MARSI in Clinical Care: How Tape Selection Prevents Skin Injury

Quick Summary: Medical adhesive-related skin injury (MARSI) is damage caused when a dressing, tape, or electrode is applied to skin and later removed — and it is far more common than most clinicians assume, especially in older adults. The 2013 consensus statement from the Journal of Wound, Ostomy and Continence Nursing defined MARSI as a distinct clinical problem with mechanical, dermatitis, and other causes. Prevention starts with assessing skin before application, choosing an adhesive matched to the patient and site, and removing tape with a deliberate low-and-slow technique or an adhesive remover.

The short answer: MARSI includes skin stripping, tension blisters or tears, and irritant or allergic contact dermatitis under adhesives. Fragile skin — thin, dry, or aged — tears more easily, which is why tape choice matters: silicone and other gentle adhesives hold securely but release with less force, and they are the first-line choice for older or steroid-treated skin. Remove tape parallel to the skin surface while supporting the skin with one finger, or use a silicone-based adhesive remover. Document any skin injury so the care plan can switch to a gentler product before the next dressing change.

What MARSI Is and Why It Matters

MARSI covers any skin injury caused by a medical adhesive — tape, wound dressing, electrodes, ostomy pouch, or securement device. The 2013 international consensus statement classified MARSI into three groups: mechanical injuries (skin stripping, tension blister, skin tear), dermatitis (irritant or allergic), and other causes such as maceration and folliculitis. Skin stripping — removal of the stratum corneum layers when adhesive is pulled off — is the most common form and is often invisible at first, showing up later as redness, soreness, or weeping.

Why it matters in clinical care: damaged skin is an entry point for infection, a source of pain, and a reason dressings stop staying on. In one 2024 review of prevalence and risk factors, MARSI was most frequent on the face and at venipuncture sites, and acrylate-containing adhesives were more likely to cause injury than silicone alternatives. Risk climbed with longer hospital stays, oedema, and lower skin integrity scores — all common in LTC and hospital populations.

The Three Mechanical Injury Types

Mechanical injuries are the most preventable because they depend on technique and product selection rather than patient biology. A blister forms when skin under a taut dressing is pulled sideways during movement; a tear happens when removal force exceeds the skin's strength. Both can be avoided with a gentler adhesive and proper removal.

Who Is at Risk: Skin That Tears Easily

Fragile skin is not a single diagnosis — it is the endpoint of several processes that matter for tape choice:

• Age: after 60, the dermis thins, elastin declines, and the epidermis flattens, so adhesives grip a weaker structure.
• Steroids and anticoagulants: long-term corticosteroid use thins skin; anticoagulants increase bruising under tape.
• Dehydration and poor nutrition: dry skin has less natural moisture barrier and is more prone to stripping.
• Oedema and repeated dressing changes: swollen skin is fragile, and each removal stresses the same area.
• Sun-damaged or chronically ill skin: reduced elasticity and delayed healing raise tear risk.

A 2020 evidence summary for elderly patients reached the same conclusion: skin injury under adhesives is common in this group, and prevention should be standard rather than reactive. Risk assessment before the first dressing application — a quick look, a light touch, and a question about previous tape reactions — costs seconds and prevents days of skin breakdown.

Choosing Tape by Patient and Site

No single tape is right for every patient. The practical rule: match adhesive aggressiveness to skin condition, and reserve the strongest tapes for the most demanding clinical jobs.

Silicone adhesives deserve special mention. They wet out onto the skin and form a secure bond, yet they peel away with notably less force than acrylate tapes — the property that makes them the frequent recommendation for older adults and repeated dressing changes. Products like the hypoallergenic paper tape in CliniEco's range suit routine use, while silicone-based options are the gentler tier for fragile skin. Both have a role in a well-stocked supply room; the mistake is using one tape for every patient.

Application and Removal Technique

Technique prevents most MARSI, regardless of product. Evidence-based guidance centres on these steps:

• Prepare the skin: clean and dry the site; do not apply tape over moisturiser, sweat, or wound exudate.
• Consider a skin barrier: barrier film or barrier wipes protect the epidermis before adhesive contact.
• Apply without tension: lay the tape flat; do not stretch it across joints or oedematous tissue.
• Remove low and slow: peel the tape back parallel to the skin surface, supporting the skin with a finger just ahead of the peel.
• Use an adhesive remover: silicone-based removers dissolve the bond without pulling skin; use them for fragile skin, hairy sites, and repeated changes.
• Rotate sites: move the tape or dressing location when a site needs repeated fixation.

Removal direction matters more than speed in many injuries. Pulling tape upward away from the skin concentrates force on a small area and strips epidermis; pulling it back on itself, parallel to skin, spreads force and is the technique recommended in consensus guidance. For a patient with fragile skin, a remover wipe is not optional — it is the standard of care that prevents the next tear.

Supply Room Implications: Stocking for Fragile Skin

A supply cart stocked with one tape does not support skin-safe care. The practical formulary for a Canadian clinic, LTC home, or home care program includes at least three adhesive tiers: a gentle everyday tape (hypoallergenic paper) for routine dressings on intact skin, a silicone tape or silicone border dressing for fragile or repeatedly dressed skin, and a stronger cloth or PE tape reserved for high-moisture areas where securement is the priority. Adhesive remover wipes belong on the cart alongside the tapes, not in a cupboard — they are used every time a dressing comes off fragile skin.

