. 2022 Nov 13;19(2):139–157. doi: 10.1007/s12519-022-00625-2

Table 1.

Relationship between skin care practices and skin injuries from binary univariate and multivariable logistic regression

Practices or variables	Yes/no	Occurrence of injuries		Univariate, OR (95% CI)	P	Multivariable, aOR (95% CI)	P
Practices or variables	Yes/no	Uncommon (rare/seldom), n (%)	Common (often/almost always/always), n (%)	Univariate, OR (95% CI)	P	Multivariable, aOR (95% CI)	P
MARSI
Local skin care guideline available	No	117 (53)	104 (47)	0.58 (0.42–0.80)	0.001	0.63 (0.45–0.88)	0.008
Local skin care guideline available	Yes	378 (66)	197 (34)	0.58 (0.42–0.80)	0.001	0.63 (0.45–0.88)	0.008
Tapes used for securing tubes to the skin
Transparent film dressing	No	323 (62)	199 (38)	0.99 (0.74–1.32)	0.960	NA	NA
Transparent film dressing	Yes	196 (62)	120 (38)	0.99 (0.74–1.32)	0.960	NA	NA
Hydrocolloid base with transparent adhesive tape	No	340 (61)	219 (39)	0.86 (0.64–1.16)	0.340	NA	NA
Hydrocolloid base with transparent adhesive tape	Yes	179 (64)	100 (36)	0.86 (0.64–1.16)	0.340	NA	NA
Silicone tapes	No	429 (61)	271 (39)	0.84 (0.57–1.23)	0.380	NA	NA
Silicone tapes	Yes	90 (65)	48 (35)	0.84 (0.57–1.23)	0.380	NA	NA
Plastic polymer skin barrier film	No	471 (61)	295 (39)	0.79 (0.47–1.33)	0.380	NA	NA
Plastic polymer skin barrier film	Yes	48 (67)	24 (33)	0.79 (0.47–1.33)	0.380	NA	NA
Zinc oxide adhesive	No	489 (63)	292 (37)	1.50 (0.87–2.58)	0.130	NA	NA
Zinc oxide adhesive	Yes	30 (53)	27 (47)	1.50 (0.87–2.58)	0.130	NA	NA
Plastic perforated tape	No	481 (63)	283 (37)	1.61 (0.99–2.59)	0.050	1.66 (1–2.75)	0.04
Plastic perforated tape	Yes	38 (51)	36 (49)	1.61 (0.99–2.59)	0.050	1.66 (1–2.75)	0.04
Hydrogel adhesives	No	470 (62)	286 (38)	1.10 (0.69–1.76)	0.660	NA	NA
Hydrogel adhesives	Yes	49 (60)	33 (40)	1.10 (0.69–1.76)	0.660	NA	NA
Other practices	No	410 (62)	254 (38)	0.96 (0.68–1.35)	0.820	NA	NA
Other practices	Yes	109 (63)	65 (37)	0.96 (0.68–1.35)	0.820	NA	NA
Use of barrier film underneath the adhesive for skin protection	No	218 (60)	146 (40)	0.84 (0.62–1.12)	0.240	NA	NA
	Yes	268 (64)	151 (36)	0.84 (0.62–1.12)	0.240	NA	NA
Use of adhesive removers when removing tapes	No	141 (54)	119 (46)	0.61 (0.45–0.83)	0.002	0.59 (0.42–0.81)	0.002
Use of adhesive removers when removing tapes	Yes	344 (66)	179 (34)	0.61 (0.45–0.83)	0.002	0.59 (0.42–0.81)	0.002
Type of adhesive remover used when removing tapes
Alcohol/organic-based products	No	255 (67)	125 (33)	1.23 (0.82–1.84)	0.290	NA	NA
Alcohol/organic-based products	Yes	89 (62)	54 (38)	1.23 (0.82–1.84)	0.290	NA	NA
Oil-based solvents	No	215 (66)	113 (34)	0.97 (0.66–1.41)	0.880	NA	NA
Oil-based solvents	Yes	129 (66)	66 (34)	0.97 (0.66–1.41)	0.880	NA	NA
Silicone-based removers	No	248 (65)	131 (35)	0.94 (0.63–1.42)	0.790	NA	NA
Silicone-based removers	Yes	96 (67)	48 (33)	0.94 (0.63–1.42)	0.790	NA	NA
