI) was assessed using the Three-Item severity score.
2. What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital? This study found that the most common causes of MARSI were gastric and endotracheal tube fixation, and the use of TPN was a significant risk factor. Recommendations by the study were that nursing strategies used to reduce MARSI should be prioritized to prevent patient harm. In my opinion, this aligns with the policy and procedures of my unit because in the ICU we have several policy and procedures that we follow to prevent patient harm related to skin injury from medical equipment including adhesives to hold tubes and lines. For example, we have holders for ET tubes that we assess daily and collaborate in that care with respiratory therapists. We check the check around the holder for skin breakdown. We have also recently changed the holder for NG tubes to prevent skin breakdown and therefore reducing the incidence of harm. I do not see any disadvantages to implementing anything from this study to my hospital, however, I do not work in NICU and am not familiar with their unit specific policies.
The study was conducted from September 1, 2023 to August 11, 2024 in the level III NICU of the National University Hospital in Korea. The hospital has a 20 bed capacity. The NICU was staffed by 3 qualified neonatal intensive and a clinical nurse specialists. 30 nurses were employed to staff the 20 bed unit. Neonates admitted to the NICU for > 48 hours were included. Neonates with MARSI at the time of admission and patients more than 24 hours had passed since birth were excluded from the data collection. The required sample size was calculated using G*Power 3,1, 9, 7. G*Power is a software program used by researchers to calculate statistical power and determine sample size for studies. 172 infants were admitted to NICU but 129 neonates are the final samples size that meet the eligibility criteria.
2. Discuss the method used by the author of the study?
A prospective observational study was conducted in a university hospital NICU. Data were collected between September 18, 2023 until August 14, 2024. The participants was hospitalized until discharge. Data were collected through direct observations and medical records. The overall skin condition was evaluated using the NEONATAL SKIN CONDITION SCALE, whereas the severity of MARSI was assessed using the THREE ITEM SEVERITY SCORE. The NEONATAL SKIN CONDITION SCALE is used to assess overall skin condition of the neonates which comprise of 3 categories: dryness, erythema and breakdown excoriation. The scoring is 1-3 points for each category totaling 9 points, with the highest score indicating poorer condition. Assessment is done at 3-day intervals. The Three Item Severity (TIS) score is a scale used to assess the severity of dematitis and MARSI. The TIS score evaluates erythema, edema, and excoriation. Each category was measured on a scale of 0 to 3, where 0 indicates none; 1 (mild); 2 (moderate) and 3 (severe). Two investigators examined the overall condition of the neonates using the NCSC, TIS score and direct observation.
1. Discuss the research question or main problem discussed in the study.
This study focused on skin injuries caused by medical adhesives in babies in the NICU. Newborn babies have very sensitive skin, and they often need tape or other adhesives to keep medical devices in place. The researchers wanted to see how often these skin injuries happened and what could increase the risk. They found that these injuries were common, especially in babies who were receiving TPN.
2. Discuss the sample size used in the study.
The study included 129 babies who were admitted to the NICU. The researchers followed these babies and checked their skin for injuries caused by medical adhesives. During the study, 67 babies developed a skin injury, while 62 did not. This gave the researchers two groups to compare and helped them identify possible risk factors for these injuries.
Discuss the research question or main problem discussed in the study? There are many reasons for NICU admissions and when a neonate is in the NICU there are many monitoring devices that need to be secured to the neonate for the purpose of stabling the patient. With the medical devices that are used to monitor and stabilize the neonates are at risk of developing medical adhesive related skin injuries, which is defined in the article as a skin integrity disorder caused using adhesive that persists after tape removal. Neonates have sensitive skin that require gentle care, the study states that with the use of the monitoring devices, there are skin barriers used to protect the neonates’ skin. These barriers include silicone and hydrocolloid-based barriers. However, even with the use of these skin protectants, neonates still developed MARSI.
Discuss the sample size used in the study. The setting used for this study was the NICU department at the National University Hospital in Korea from September 1, 2023 to August 11, 2024. The total number of neonates that were included in this study was 129. Most of the neonates had respiratory problems, a total of 67 patients developed MARIs and 62 did not. The risk factors identified as causing the MARSI were gastric and endotracheal tube fixation. Although 129 neonates is a good number of participants, the sample size is small and due to this being an observation study that was only done in one hospital, the identification of TPN as in independent risk factor for MARSI cannot be identified reliably as a direct cause.
1. Describe the method used by the author of the study. The study used a prospective observational design conducted in a Level III neonatal intensive care unit (NICU) at a university hospital. The researchers followed 129 neonates during their hospitalization and assessed their overall skin condition using the Neonatal Skin Condition Score (NSCS). The severity of medical adhesive-related skin injuries (MARSI) was assessed using the Three-Item Severity (TIS) score. The researchers also collected clinical information to identify factors associated with the development of MARSI.
2. Discuss the limitations of the article; limited sample size, design flaws, and/or author bias. One limitation of the study was the relatively small sample of 129 neonates from only one university hospital NICU, which limits how well the findings can be generalized to other NICUs. The prospective observational design could identify relationships between risk factors and MARSI but could not prove that a specific factor, such as TPN, directly caused the skin injury. There was also potential for observer or reporting bias when researchers and nurses assessed and documented skin injuries, although standardized assessment tools were used to reduce this risk. The authors reported no conflicts of interest, so there was no clear evidence of significant author bias.
Discuss the limitations of the article: Limited sample size, design flaws, and or author bias
One limitation of this study was sample size. The study included only 129 neonates from one level three NICU at a university hospital in Korea. Because of this, the study limits the data and results to a certain population. Another limitation of the study included variability within the study itself, including differences in adhesives, application technique and frequency of adhesive changes. Because the investigators of the study itself performed the majority of the skin assessments this left room for potential author bias. Although the investigators were also doing the assessments, they attempted to adequately train the investigators to help reduce possible issues in data and results.
Describe the method used by the author of the study?
