Skin injury related to medical adhesive usage is a prevalent but unrecognized complication that occurs across a wide variety of care settings and has a significant impact on patient safety. Certain patient populations, including orthopaedic patients, are at increased risk for adhesive-related skin injury.
In December 2012, I was privileged to represent NAON at a Medical Adhesive Summit sponsored by a grant from 3M to look at adhesive skin-related injuries and their prevention. A total of 20 panelists from a variety of areas were present at the summit. Specialties represented included critical care; dermatology; electrophysiology geriatrics; infection control; infusion therapy; neonatology; oncology; orthopaedics; pediatrics; perioperative; physical therapy, plastics; research; and wound, ostomy and continence.
During the 2-day summit, we specifically looked at areas related to:
* Increasing awareness of skin damage caused by medical adhesives
* Identifying knowledge gaps regarding medical adhesives and skin safety
* Documenting the spectrum of care settings and medical applications where such skin damage occurs
* Best practices for prevention of skin damage caused by medical adhesives
* Research priorities for development of new adhesive technologies and protocols for skin protection
* Infection control practices related to medical adhesives and cost associated with medical adhesive-related injuries
We know that skin injuries related to dressings have been a concern for orthopaedic nurses, as evidenced by the number of articles that have been published in the Orthopaedic Nursing Journal (ONJ) related to the subject. Our presummit reading list included numerous articles regarding tape blisters and other tape-related issues from both the ONJ and the Journal of Bone and Joint Surgery. We may no longer do the large compression dressings covered in elastic adhesive bandages and secured with benzoin on total hip patients that were common when I began in orthopaedics, but clearly safely securing dressings on the orthopaedic patients can still be problematic.
In our discussions at the summit, we looked at the properties and function of medical adhesives, as well as the patient physiological responses to these adhesives. Specific patient populations, including orthopaedics, were identified as being at higher risk for skin-related injury. Specific concerns for orthopaedic patients include the changes in the skin due to edema and joint movement under dressings (such as postoperative total joints), and the role of skin tension (Langer's lines) and the effects of medical adhesives when applied with or across/against these lines. Orthopaedic patients can also be in other at-risk categories, such as the elderly and pediatrics, which each have their own specific issues.
Also addressed were the proper application and removal of medical adhesives, which was an eye opener to me. I have to admit; I have been removing transparent film dressings incorrectly, inadvertently exposing my patients' skin to injury. When attempting to remove transparent dressings, rather than pull straight up, you lift a corner of the dressing and pull horizontally to the skin, and the adhesive will release, much like temporary wall hangers. I also found myself thinking about the issue when I was removing all the small stickers from my elderly mother's skin after her last electrocardiogram, and noticing how they well adhered and how hard they were to take off without pulling her skin.
The Medical Adhesive Safety Summit produced a consensus document, and I'm pleased that within the document are several consensus statements that directly relate to orthopaedic patients. In addition are statements regarding assessment and selection and removal for all medical adhesives. The intent of the following article is to give nurses another tool to enable them to provide the best care for their patients, while protecting them from injury. I'm very pleased that ONJ is able to reprint this article, giving orthopaedic nurses access to evidence-based information to improve their practice.