Other removers	No	297 (67)	149 (33)	1.27 (0.77–2.09)	0.340	NA	NA
Other removers	Yes	47 (61)	30 (39)	1.27 (0.77–2.09)	0.340	NA	NA
Additional strategies for MARSI prevention
Remove adhesives slowly using moistened gauze/pad	No	129 (65)	68 (35)	1.22 (0.87–1.70)	0.240	NA	NA
Remove adhesives slowly using moistened gauze/pad	Yes	390 (61)	251 (39)	1.22 (0.87–1.70)	0.240	NA	NA
Pull adhesive tapes in a horizontal plane	No	318 (60)	210 (40)	0.82 (0.61–1.09)	0.180	0.76 (0.55–1.05)	0.090
Pull adhesive tapes in a horizontal plane	Yes	201 (65)	109 (35)	0.82 (0.61–1.09)	0.180	0.76 (0.55–1.05)	0.090
Fold the tape back onto itself while wetting the adhesive-skin interface	No	300 (64)	169 (36)	1.21 (0.91–1.60)	0.170	1.47 (1.07–2.01)	0.010
	Yes	219 (59)	150 (41)	1.21 (0.91–1.60)	0.170	1.47 (1.07–2.01)	0.010
Other practices	No	501 (61)	314 (39)	0.44 (0.16–1.20)	0.110	NA	NA
Other practices	Yes	18 (78)	5 (22)	0.44 (0.16–1.20)	0.110	NA	NA
Abrasion/friction injuries
Skin assessments at least every 4 h	No	141 (66)	72 (34)	0.48 (0.34–0.68)	< 0.001	0.48 (0.33–0.71)	< 0.001
Skin assessments at least every 4 h	Yes	441 (80)	109 (20)	0.48 (0.34–0.68)	< 0.001	0.48 (0.33–0.71)	< 0.001
Local skin care guideline available	No	161 (72)	62 (28)	0.76 (0.54–1.09)	0.140	NA	NA
Local skin care guideline available	Yes	442 (77)	131 (23)	0.76 (0.54–1.09)	0.140	NA	NA
Use of alcohol-free skin protectants	No	291 (76)	90 (24)	0.88 (0.60–1.28)	0.520	NA	NA
Use of alcohol-free skin protectants	Yes	212 (79)	58 (21)	0.88 (0.60–1.28)	0.520	NA	NA
Strategies for injury prevention
Frequent vigilance	No	147 (72)	57 (28)	0.77 (0.54–1.11)	0.160	NA	NA
Frequent vigilance	Yes	487 (77)	147 (23)	0.77 (0.54–1.11)	0.160	NA	NA
Routinely rotating site of monitoring device	No	86 (67)	43 (33)	0.58 (0.39–0.88)	0.010	NA	NA
Routinely rotating site of monitoring device	Yes	548 (77)	161 (23)	0.58 (0.39–0.88)	0.010	NA	NA
Routinely changing body position	No	86 (73)	32 (27)	0.84 (0.54–1.31)	0.440	0.58 (0.34–0.98)	0.040
Routinely changing body position	Yes	548 (76)	172 (24)	0.84 (0.54–1.31)	0.440	0.58 (0.34–0.98)	0.040
Use of pressure injury prevention devices	No	360 (75)	118 (25)	0.95 (0.69–1.31)	0.790	NA	NA
Use of pressure injury prevention devices	Yes	274 (76)	86 (24)	0.95 (0.69–1.31)	0.790	NA	NA
Special purpose mattress	No	474 (75)	160 (25)	0.81 (0.55–1.18)	0.280	NA	NA
Special purpose mattress	Yes	160 (78)	44 (22)	0.81 (0.55–1.18)	0.280	NA	NA
Petroleum based ointments	No	566 (77)	173 (23)	1.49 (0.94–2.35)	0.080	1.73 (1.06–2.82)	0.020
Petroleum based ointments	Yes	68 (69)	31 (31)	1.49 (0.94–2.35)	0.080	1.73 (1.06–2.82)	0.020
Availability of a skin assessment tool (local tool or none)	No	91 (64)	52 (36)	0.45 (0.22–0.91)	0.020	NA	NA
Availability of a skin assessment tool (local tool or none)	Yes	50 (79)	13 (21)	0.45 (0.22–0.91)	0.020	NA	NA