The research was obtained using a prospective observational study to assess and evaluate the incidence of medical adhesive related skin injuries and potential risk factors. The data collected was done from September 2023 to August 2024 at one designated NICU located in Korea. The data was collected by investigators performing daily skin assessments in patients admitted to the NICU being studied. Not only was research collected from observation and physical assessment, but also through clinical information received from medical records. Data collected was evaluated using such tests as t tests, Fisher’s exact tests and ANOVA.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
There were many limitations from the article. The study was conducted in the NICU of a university hospital so data will be limited only to this one NICU. MARSIs (medical adhesive related skin injury) were asked to be monitored at documented at certain times by nurses, but when the NICU was busy, assessments might have not been able to be done at consistently at the same times. infants in this study were also not extremely premature which can limit the study because the extremely premature are at much greater risk of skin injury.
Discuss the research question or main problem discussed in the study?
The main problem discussed in this study is neonates admitted to the NICU frequently need medical device securements such as ekg electrodes, endotracheal tubes, and nasogastric tubes, which can cause MARSIs due to their immature skin. A MARSI is defined as damage to skin integrity due to the use of adhesives that persists for greater than 30 minutes after removing tape that causes erythema, blisters, erosion, or tears. There are medical adhesives that are used to protect the skin, however due to the neonates delicate skin, there is still the risk of infections, prolonged hospital stays, increased medical costs, and pain/discomfort to the patient.
1. Describe the method used by the author of the study The authors of the article utilized a prospective observational study for their look at how medical adhesives cause skin injuries in patients in the NICU, also known as MARSI (Medical Adhesive-Related Skin Injuries). Their sample size was 129 neonates at a level III NICU at a hospital in Korea. The study used 2 measurement tools: 1) the Neonate Skin Condition Score (NSCS), which looks at three categories: skin dryness, erythema and breakdown or excoriation and 2) the Three Item Severity (TIS) score which looks at dermatitis severity.
2. Discuss the limitations of the article: limited sample size, design flaws, and/or author bias There are some limitations to this study. Perhaps the largest limitation was sample size: only 129 neonates were studied, at one hospital over a three-week period. It was determined that 51.9% of the babies in this study developed a MARSI. A wider, longer, more comprehensive study might give a more realistic result. Of note, incidences at other hospitals in other similar studies had significantly lower and higher rates, ranging from 19.5% to 58.3%. The authors touch on possible reasons for the variance, one being data collection methods. To get a truer number, a future study might look at casting a wider net.
David Kahn 5south Research Question or main study problem: The study is basically trying to understand how often medical adhesive related skin injuries happen in NICU babies and what makes them more likely. Neonates have super fragile skin, so even something simple like tape can cause real damage. The researchers wanted to figure out what these injuries can look like, which babies are most at risk, and what factors (like TPN or certain devices) seem to make MARSI more common. Advantages and disadvantages of the recommendations: The recommendations in the article mostly focus on doing more frequent skin checks, using gentler adhesive removers, and being more careful with how tubes and devices are secured. The good part is that these changes could help catch skin problems earlier and prevent a lot of unnecessary injuries. They also make care more consistent, since everyone would be following the same steps instead of doing things differently.
The disadvantages: some of the suggestions could add extra work for nurses, especially during busy shifts. Using special adhesive removers or different products might cost more or require training, which isn’t always available for every unit. And because the study was only from one NICU, some places might not have the same resources or staffing to put all the recommendations into practice right away.
Q: Describe the method used by the author or the study. Researchers conducted a prospective observational study in which they implemented a Neonatal Skin Condition Scale (NSCS) to assess the overall skin condition of neonates, and a Three- item Severity (TIS) score to measure how significant any skin injuries were. Skin was assessed within 24hrs of admission to the NICU and then every day during routine nursing care until the neonate left the NICU. Further, researchers compared patient specific information and used statistical test to compare neonates who developed medical adhesive related skin injuries (MARSIs) versus those who did not. This helped them identify independent risk factors for MARSIs development. Q: Discuss the sample size used in the study. This observational study of neonates was conducted over a one-year period. It investigated neonates admitted to a Level III NICU in South Korea, for >48hrs. Researchers initially enrolled 172 neonates to be a part of the study. However, after exclusions the final sample size totaled to 129 neonates. The study concluded that MARSIs occurred in 51.9% of the included neonates, with the head and face being the most frequently affected areas, and total parenteral nutrition (TPN) identified to be a significant risk factor.
1: What are the advantages and disadvantages to the proposed recommendations in the article? A: The proposed recommendations include increasing skin assessments during NICU days 3-7, using gentle adhesive- removal techniques, and providing additional nurse education. An advantage of implementing these recommendations is the early identification and prevention of medical adhesive- related skin injuries, which may reduce pain, infection risk, and skin breakdown in neonates. A disadvantage is that more frequent assessments and documentation may increase nurses’ workload, particularly in a busy NICU. Additionally, implementing new protocols and silicone- based adhesives, and further research is needed to confirm their effectiveness.
2: Discuss the methods used by the authors of the study. A: The authors conducted a prospective observational study involving 129 neonates admitted to a Level III NICU at a university hospital in South Korea. Researchers performed daily skin assessments using the Neonatal Skin Conditioning Score to evaluate overall skin condition and the Three- Item Severity score to measure the severity of medical adhesive- related skin injuries (MARSI). Data were collected through direct observations, photographs, and medical records throughout hospitalization. Statistical analyses, including logistic regression, were used to compare neonates with and without MARSI and identity associated risk factors, such as total parenteral nutrition.
1. What are the advantages to the proposed recommendations in the article? The main problem in this study is medical adhesive-related skin injuries (MARSIs) in newborns receiving care in the neonatal intensive care unit (NICU). The researchers were concerned that premature and sick newborns have very fragile and immature skin. This will make them more vulnerable to skin damage when medical adhesives are applied or removed. The researchers wanted to find out how often these skin injuries happen, where they occur, how serious they are, and what factors may increase the risk of getting them. 2. Discuss the methods used by the authors of the study. The authors studied newborns in the NICU. They checked the babies skin for injuries caused by medical tape or adhesives. They recorded where the injuries happened and how serious they were. They also looked at treatments, such as TPN and tubes, to find out what increased the risk of skin injuries.
