There was a time when skin injuries were not recognized as developing in the perioperative setting, given the relatively abbreviated period of time patients spent in the O.R. Yet the perioperative setting involves multiple opportunities for injuries to occur.  In fact, MASDs, or moisture-associated skin damage is only one of a trio of skin injuries that you might not expect to occur in the operating room. 

MARSI, medical adhesive-related skin injury, is “an occurrence in which erythema or cutaneous abnormalities form, such as vesicles, bulla, skin erosion, or in which tear persists thirty minutes or more after an adhesive is removed. MARSIs can:

  • cause pain
  • increase the risk of infection
  • increase wound size
  • delay healing
  • enflame hair follicles

In fact, as we at Action Products are so uniquely aware, when MARSI causes maceration (the skin appears white or gray in color and becomes wrinkled), that skin then becomes susceptible to damage from friction. Action® reusable pads and positioners are therefore designed to offer optimum friction prevention and shear reduction in the operating room.

Yet another condition that must be prevented is skin tear or skin shear. This was defined by the International Skin Tear Advisory Panel as “a wound caused by shear, friction, or blunt force resulting in the separation of skin layers.” There are two degrees of skin tear:

  1. partial thickness – the epidermis separates from the dermis
  2. full thickness – both the epidermis and dermis separate from the underlying structures

“Friction and shear are mechanical forces contributing to pressure ulcer formation,” Cathy Thomas Hess, BSN, RN explains in Skin & Wound Care. Shear injury will not be seen at the skin level; friction injury will be visible. Shear and friction go hand in hand – one rarely occurs without the other, Hess adds. The three mechanical forces of pressure, friction, and shear may act in concert to create skin damage. 

“The National Pressure Ulcer Advisory Panel pressure injury definition states that the ability of soft tissue to tolerate shear and pressure may also be affected by the factors of microclimate, nutrition, perfusion, co-morbidities, and condition of the soft tissue.” 

At Action Products, skin injury prevention in the O.R. is our stock in trade.  We know that hospital-acquired injuries, including MASD, MARSI and skin shear, are not only detrimental to patients’ health but negatively impact the hospital’s bottom line.