Frequency of skin assessment differed for infants ≤ 25 wk	No	389 (76)	121 (24)	1.16 (0.83–1.60)	0.360	NA	NA
Frequency of skin assessment differed for infants ≤ 25 wk	Yes	227 (73)	82 (27)	1.16 (0.83–1.60)	0.360	NA	NA
Head to toe examination at least 6 h	No	389 (76)	121 (24)	0.83 (0.60–1.16)	0.280	NA	NA
Head to toe examination at least 6 h	Yes	261 (77)	77 (23)	0.83 (0.60–1.16)	0.280	NA	NA
Oil-based emollient application	No	384 (73)	139 (27)	0.71 (0.51–1.00)	0.050	0.65 (0.45–0.95)	0.020
Oil-based emollient application	Yes	250 (79)	65 (21)	0.71 (0.51–1.00)	0.050	0.65 (0.45–0.95)	0.020
Petrolatum-base emollient application	No	522 (76)	161 (24)	1.24 (0.83–1.80)	0.270	NA	NA
Petrolatum-base emollient application	Yes	112 (72)	43 (28)	1.24 (0.83–1.80)	0.270	NA	NA
Pressure injuries
Skin assessments at least every 4 h	No	148 (69)	66 (31)	0.50 (0.35–0.72)	< 0.001	0.51 (0.34–0.78)	0.002
Skin assessments at least every 4 h	Yes	452 (82)	102 (18)	0.50 (0.35–0.72)	< 0.001	0.51 (0.34–0.78)	0.002
Local skin care guideline available	No	168 (75)	57 (25)	0.71 (0.49–1.03)	0.070	0.71 (0.47–1.09)	0.120
Local skin care guideline available	Yes	463 (80)	113 (20)	0.71 (0.49–1.03)	0.070	0.71 (0.47–1.09)	0.120
Use of alcohol-free skin protectants	No	293 (76)	90 (24)	0.74 (0.50–1.09)	0.130	NA	NA
Use of alcohol-free skin protectants	Yes	222 (81)	51 (19)	0.74 (0.50–1.09)	0.130	NA	NA
Injury prevention strategies
Frequent vigilance	No	160 (78)	46 (22)	0.95 (0.65–1.39)	0.800	NA	NA
Frequent vigilance	Yes	500 (78)	137 (22)	0.95 (0.65–1.39)	0.800	NA	NA
Routinely rotating site of monitoring device	No	102 (79)	27 (21)	1.05 (0.66–1.67)	0.810	NA	NA
Routinely rotating site of monitoring device	Yes	558 (78)	156 (22)	1.05 (0.66–1.67)	0.810	NA	NA
Routinely changing body position	No	99 (84)	19 (16)	1.52 (0.90–2.56)	0.110	NA	NA
Routinely changing body position	Yes	561 (77)	164 (23)	1.52 (0.90–2.56)	0.110	NA	NA
Use of pressure injury prevention devices	No	380 (79)	100 (21)	1.12 (0.81–1.56)	0.470	NA	NA
Use of pressure injury prevention devices	Yes	280 (77)	83 (23)	1.12 (0.81–1.56)	0.470	NA	NA
Special purpose mattress	No	494 (77)	144 (23)	0.80 (0.54–1.19)	0.280	NA	NA
Special purpose mattress	Yes	166 (81)	39 (19)	0.80 (0.54–1.19)	0.280	NA	NA
Petrolatum-based ointments	No	591 (79)	153 (21)	1.67 (1.05–2.67)	0.020	NA	NA
Petrolatum-based ointments	Yes	69 (70)	30 (30)	1.67 (1.05–2.67)	0.020	NA	NA
Availability of a skin assessment tool (local tool or none)	No	110 (77)	33 (23)	1.23 (0.62–2.42)	0.540	NA	NA
Availability of a skin assessment tool (local tool or none)	Yes	46 (73)	17 (27)	1.23 (0.62–2.42)	0.540	NA	NA
Frequency of skin assessment differed for infants ≤ 25 wk	No	400 (78)	121 (22)	1.04 (0.74–1.46)	0.810	NA	NA
Frequency of skin assessment differed for infants ≤ 25 wk	Yes	240 (77)	70 (23)	1.04 (0.74–1.46)	0.810	NA	NA