1, How does this research article compare to our practice, policy and/or procedure?
This research article relates to our practice because we also frequently use medical adhesives, such as tape and dressings, to secure medical devices. In this study, gastric tube fixation (28.4%) and endotracheal tube fixation (22.4%) were common causes of MARSI (Medical Adhesive-Related Skin Injuries). The study was conducted in a NICU, which is different from our patient population. Our unit has many older patients with fragile skin. Even though the patient population is different, this study reminds us to be careful when applying and removing medical adhesives and to closely assess the skin around medical devices. The study also found that patients receiving TPN had about 4.28 times higher odds of developing MARSI. This does not mean that TPN directly causes MARSI, but there was a significant association between TPN use and MARSI. Another important finding was that MARSI occurred most often during ICU days 4–7 (30.2%), followed by days 1–3 (22.4%). This suggests that the first week after admission is an important time for skin assessment and MARSI prevention in this NICU population. In our practice, we regularly assess patients’ skin and monitor areas around medical devices, tape, and dressings. This research supports our current practice of careful skin assessment and early prevention of skin injury. It also reminds us to pay closer attention during the first week of hospitalization, especially in patients with fragile skin and those who require frequent or long-term use of medical adhesives.
2, What are the advantages and disadvantages of implementing the article's recommendations on your unit and/or hospital?
One benefit of using the recommendations from this article in our unit is that it may help us prevent MARSI (Medical Adhesive-Related Skin Injuries) and identify skin damage earlier. The study found that MARSI occurred most often during the first week of hospitalization, especially on ICU days 4–7. Therefore, paying closer attention to the skin during the first week may help nurses recognize skin problems earlier. Another benefit is increasing awareness of skin injury caused by medical adhesives. Our unit frequently uses tape and dressings to secure medical devices, and many of our older patients have fragile skin. More careful assessment of the skin around medical devices may help prevent further skin damage. One disadvantage is that this study was conducted with neonates in a NICU, so the results may not apply directly to our adult population. Also, more frequent skin assessments may require additional nursing time and workload. The article also used specific tools, such as the NSCS (Neonatal Skin Condition Scores) and TIS (Three-Item Severity) score, which may require additional education and training before they can be used in our unit. Overall, the recommendations may improve skin assessment and MARSI prevention, but they would need to be adjusted to fit our patient population and current hospital practice.
1.What are the advantages and disadvantages of implementing the article's recommendations on your unit and/or hospital?
Using the recommendations from this study in our unit could give us a serious head start on preventing Medical Adhesive-Related Skin Injuries (MARSI) and catching skin breakdown early. The data shows that MARSI is most likely to pop up during a patient's first week in the hospital, spiking specifically between ICU days 4 and 7. Hyper-focusing our skin checks during that first-week window could help us flag problems before they get worse.
It is also a great opportunity to get our team talking about the damage medical adhesives can actually do. Our unit is constantly taping down lines and securing devices, and a lot of our older patients have highly fragile skin. Stepping up how carefully we inspect the skin right around those securement sites could prevent some serious, unnecessary skin tears.
The obvious catch is the population mismatch. This research was done on neonates in a NICU, so the findings might not translate perfectly to our adult patients. On top of that, adding more frequent skin checks means adding to everyone's workload and shift time. The researchers also relied on specialized tools like the Neonatal Skin Condition Score (NSCS) and the Three-Item Severity (TIS) score, meaning we would have to build out new staff training and education before we could even launch this in our unit.
The Bottom Line: These strategies could absolutely upgrade our skin protocols and cut down on MARSI, but we can't just copy and paste them; we will need to tweak the tools to fit an adult population and our actual workflow.
2. Discuss the methods used by the authors of the study.
The researchers focused their investigation on neonates admitted to the intensive care nursery. They closely monitored the infants to identify any epidermal breakdown linked directly to medical tapes or securement dressings. For every injury detected, the team documented the exact anatomical location and graded the overall severity. Additionally, they analyzed specific clinical interventions—including total parenteral nutrition (TPN) and the placement of various indwelling lines—to determine which factors significantly elevated the risk of skin damage.
Discuss the research question or main problem discussed in the study.
The study examines the incidence and risk factors for medical adhesive-related skin injuries (MARSI) in newborns admitted to the NICU. Neonates are especially vulnerable because their skin is thin and immature and they often require adhesives for medical devices. The study found that these injuries were common, particularly with gastric and endotracheal tube fixation.
What are the advantages and disadvantages of implementing the recommendations?
An advantage is that increased skin assessment and careful use of medical adhesives may help prevent skin injuries in NICU patients. These practices could reduce pain, infection risk, and complications associated with skin damage. A disadvantage is that implementation may require additional staff education, time, and resources to ensure consistent preventive care.
Discuss the research question or main problem discussed in the study.
The primary challenge in neonatal intensive care is the high vulnerability of neonates to medical adhesive-related skin injuries (MARSI). Despite this, there is a significant lack of data regarding the frequency and specific risk factors associated with these injuries. By identifying these critical risk factors—particularly for infants receiving total parenteral nutrition (TPN) and those requiring adhesive fixation near the head and face—nursing staff can implement more effective, targeted prevention strategies to improve patient safety.
Discuss the methods used by the authors of the study.
This prospective observational study, conducted at a Level III NICU in a South Korean university hospital, analyzed 129 neonates to assess the incidence and risk factors associated with medical adhesive-related skin injuries (MARSI). Researchers performed daily evaluations using the Neonatal Skin Conditioning Score and the Three-Item Severity score, utilizing direct observations, clinical photography, and medical record reviews.For every injury detected, the team documented the exact anatomical location and graded the overall severity. Statistical analysis, including logistic regression, was employed to compare cohorts and identify significant risk factors, such as the administration of total parenteral nutrition.
