“Although evidence is lacking, clinical experience suggests that MASD (moisture-associated skin damage) requires more than moisture alone,” researchers from the University of Virginia’s Department of Urology comment.

Damage might be attributable to multiple factors, they point out, including:

  • chemical irritants within the moisture source
  • the PH of the moisture source
  • mechanical factors such as friction
  • associated microorganisms

To prevent MASD, the authors caution, “Clinicians need to be vigilant both in maintaining optimal skin conditions and in diagnosing and treating minor cases of MASD prior to progression and skin breakdown.”

NPUAP stage 2 pressure ulcerMASD can be caused by prolonged exposure to various sources of moisture, such as:

  • urine
  • stool
  • perspiration
  • wound exudates
  • mucus
  • saliva

A surgical patient may also have exposure to moisture from prep solutions or irrigation fluids, which, along with friction, can contribute to MASD.

Initially, as Kim Haines of medline.com points out, skin injuries like MASD were not recognized as developing in the perioperative setting, “since patients were only in our care for a short period of time.” However, Haines explains, evidence suggests that the perioperative setting involves multiple opportunities for MASD injuries to occur.

In fact, as we at Action Products are so uniquely aware, the perioperative setting poses an especially high risk of MASD. Management of Moisture-Associated Skin Damage: A Scoping Review clearly states: Wet skin has a high coefficient of friction, making it susceptible to friction and shear damage.” 

Action® reusable pads and positioners, designed to offer optimum pressure relief and shear reduction in the operating room, are also conducive to MASD prevention in that they are all non-allergenic and non-supportive of bacterial growth.

“Changes in Medicare reimbursement associated with hospital-acquired conditions are also forcing perioperative nurses into taking a proactive role in developing preventative measures… including the prevention of skin-related injuries,” Kim Haines observes.

But the issue of MASD is not a simple one, as Rebecca McKenzie and Candace Ramirez note in American Nurse Today. There are many possible contributing factors, and many are intrinsic:

Factors contributing to MASD may include co-morbidities such as diabetes, peripheral vascular disease, obesity, poor nutritional status, cancer, fractures, infection, and neurologic disease in addition to possible extrinsic causes such as instrumentation, anesthetic agents, and medications. 

Pre and perioperative vigilance on the part of nurses is critical since hospital-acquired injuries are detrimental to patients’ health while negatively impacting the hospital’s bottom line. It may take more than moisture to create a MASD, and it will take a concerted team effort to prevent one!