Head to toe examination at least 6 h	No	363 (77)	111 (23)	0.84 (0.60–1.18)	0.330	NA	NA
Head to toe examination at least 6 h	Yes	270 (79)	70 (21)	0.84 (0.60–1.18)	0.330	NA	NA
Petrolatum-based emollient application	No	550 (80)	136 (20)	1.72 (1.17–2.55)	0.006	1.52 (0.94–2.46)	0.080
Petrolatum-based emollient application	Yes	110 (70)	47 (30)	1.72 (1.17–2.55)	0.006	1.52 (0.94–2.46)	0.080
Perineal injuries
Skin assessments at least every 4 h	No	142 (66)	72 (34)	0.58 (0.41–0.82)	0.002	0.52 (0.36–0.75)	0.001
Skin assessments at least every 4 h	Yes	425 (77)	126 (23)	0.58 (0.41–0.82)	0.002	0.52 (0.36–0.75)	0.001
Local skin care guideline available	No	159 (71)	66 (29)	0.76 (0.54–1.07)	0.120	0.66 (0.45–0.96)	0.030
Local skin care guideline available	Yes	436 (76)	138 (24)	0.76 (0.54–1.07)	0.120	0.66 (0.45–0.96)	0.030
Strategies for injury prevention
Frequent vigilance	No	160 (77)	47 (23)	1.26 (0.87–1.82)	0.220	NA	NA
Frequent vigilance	Yes	462 (73)	171 (27)	1.26 (0.87–1.82)	0.220	NA	NA
Routinely rotating site of monitoring device	No	97 (76)	31 (24)	1.11 (0.71–1.72)	0.620	NA	NA
Routinely rotating site of monitoring device	Yes	525 (74)	187 (26)	1.11 (0.71–1.72)	0.620	NA	NA
Routinely changing body position	No	96 (82)	21 (18)	1.71 (1.03–2.82)	0.030	1.94 (0.88–4.25)	0.09
Routinely changing body position	Yes	526 (73)	197 (27)	1.71 (1.03–2.82)	0.030	1.94 (0.88–4.25)	0.09
Use of pressure injury prevention devices	No	359 (75)	120 (25)	1.11 (0.81–1.52)	0.490	NA	NA
Use of pressure injury prevention devices	Yes	263 (73)	98 (27)	1.11 (0.81–1.52)	0.490	NA	NA
Special purpose mattress	No	480 (75)	157 (25)	1.31 (0.92–1.86)	0.120	1.33 (0.90–1.97)	0.150
Special purpose mattress	Yes	142 (70)	61 (30)	1.31 (0.92–1.86)	0.120	1.33 (0.90–1.97)	0.150
Petrolatum-based ointments	No	558 (73)	183 (25)	1.66 (1.06–2.60)	0.020	1.50 (0.89–2.53)	0.120
Petrolatum-based ointments	Yes	64 (65)	35 (35)	1.66 (1.06–2.60)	0.020	1.50 (0.89–2.53)	0.120
Availability of a skin assessment tool (local tool or none)	No	94 (65)	50 (35)	0.87 (0.46–1.64)	0.670	NA	NA
Availability of a skin assessment tool (local tool or none)	Yes	43 (68)	20 (32)	0.87 (0.46–1.64)	0.670	NA	NA
Frequency of skin assessment differed for infants ≤ 25 wk	No	372 (73)	137 (27)	0.89 (0.64–1.24)	0.510	NA	NA
Frequency of skin assessment differed for infants ≤ 25 wk	Yes	233 (75)	77 (25)	0.89 (0.64–1.24)	0.510	NA	NA
Head to toe examination at least 6 h	No	347 (73)	126 (27)	0.89 (0.64–1.23)	0.480	NA	NA
Head to toe examination at least 6 h	Yes	256 (76)	83 (24)	0.89 (0.64–1.23)	0.480	NA	NA
Oil-base emollient application	No	382 (73)	144 (27)	0.81 (0.59–1.13)	0.220	NA	NA
Oil-base emollient application	Yes	240 (76)	74 (24)	0.81 (0.59–1.13)	0.220	NA	NA
Petrolatum-base emollient application	No	523 (76)	161 (24)	1.87 (1.29–2.70)	0.001	1.88 (1.21–2.91)	0.004