The study included 129 newborns admitted to the NICU. The researchers originally calculated that they needed at least 117 participants and planned for 129 in case some participants dropped out. The final sample still included 129 newborns, which gave the researchers enough participants for their planned analysis. Out of the 129 newborns, 67 developed a medical adhesive-related skin injury (MARSI) and 62 did not.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
One limitation is that the study was done in only one university hospital NICU, so the results may not apply to every NICU. Nurses may have also missed some skin injuries during busy periods, which could mean that the actual number of injuries was higher. The researchers also explained that the types of devices, adhesives, and how often they were reapplied were not completely standardized. Another limitation is that this was an observational study, so the researchers could find connections between risk factors and skin injuries, but they could not prove that one directly caused the other.
Discuss the sample size used in the study. To examine the prevalence of hospital adhesive-related skin injuries among patients in the neonatal intensive care unit (NICU), the study was carried out in the Level III NICU unit of the National University Hospital of Korea. This facility acts as a referral center for premature and high-risk infants with 20 beds. The research team calculated the required sample size and determined they would need a minimum of 117 participants, but due to a 10% attrition rate, the target goal was arranged to be 129. During the study period from September 1, 2023 to August 11, 2024, 172 neonates resided in the NICU but after going through the eligiblity criteria and consent to participate, the final sample size was 129 neonates.
Describe the method used by the author of the study The research conducted at the National University Hospital of Korea was a prospective observational study in a 20 bed NICU. At the time of the study, there were 172 neonates admitted. In order to study the incidence of medical adhesive-related skin injuries (MARSIs) among this patient population to learn more about prevention, treatment, and risk factors, the neonatal skin condition score required daily skin assessments from the nurses using the neonatal skin condition scale while any MARSIs discovered would then be assessed using the Three Item Severity score. The skin would be scored with 3 categories such as dryness, erythema, and skin breakdown and/or excoriation with a total score of 9 (the highest indicating the infant has worsening skin). To shed more light on MARSIs, the team also investigated common sites of skin injuries among the neonates and as such adopted the "Rule of Nines."
Discuss the research question or main problem discussed in the study. Patients in the NICU need tape and adhesives to keep things like feeding tubes, ET tubes, and ECG leads in place. Their skin is more thin and fragile than an adults, so it can be irritated and damaged easily. There is not much research on how often adhesive injuries happen in newborns, or who is most at risk. The researchers wanted to find out how common medical adhesive related skin injury (MARSI) occurred, locations of occurrence, what caused increased risk, and how severe they were. They found that half of the babies developed one, with the most common being on the face from tube fixation, with TPN having the highest risk of occurrence.
What are the advantages and disadvantages to the proposed recommendations in the article? The article recommends checking the skin more often during days 3 to 7 of admission to NICU. They also recommend using adhesive removers and gentle removal techniques. It is highlighted to keep a close eye on babies on TPN and to provide more education to nurses on preventing MARSIs. One advantage is that the recommendations suggest focusing on the days and patients with the highest risk. A disadvantage is that more frequent skin checks, new products, and staff training will require additional time which may be difficult to complete on a busy unit.
The study included 129 neonates admitted to a neonatal intensive care unit. The sample consisted of infants who were monitored for medical adhesive-related skin injuries. This sample allowed the researchers to examine factors associated with these injuries.
Describe the method used by the author of the study
The authors used a prospective observational study design. They monitored the neonates for medical adhesive-related skin injuries and recorded relevant clinical information. The researchers then analyzed the data to identify risk factors associated with these injuries.
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.
1. What are the main findings of the study?
ReplyDeleteThe study found that medical adhesive-related skin injuries were very common in newborns in the NICU. About 51.9% of the newborns developed this type of skin injury. The head and face were the areas most often affected, mainly because of adhesives used to secure gastric and endotracheal tubes. The study also found that newborns receiving total parenteral nutrition (TPN) had a higher risk of developing these injuries. Overall, the findings show that NICU patients need careful and frequent skin assessments.
2. How can the findings of this study be applied to patient care?
These findings can help NICU nurses identify babies who may be at higher risk for skin injuries from medical adhesives. Nurses should closely monitor areas where tubes, tape, and other adhesive devices are attached, especially around the head and face. Extra attention should also be given to babies receiving TPN because the study found they had a higher risk. Using gentle adhesive removal techniques and checking the skin regularly may help prevent injuries. Early identification can allow nurses to make changes before the skin damage becomes more serious.
This comment has been removed by the author.
Delete1). Discuss the research question or main problem discussed in the study.
ReplyDeleteThe main problem is this study is neonates in the neonatal intensive care unit (NICU) frequently require medical adhesives for device fixation; yet, their immature skin makes them vulnerable to medical adhesive-related skin injuries. Research on the incidence of medical adhesive-related skin injuries and clinical risk factors in this population is very limited. The research question is to investigate the incidence, characteristics, and clinical risk factors of medical adhesive-related skin injuries in neonates admitted to the NICU. According to this study, medical adhesive-related skin injury is defined as a skin integrity disorder caused by the use of adhesives that persists for greater than 30 minutes after tape removal and presents as erythema, blisters, erosion, vesicles, or tears. The study states that the skin of neonates is 20% to 30% thinner than skin of adults, leading to increased moisture loss, compromised barrier function, and more prone to skin damage.
2). Discuss the sample size used in the study.
The study was conducted from September 1, 2023 to August 11, 2024, in the Level III NICU of the National University Hospital in Korea. This hospital has a 20 bed capacity and serves as a referral center for premature and high-risk newborns, with an average annual admission of approximately 280 infants. During the study period, 172 infants were admitted to the NICU. After all was said and done, the exclusion criteria ended up resulting in a final sample of 129 neonates.
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. Neonates have immature, fragile skin, yet they frequently require adhesives to secure medical devices such as gastric and endotracheal tubes. It was significant because the study found that 51.9% of the 129 neonates developed MARSI. 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 to the proposed recommendation were, 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, and they are consistent with evidence-based neonatal care. Disadvantages were, additional nursing workload, additional costs, not all prevention strategies are appropriate for every neonate. Also, it requires staff education and consistency and the study’s sample does not prove that the recommended strategies will prevent MARSI.