Procurement teams should also check the adhesion testing claims behind the products they buy. ASTM tape adhesion standards and manufacturer peel-force data give a comparable number, but the clinically meaningful question is how the tape behaves on aged or damaged skin. Distributors serving the Canadian market, such as CliniEco Medical, publish product specifications so clinicians can compare silicone-based and paper options side by side before ordering.

Staff training closes the loop: a tape that protects fragile skin still causes injury if removed upward instead of parallel. A fifteen-minute refresher covering skin assessment, tape selection, and low-and-slow removal — repeated at annual orientation — is the intervention with the highest return in MARSI prevention.

Documentation and Care Planning

When MARSI occurs, it should be documented like any other skin injury: location, type (stripping, tear, dermatitis), size, and the adhesive used. Documentation drives two changes: the care plan switches to a gentler adhesive or barrier product for that patient, and the supply team learns which products perform on fragile skin in that population. In Canadian LTC and home care, skin injury documentation also feeds into pressure-injury and skin-integrity reporting, so catching MARSI early keeps quality indicators accurate.

Prevention is a team habit, not a one-time training. Regular review of tape products, skin checks at dressing changes, and a visible note on the care plan — "use silicone tape; remove with remover" — reduce repeat injuries and the cost of treating them.

A Five-Point MARSI Prevention Checklist for Care Teams

Teams that want a quick audit of their adhesive practices can run through five questions at the next dressing change:

• Was the skin assessed before this adhesive was applied, including a question about past tape reactions?
• Is the adhesive matched to the patient and site, with silicone or paper options used on fragile skin?
• Was a barrier product used where skin is thin, moist, or repeatedly dressed?
• Is removal technique consistent — parallel to skin, supporting the skin, using remover when needed?
• Is any injury documented in the same language as other skin events, so trends become visible?

The checklist works because it converts a clinical concept into observable actions. MARSI prevention is not a product category debate; it is a behaviour pattern that starts at the supply cart and ends at the bedside. When the answer to any question is no, the fix is usually small — a different tape on the cart, a remover at the change station, or a note on the care plan — and the payoff is skin that stays intact through a hospital stay or years of home care.

References

1. McNichol L, Lund C, Rosen T, Gray M. Medical adhesives and patient safety: state of the science and consensus statements for the assessment, prevention and treatment of adhesive-related skin injuries. J Wound Ostomy Continence Nurs, 2013. PubMed 23827790
2. Prevalence, Risk Factors, Causes, Assessments and Prevention of Medical Adhesive-Related Skin Injury. Advances in Skin & Wound Care, 2024. ovid.com
3. Summary of the Evidence for Prevention and Management of Medical Adhesive-Related Skin Injury. PMC12423774
4. Wounds UK — Preventing MARSI: introducing a skincare regimen for good practice. wounds-uk.com
5. Health Canada — Medical devices regulatory framework. canada.ca

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Related Reading

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• CliniEco learning hub for clinic supply guides
• free sterilization log tool

Frequently Asked Questions

What does MARSI stand for?

Medical adhesive-related skin injury. It is the umbrella term for skin damage caused by medical adhesives — including tape, dressings, electrodes, and ostomy products — defined in the 2013 Journal of Wound, Ostomy and Continence Nursing consensus statement.

How do you prevent MARSI?

Assess the skin before applying adhesive, choose a tape matched to skin fragility (silicone for fragile skin), prepare the site with cleansing and optional barrier film, apply without tension, and remove parallel to the skin while supporting it with a finger. Use a silicone adhesive remover for fragile or repeatedly dressed skin, and rotate tape sites when fixation is needed long term.

What is the difference between MARSI and a skin tear?

A skin tear is one type of MARSI — a full or partial thickness wound caused by friction or shearing, often during adhesive removal. MARSI also includes skin stripping, tension blisters, and contact dermatitis. Skin tears can also happen without adhesive, from bumping furniture or transferring, but adhesive removal is a common preventable cause.

Which tape is gentle on fragile skin?

Silicone adhesive tape is generally the gentlest option: it bonds securely but releases with low force. Hypoallergenic paper tape is a reasonable everyday choice for normal skin. Avoid strong acrylate or rubber-based tapes on aged, steroid-treated, or repeatedly dressed skin, and always combine any tape with proper removal technique.

Can MARSI be treated?

Yes, and treatment starts with stopping the cause: switch to a gentler adhesive or use a barrier product at the next change. Clean the injured area gently with saline on sterile gauze sponges or a mild cleanser, protect it with a non-adherent foam wound dressing if needed, and monitor for infection. Document the injury and update the care plan so the same site is not re-injured by the next adhesive application.

Is MARSI common in hospitals and LTC?

More common than is reported. Observational studies in acute care have documented adhesive-related injuries in a significant share of adult patients — one 2015 single-centre study found them in over a fifth of acute care patients assessed — and risk rises in older adults, longer stays, and fragile skin. Because early damage may look like simple redness or dryness, systematic skin checks and documentation are the way to keep MARSI visible, measurable, and preventable.

Last updated: 2026-09-08. CliniEco Medical is a licensed medical device establishment (MDEL #35334).