Petrolatum-base emollient application	Yes	99 (63)	57 (37)	1.87 (1.29–2.70)	0.001	1.88 (1.21–2.91)	0.004
Diaper dermatitis
Skin assessments at least every 4 h	No	121 (57)	93 (43)	0.77 (0.56–1.06)	0.110	0.71 (0.51–0.99)	0.040
Skin assessments at least every 4 h	Yes	345 (63)	205 (37)	0.77 (0.56–1.06)	0.110	0.71 (0.51–0.99)	0.040
Local skin care guideline available	No	134 (60)	91 (40)	0.90 (0.65–1.23)	0.530	NA	NA
Local skin care guideline available	Yes	355 (62)	218 (38)	0.90 (0.65–1.23)	0.530	NA	NA
Strategies to injury prevention
Frequent vigilance	No	128 (62)	79 (38)	1.07 (0.77–1.47)	0.670	NA	NA
Frequent vigilance	Yes	381 (60)	252 (40)	1.07 (0.77–1.47)	0.670	NA	NA
Routinely rotating site of monitoring device	No	81 (62)	49 (38)	1.08 (0.74–1.60)	0.660	NA	NA
Routinely rotating site of monitoring device	Yes	428 (60)	282 (40)	1.08 (0.74–1.60)	0.660	NA	NA
Routinely changing body position	No	79 (67)	39 (33)	1.37 (0.91–2.07)	0.120	1.64 (0.92–2.90)	0.080
Routinely changing body position	Yes	430 (60)	292 (40)	1.37 (0.91–2.07)	0.120	1.64 (0.92–2.90)	0.080
Use of pressure injury prevention devices	No	288 (60)	191 (40)	0.95 (0.72–1.26)	0.740	NA	NA
Use of pressure injury prevention devices	Yes	221 (61)	140 (39)	0.95 (0.72–1.26)	0.740	NA	NA
Special purpose mattress	No	389 (61)	246 (39)	1.12 (0.81–1.54)	0.480	NA	NA
Special purpose mattress	Yes	120 (59)	85 (41)	1.12 (0.81–1.54)	0.480	NA	NA
Petroleum based ointments	No	453 (61)	288 (39)	1.20 (0.79–1.84)	0.380	NA	NA
Petroleum based ointments	Yes	56 (57)	43 (43)	1.20 (0.79–1.84)	0.380	NA	NA
Availability of a skin assessment tool (local tool or none)	No	88 (61)	56 (39)	1.38 (0.75–2.51)	0.290	NA	NA
Availability of a skin assessment tool (local tool or none)	Yes	33 (53)	29 (47)	1.38 (0.75–2.51)	0.290	NA	NA
Frequency of skin assessment differed for infants ≤ 25 wk	No	303 (59)	208 (41)	0.92 (0.69–1.24)	0.620	NA	NA
Frequency of skin assessment differed for infants ≤ 25 wk	Yes	188 (61)	120 (39)	0.92 (0.69–1.24)	0.620	NA	NA
Head to toe examination at least 6 h	No	290 (61)	183 (39)	1.08 (0.81–1.43)	0.590	NA	NA
Head to toe examination at least 6 h	Yes	201 (59)	137 (41)	1.08 (0.81–1.43)	0.590	NA	NA
Oil-based emollient application	No	305 (58)	219 (42)	0.76 (0.57–1.02)	0.060	NA	NA
Oil-based emollient application	Yes	204 (65)	112 (35)	0.76 (0.57–1.02)	0.060	NA	NA
Petrolatum-based emollient application	No	429 (63)	254 (37)	1.62 (1.14–2.30)	0.006	1.62 (1.12–2.33)	0.009
Petrolatum-based emollient application	Yes	80 (51)	77 (49)	1.62 (1.14–2.30)	0.006	1.62 (1.12–2.33)	0.009
Complications from emollient use
Increased CONS infection
Prophylactic application	No	136 (93)	10 (7)	0.43 (0.17–1.10)	0.080	0.38 (0.15–0.99)	0.040
Prophylactic application	Yes	279 (97)	9 (3)	0.43 (0.17–1.10)	0.080	0.38 (0.15–0.99)	0.040