1. Discuss the research question or main problem discussed in the study.
ReplyDelete- The study's main problem is medical adhesive-related skin injury (MARSI) in NICU patients. Because premature and critically ill newborns have fragile, immature skin and frequently require adhesive medical devices, they are particularly vulnerable to skin damage. The research focuses on determining how often MARSI occurs in newborn patients, where and how the injuries occur, and what factors increase the risk of developing MARSI. The goal is to better identify at-risk infants and help nurses and other healthcare professionals develop strategies to prevent adhesive-related skin injuries.
2. Discuss the limitations in the article: limited sample size, design flaws, and/or author bias.
- One limitation of this study is the relatively small sample size of 129 neonates and that the research was conducted in only one university hospital NICU. This limits how well the findings can be generalized to other NICUs with different patient populations, adhesive products, or nursing practices. In addition, the study used a prospective observational design, so it can identify associations between risk factors and MARSI, but cannot prove that a specific factor caused the injury. For example, TPN was identified as a significant risk factor, but infants receiving TPN may also be more critically ill and require more devices and adhesives. There is also potential for observer bias when assessing and grading skin injuries, although the researchers used standardized skin assessment tools to help reduce this. The authors reported no conflicts of interest, so there is no clear evidence of significant author bias. Overall, larger multicenter studies would help confirm the findings and make them more applicable to a broader NICU population.
1. Discuss the research question or main problem discussed in the study.
ReplyDeleteThe main problem discussed in the study is medical adhesive-related skin injuries (MARSI) in newborns admitted to the neonatal intensive care unit (NICU). Medical adhesives are commonly needed to secure devices such as gastric tubes, endotracheal tubes, and other lines. Still, a newborn’s skin is very thin and sensitive, making it more likely to become damaged. The researchers wanted to find out how often these skin injuries occur, where they commonly develop, how severe they are, and what factors increase the risk.
The study also focused on identifying clinical factors that could help nurses recognize babies who are at higher risk for MARSI. By understanding these risks, nurses can provide better skin care and take preventive measures before an injury develops.
2. Discuss the sample size used in the study.
The study included 129 newborns who were admitted to the NICU. The researchers originally determined that they needed at least 117 participants, but they increased the number to 129 in case some participants dropped out. A total of 172 babies were considered for the study, but some were excluded because they did not meet the requirements or their parents did not agree to participate. In the end, 129 newborns were included, giving the researchers a sufficient sample size to analyze the results.
1. Describe the method used by the author of the study.
ReplyDeleteThe method used in this article was an observational study conducted in the neonatal ICU unit at a university hospital. The study was conducted on 129 admitted NICU patients. The neonatal condition scale was used to assess the overall skin condition. However, the severity of medical adhesive related skin injuries (MARSI) was assessed using the Three-Item severity score.
2. What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
This study found that the most common causes of MARSI were gastric and endotracheal tube fixation, and the use of TPN was a significant risk factor. Recommendations by the study were that nursing strategies used to reduce MARSI should be prioritized to prevent patient harm. In my opinion, this aligns with the policy and procedures of my unit because in the ICU we have several policy and procedures that we follow to prevent patient harm related to skin injury from medical equipment including adhesives to hold tubes and lines. For example, we have holders for ET tubes that we assess daily and collaborate in that care with respiratory therapists. We check the check around the holder for skin breakdown. We have also recently changed the holder for NG tubes to prevent skin breakdown and therefore reducing the incidence of harm. I do not see any disadvantages to implementing anything from this study to my hospital, however, I do not work in NICU and am not familiar with their unit specific policies.
1. Discuss the sample size used in the study?
ReplyDeleteThe study was conducted from September 1, 2023 to August 11, 2024 in the level III NICU of the National University Hospital in Korea. The hospital has a 20 bed capacity. The NICU was staffed by 3 qualified neonatal intensive and a clinical nurse specialists. 30 nurses were employed to staff the 20 bed unit.
Neonates admitted to the NICU for > 48 hours were included. Neonates with MARSI at the time of admission and patients more than 24 hours had passed since birth were excluded from the data collection.
The required sample size was calculated using G*Power 3,1, 9, 7. G*Power is a software program used by researchers to calculate statistical power and determine sample size for studies. 172 infants were admitted to NICU but 129 neonates are the final samples size that meet the eligibility criteria.
2. Discuss the method used by the author of the study?
A prospective observational study was conducted in a university hospital NICU. Data were collected between September 18, 2023 until August 14, 2024. The participants was hospitalized until discharge. Data were collected through direct observations and medical records.
The overall skin condition was evaluated using the NEONATAL SKIN CONDITION SCALE, whereas the severity of MARSI was assessed using the THREE ITEM SEVERITY SCORE. The NEONATAL SKIN CONDITION SCALE is used to assess overall skin condition of the neonates which comprise of 3 categories: dryness, erythema and breakdown excoriation. The scoring is 1-3 points for each category totaling 9 points, with the highest score indicating poorer condition. Assessment is done at 3-day intervals.
The Three Item Severity (TIS) score is a scale used to assess the severity of dematitis and MARSI. The TIS score evaluates erythema, edema, and excoriation. Each category was measured on a scale of 0 to 3, where 0 indicates none; 1 (mild); 2 (moderate) and 3 (severe). Two investigators examined the overall condition of the neonates using the NCSC, TIS score and direct observation.
1. Discuss the research question or main problem discussed in the study.
ReplyDeleteThis study focused on skin injuries caused by medical adhesives in babies in the NICU. Newborn babies have very sensitive skin, and they often need tape or other adhesives to keep medical devices in place. The researchers wanted to see how often these skin injuries happened and what could increase the risk. They found that these injuries were common, especially in babies who were receiving TPN.
2. Discuss the sample size used in the study.
The study included 129 babies who were admitted to the NICU. The researchers followed these babies and checked their skin for injuries caused by medical adhesives. During the study, 67 babies developed a skin injury, while 62 did not. This gave the researchers two groups to compare and helped them identify possible risk factors for these injuries.
Discuss the research question or main problem discussed in the study?
ReplyDeleteThere are many reasons for NICU admissions and when a neonate is in the NICU there are many monitoring devices that need to be secured to the neonate for the purpose of stabling the patient. With the medical devices that are used to monitor and stabilize the neonates are at risk of developing medical adhesive related skin injuries, which is defined in the article as a skin integrity disorder caused using adhesive that persists after tape removal. Neonates have sensitive skin that require gentle care, the study states that with the use of the monitoring devices, there are skin barriers used to protect the neonates’ skin. These barriers include silicone and hydrocolloid-based barriers. However, even with the use of these skin protectants, neonates still developed MARSI.
Discuss the sample size used in the study.
The setting used for this study was the NICU department at the National University Hospital in Korea from September 1, 2023 to August 11, 2024. The total number of neonates that were included in this study was 129. Most of the neonates had respiratory problems, a total of 67 patients developed MARIs and 62 did not. The risk factors identified as causing the MARSI were gastric and endotracheal tube fixation. Although 129 neonates is a good number of participants, the sample size is small and due to this being an observation study that was only done in one hospital, the identification of TPN as in independent risk factor for MARSI cannot be identified reliably as a direct cause.
1. Describe the method used by the author of the study.
ReplyDeleteThe study used a prospective observational design conducted in a Level III neonatal intensive care unit (NICU) at a university hospital. The researchers followed 129 neonates during their hospitalization and assessed their overall skin condition using the Neonatal Skin Condition Score (NSCS). The severity of medical adhesive-related skin injuries (MARSI) was assessed using the Three-Item Severity (TIS) score. The researchers also collected clinical information to identify factors associated with the development of MARSI.
2. Discuss the limitations of the article; limited sample size, design flaws, and/or author bias.
One limitation of the study was the relatively small sample of 129 neonates from only one university hospital NICU, which limits how well the findings can be generalized to other NICUs. The prospective observational design could identify relationships between risk factors and MARSI but could not prove that a specific factor, such as TPN, directly caused the skin injury. There was also potential for observer or reporting bias when researchers and nurses assessed and documented skin injuries, although standardized assessment tools were used to reduce this risk. The authors reported no conflicts of interest, so there was no clear evidence of significant author bias.
Discuss the limitations of the article: Limited sample size, design flaws, and or author bias
ReplyDeleteOne limitation of this study was sample size. The study included only 129 neonates from one level three NICU at a university hospital in Korea. Because of this, the study limits the data and results to a certain population. Another limitation of the study included variability within the study itself, including differences in adhesives, application technique and frequency of adhesive changes. Because the investigators of the study itself performed the majority of the skin assessments this left room for potential author bias. Although the investigators were also doing the assessments, they attempted to adequately train the investigators to help reduce possible issues in data and results.
Describe the method used by the author of the study?
The research was obtained using a prospective observational study to assess and evaluate the incidence of medical adhesive related skin injuries and potential risk factors. The data collected was done from September 2023 to August 2024 at one designated NICU located in Korea. The data was collected by investigators performing daily skin assessments in patients admitted to the NICU being studied. Not only was research collected from observation and physical assessment, but also through clinical information received from medical records. Data collected was evaluated using such tests as t tests, Fisher’s exact tests and ANOVA.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
ReplyDeleteThere were many limitations from the article. The study was conducted in the NICU of a university hospital so data will be limited only to this one NICU. MARSIs (medical adhesive related skin injury) were asked to be monitored at documented at certain times by nurses, but when the NICU was busy, assessments might have not been able to be done at consistently at the same times. infants in this study were also not extremely premature which can limit the study because the extremely premature are at much greater risk of skin injury.
Discuss the research question or main problem discussed in the study?
The main problem discussed in this study is neonates admitted to the NICU frequently need medical device securements such as ekg electrodes, endotracheal tubes, and nasogastric tubes, which can cause MARSIs due to their immature skin. A MARSI is defined as damage to skin integrity due to the use of adhesives that persists for greater than 30 minutes after removing tape that causes erythema, blisters, erosion, or tears. There are medical adhesives that are used to protect the skin, however due to the neonates delicate skin, there is still the risk of infections, prolonged hospital stays, increased medical costs, and pain/discomfort to the patient.
1. Describe the method used by the author of the study
ReplyDeleteThe authors of the article utilized a prospective observational study for their look at how medical adhesives cause skin injuries in patients in the NICU, also known as MARSI (Medical Adhesive-Related Skin Injuries). Their sample size was 129 neonates at a level III NICU at a hospital in Korea. The study used 2 measurement tools: 1) the Neonate Skin Condition Score (NSCS), which looks at three categories: skin dryness, erythema and breakdown or excoriation and 2) the Three Item Severity (TIS) score which looks at dermatitis severity.
2. Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
There are some limitations to this study. Perhaps the largest limitation was sample size: only 129 neonates were studied, at one hospital over a three-week period. It was determined that 51.9% of the babies in this study developed a MARSI. A wider, longer, more comprehensive study might give a more realistic result. Of note, incidences at other hospitals in other similar studies had significantly lower and higher rates, ranging from 19.5% to 58.3%. The authors touch on possible reasons for the variance, one being data collection methods. To get a truer number, a future study might look at casting a wider net.
David Kahn 5south
ReplyDeleteResearch Question or main study problem:
The study is basically trying to understand how often medical adhesive related skin injuries happen in NICU babies and what makes them more likely. Neonates have super fragile skin, so even something simple like tape can cause real damage. The researchers wanted to figure out what these injuries can look like, which babies are most at risk, and what factors (like TPN or certain devices) seem to make MARSI more common.
Advantages and disadvantages of the recommendations:
The recommendations in the article mostly focus on doing more frequent skin checks, using gentler adhesive removers, and being more careful with how tubes and devices are secured. The good part is that these changes could help catch skin problems earlier and prevent a lot of unnecessary injuries. They also make care more consistent, since everyone would be following the same steps instead of doing things differently.
The disadvantages: some of the suggestions could add extra work for nurses, especially during busy shifts. Using special adhesive removers or different products might cost more or require training, which isn’t always available for every unit. And because the study was only from one NICU, some places might not have the same resources or staffing to put all the recommendations into practice right away.
Q: Describe the method used by the author or the study.