Oil-based emollient	No	178 (94)	12 (6)	0.37 (0.14–0.97)	0.040	NA	NA
Oil-based emollient	Yes	275 (98)	7 (2)	0.37 (0.14–0.97)	0.040	NA	NA
Petrolatum-based emollient	No	323 (98)	8 (2)	3.41 (1.34–8.69)	0.010	3.66 (1.42–9.46)	0.007
Petrolatum-based emollient	Yes	130 (92)	11 (8)	3.41 (1.34–8.69)	0.010	3.66 (1.42–9.46)	0.007
Hyperthermia
Prophylactic application	No	135 (96)	5 (4)	0.87 (0.28–2.64)	0.800	NA	NA
Prophylactic application	Yes	279 (97)	9 (3)	0.87 (0.28–2.64)	0.800	NA	NA
Oil-based emollient	No	177 (96)	7 (4)	1.02 (0.39–2.69)	0.950	NA	NA
Oil-based emollient	Yes	271 (96)	11 (4)	1.02 (0.39–2.69)	0.950	NA	NA
Petrolatum-based emollient	No	320 (98)	7 (2)	3.92 (1.48–10.35)	0.006	NA	NA
Petrolatum-based emollient	Yes	128 (92)	11 (8)	3.92 (1.48–10.35)	0.006	NA	NA
Tissue burns
Prophylactic application	No	137 (97)	4 (3)	1.36 (0.42–4.34)	0.600	NA	NA
Prophylactic application	Yes	277 (96)	11 (4)	1.36 (0.42–4.34)	0.600	NA	NA
Oil-based emollient	No	178 (96)	7 (4)	0.75 (0.26–2.10)	0.580	NA	NA
Oil-based emollient	Yes	271 (97)	8 (3)	0.75 (0.26–2.10)	0.580	NA	NA
Petrolatum-based emollient	No	318 (98)	6 (2)	3.64 (1.27–10.43)	0.010	NA	NA
Petrolatum-based emollient	Yes	131 (94)	9 (6)	3.64 (1.27–10.43)	0.010	NA	NA
Interference with adhesive tapes
Prophylactic application	No	113 (78)	31 (26)	1.10 (0.68–1.79)	0.680	NA	NA
Prophylactic application	Yes	221 (77)	67 (23)	1.10 (0.68–1.79)	0.680	NA	NA
Oil-based emollient	No	143 (77)	42 (23)	1.12 (0.73–1.74)	0.580	NA	NA
Oil-based emollient	Yes	214 (75)	71 (25)	1.12 (0.73–1.74)	0.580	NA	NA
Petrolatum-based emollient	No	259 (79)	70 (21)	1.62 (1.04–2.52)	0.030	NA	NA
Petrolatum-based emollient	Yes	98 (70)	43 (31)	1.62 (1.04–2.52)	0.030	NA	NA
Environmental contamination leading to invasive sepsis
Prophylactic application	No	133 (96)	6 (4)	1.13 (0.42–3.02)	0.790	NA	NA
Prophylactic application	Yes	273 (95)	14 (3)	1.13 (0.42–3.02)	0.790	NA	NA
Oil-based emollient	No	173 (95)	9 (5)	1.00 (0.42–2.37)	0.990	NA	NA
Oil-based emollient	Yes	269 (95)	14 (5)	1.00 (0.42–2.37)	0.990	NA	NA
Petrolatum-based emollient	No	318 (97)	9 (3)	4.02 (1.69–9.53)	0.002	NA	NA
Petrolatum-based emollient	Yes	123 (90)	14 (10)	4.02 (1.69–9.53)	0.002	NA	NA

Responses reported as number (%), percentages rounded to the nearest whole number. Adjusted odds ratio from stepwise backward binary multivariate logistic regression models, adjusted for regions. Uncommon occurrence of skin injuries was arbitrarily used as the reference group (base). Occurrence of injuries uncommon: responses rare and seldom; occurrence of injuries common: responses often, almost always and always. MARSI medical adhesive-related skin injury, CONS coagulase negative staphylococci, OR unadjusted odds ratio, aOR adjusted odds ratio, CI confidence interval, NA effect output not included as P ≥ 0.2 for stepwise regression