ReplyDeleteResearchers conducted a prospective observational study in which they implemented a Neonatal Skin Condition Scale (NSCS) to assess the overall skin condition of neonates, and a Three- item Severity (TIS) score to measure how significant any skin injuries were. Skin was assessed within 24hrs of admission to the NICU and then every day during routine nursing care until the neonate left the NICU. Further, researchers compared patient specific information and used statistical test to compare neonates who developed medical adhesive related skin injuries (MARSIs) versus those who did not. This helped them identify independent risk factors for MARSIs development.
Q: Discuss the sample size used in the study.
This observational study of neonates was conducted over a one-year period. It investigated neonates admitted to a Level III NICU in South Korea, for >48hrs. Researchers initially enrolled 172 neonates to be a part of the study. However, after exclusions the final sample size totaled to 129 neonates. The study concluded that MARSIs occurred in 51.9% of the included neonates, with the head and face being the most frequently affected areas, and total parenteral nutrition (TPN) identified to be a significant risk factor.
1: What are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteA: The proposed recommendations include increasing skin assessments during NICU days 3-7, using gentle adhesive- removal techniques, and providing additional nurse education. An advantage of implementing these recommendations is the early identification and prevention of medical adhesive- related skin injuries, which may reduce pain, infection risk, and skin breakdown in neonates. A disadvantage is that more frequent assessments and documentation may increase nurses’ workload, particularly in a busy NICU. Additionally, implementing new protocols and silicone- based adhesives, and further research is needed to confirm their effectiveness.
2: Discuss the methods used by the authors of the study.
A: The authors conducted a prospective observational study involving 129 neonates admitted to a Level III NICU at a university hospital in South Korea. Researchers performed daily skin assessments using the Neonatal Skin Conditioning Score to evaluate overall skin condition and the Three- Item Severity score to measure the severity of medical adhesive- related skin injuries (MARSI). Data were collected through direct observations, photographs, and medical records throughout hospitalization. Statistical analyses, including logistic regression, were used to compare neonates with and without MARSI and identity associated risk factors, such as total parenteral nutrition.
1. What are the advantages to the proposed recommendations in the article?
ReplyDeleteThe main problem in this study is medical adhesive-related skin injuries (MARSIs) in newborns receiving care in the neonatal intensive care unit (NICU). The researchers were concerned that premature and sick newborns have very fragile and immature skin. This will make them more vulnerable to skin damage when medical adhesives are applied or removed. The researchers wanted to find out how often these skin injuries happen, where they occur, how serious they are, and what factors may increase the risk of getting them.
2. Discuss the methods used by the authors of the study.
The authors studied newborns in the NICU. They checked the babies skin for injuries caused by medical tape or adhesives. They recorded where the injuries happened and how serious they were.
They also looked at treatments, such as TPN and tubes, to find out what increased the risk of skin injuries.
1, How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThis research article relates to our practice because we also frequently use medical adhesives, such as tape and dressings, to secure medical devices. In this study, gastric tube fixation (28.4%) and endotracheal tube fixation (22.4%) were common causes of MARSI (Medical Adhesive-Related Skin Injuries). The study was conducted in a NICU, which is different from our patient population. Our unit has many older patients with fragile skin. Even though the patient population is different, this study reminds us to be careful when applying and removing medical adhesives and to closely assess the skin around medical devices. The study also found that patients receiving TPN had about 4.28 times higher odds of developing MARSI. This does not mean that TPN directly causes MARSI, but there was a significant association between TPN use and MARSI.
Another important finding was that MARSI occurred most often during ICU days 4–7 (30.2%), followed by days 1–3 (22.4%). This suggests that the first week after admission is an important time for skin assessment and MARSI prevention in this NICU population. In our practice, we regularly assess patients’ skin and monitor areas around medical devices, tape, and dressings. This research supports our current practice of careful skin assessment and early prevention of skin injury. It also reminds us to pay closer attention during the first week of hospitalization, especially in patients with fragile skin and those who require frequent or long-term use of medical adhesives.
2, What are the advantages and disadvantages of implementing the article's recommendations on your unit and/or hospital?
One benefit of using the recommendations from this article in our unit is that it may help us prevent MARSI (Medical Adhesive-Related Skin Injuries) and identify skin damage earlier. The study found that MARSI occurred most often during the first week of hospitalization, especially on ICU days 4–7. Therefore, paying closer attention to the skin during the first week may help nurses recognize skin problems earlier.
Another benefit is increasing awareness of skin injury caused by medical adhesives. Our unit frequently uses tape and dressings to secure medical devices, and many of our older patients have fragile skin. More careful assessment of the skin around medical devices may help prevent further skin damage.
One disadvantage is that this study was conducted with neonates in a NICU, so the results may not apply directly to our adult population. Also, more frequent skin assessments may require additional nursing time and workload. The article also used specific tools, such as the NSCS (Neonatal Skin Condition Scores) and TIS (Three-Item Severity) score, which may require additional education and training before they can be used in our unit.
Overall, the recommendations may improve skin assessment and MARSI prevention, but they would need to be adjusted to fit our patient population and current hospital practice.
1.What are the advantages and disadvantages of implementing the article's recommendations on your unit and/or hospital?
ReplyDeleteUsing the recommendations from this study in our unit could give us a serious head start on preventing Medical Adhesive-Related Skin Injuries (MARSI) and catching skin breakdown early. The data shows that MARSI is most likely to pop up during a patient's first week in the hospital, spiking specifically between ICU days 4 and 7. Hyper-focusing our skin checks during that first-week window could help us flag problems before they get worse.
It is also a great opportunity to get our team talking about the damage medical adhesives can actually do. Our unit is constantly taping down lines and securing devices, and a lot of our older patients have highly fragile skin. Stepping up how carefully we inspect the skin right around those securement sites could prevent some serious, unnecessary skin tears.
The obvious catch is the population mismatch. This research was done on neonates in a NICU, so the findings might not translate perfectly to our adult patients. On top of that, adding more frequent skin checks means adding to everyone's workload and shift time. The researchers also relied on specialized tools like the Neonatal Skin Condition Score (NSCS) and the Three-Item Severity (TIS) score, meaning we would have to build out new staff training and education before we could even launch this in our unit.
The Bottom Line: These strategies could absolutely upgrade our skin protocols and cut down on MARSI, but we can't just copy and paste them; we will need to tweak the tools to fit an adult population and our actual workflow.
2. Discuss the methods used by the authors of the study.
The researchers focused their investigation on neonates admitted to the intensive care nursery. They closely monitored the infants to identify any epidermal breakdown linked directly to medical tapes or securement dressings. For every injury detected, the team documented the exact anatomical location and graded the overall severity. Additionally, they analyzed specific clinical interventions—including total parenteral nutrition (TPN) and the placement of various indwelling lines—to determine which factors significantly elevated the risk of skin damage.
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ReplyDeleteDiscuss the research question or main problem discussed in the study.
DeleteThe study examines the incidence and risk factors for medical adhesive-related skin injuries (MARSI) in newborns admitted to the NICU. Neonates are especially vulnerable because their skin is thin and immature and they often require adhesives for medical devices. The study found that these injuries were common, particularly with gastric and endotracheal tube fixation.
What are the advantages and disadvantages of implementing the recommendations?
An advantage is that increased skin assessment and careful use of medical adhesives may help prevent skin injuries in NICU patients. These practices could reduce pain, infection risk, and complications associated with skin damage. A disadvantage is that implementation may require additional staff education, time, and resources to ensure consistent preventive care.
Discuss the research question or main problem discussed in the study.
ReplyDeleteThe primary challenge in neonatal intensive care is the high vulnerability of neonates to medical adhesive-related skin injuries (MARSI). Despite this, there is a significant lack of data regarding the frequency and specific risk factors associated with these injuries. By identifying these critical risk factors—particularly for infants receiving total parenteral nutrition (TPN) and those requiring adhesive fixation near the head and face—nursing staff can implement more effective, targeted prevention strategies to improve patient safety.
Discuss the methods used by the authors of the study.
This prospective observational study, conducted at a Level III NICU in a South Korean university hospital, analyzed 129 neonates to assess the incidence and risk factors associated with medical adhesive-related skin injuries (MARSI). Researchers performed daily evaluations using the Neonatal Skin Conditioning Score and the Three-Item Severity score, utilizing direct observations, clinical photography, and medical record reviews.For every injury detected, the team documented the exact anatomical location and graded the overall severity. Statistical analysis, including logistic regression, was employed to compare cohorts and identify significant risk factors, such as the administration of total parenteral nutrition.
Discuss the sample size used in the study.
ReplyDeleteThe study included 129 newborns admitted to the NICU. The researchers originally calculated that they needed at least 117 participants and planned for 129 in case some participants dropped out. The final sample still included 129 newborns, which gave the researchers enough participants for their planned analysis. Out of the 129 newborns, 67 developed a medical adhesive-related skin injury (MARSI) and 62 did not.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
One limitation is that the study was done in only one university hospital NICU, so the results may not apply to every NICU. Nurses may have also missed some skin injuries during busy periods, which could mean that the actual number of injuries was higher. The researchers also explained that the types of devices, adhesives, and how often they were reapplied were not completely standardized. Another limitation is that this was an observational study, so the researchers could find connections between risk factors and skin injuries, but they could not prove that one directly caused the other.
Discuss the sample size used in the study.
ReplyDeleteTo examine the prevalence of hospital adhesive-related skin injuries among patients in the neonatal intensive care unit (NICU), the study was carried out in the Level III NICU unit of the National University Hospital of Korea. This facility acts as a referral center for premature and high-risk infants with 20 beds. The research team calculated the required sample size and determined they would need a minimum of 117 participants, but due to a 10% attrition rate, the target goal was arranged to be 129. During the study period from September 1, 2023 to August 11, 2024, 172 neonates resided in the NICU but after going through the eligiblity criteria and consent to participate, the final sample size was 129 neonates.
Describe the method used by the author of the study
The research conducted at the National University Hospital of Korea was a prospective observational study in a 20 bed NICU. At the time of the study, there were 172 neonates admitted. In order to study the incidence of medical adhesive-related skin injuries (MARSIs) among this patient population to learn more about prevention, treatment, and risk factors, the neonatal skin condition score required daily skin assessments from the nurses using the neonatal skin condition scale while any MARSIs discovered would then be assessed using the Three Item Severity score. The skin would be scored with 3 categories such as dryness, erythema, and skin breakdown and/or excoriation with a total score of 9 (the highest indicating the infant has worsening skin). To shed more light on MARSIs, the team also investigated common sites of skin injuries among the neonates and as such adopted the "Rule of Nines."
Discuss the research question or main problem discussed in the study.
ReplyDeletePatients in the NICU need tape and adhesives to keep things like feeding tubes, ET tubes, and ECG leads in place. Their skin is more thin and fragile than an adults, so it can be irritated and damaged easily. There is not much research on how often adhesive injuries happen in newborns, or who is most at risk. The researchers wanted to find out how common medical adhesive related skin injury (MARSI) occurred, locations of occurrence, what caused increased risk, and how severe they were. They found that half of the babies developed one, with the most common being on the face from tube fixation, with TPN having the highest risk of occurrence.
What are the advantages and disadvantages to the proposed recommendations in the article?
The article recommends checking the skin more often during days 3 to 7 of admission to NICU. They also recommend using adhesive removers and gentle removal techniques. It is highlighted to keep a close eye on babies on TPN and to provide more education to nurses on preventing MARSIs. One advantage is that the recommendations suggest focusing on the days and patients with the highest risk. A disadvantage is that more frequent skin checks, new products, and staff training will require additional time which may be difficult to complete on a busy unit.
Discuss the sample size used in the study.
ReplyDeleteThe study included 129 neonates admitted to a neonatal intensive care unit. The sample consisted of infants who were monitored for medical adhesive-related skin injuries. This sample allowed the researchers to examine factors associated with these injuries.
Describe the method used by the author of the study
The authors used a prospective observational study design. They monitored the neonates for medical adhesive-related skin injuries and recorded relevant clinical information. The researchers then analyzed the data to identify risk factors associated with these injuries.