Can Moisture-Associated Skin Damage (MASD) increase the risk of developing a pressure injury?

Moisture-Associated Skin Damage (MASD) and Pressure Injury Risk

Yes, moisture-associated skin damage (MASD) significantly increases the risk of developing pressure injuries by compromising skin integrity, which can lead to tissue breakdown and subsequent pressure injury development.

Understanding MASD and Its Relationship to Pressure Injuries

MASD is characterized by inflammation of the skin with or without erosion caused by prolonged exposure to various sources of moisture including:

• Urine or stool (incontinence-associated dermatitis)
• Perspiration
• Wound exudate
• Mucus or saliva 1

Pathophysiology of MASD Leading to Pressure Injuries

When skin is exposed to excessive moisture:

• The skin becomes overhydrated and prone to maceration
• The protective acid mantle of the skin is disrupted
• Skin integrity is reduced, making it more susceptible to mechanical forces
• Irritants and microorganisms can more easily penetrate the skin 2
• These changes create ideal conditions for pressure injury development when combined with pressure and/or shear forces

Risk Factors That Connect MASD and Pressure Injuries

Several overlapping risk factors contribute to both MASD and pressure injuries:

• Urinary or fecal incontinence 3
• Physical impairments limiting mobility 3
• Comorbidities affecting tissue integrity and healing (diabetes, edema, impaired microcirculation) 3
• Nutritional deficiencies (hypoalbuminemia, malnutrition) 3
• Excessive humidity due to sweating, drainage, or poorly managed incontinence 3

Clinical Implications

The presence of MASD creates a dangerous situation where:

• Macerated skin has reduced resistance to pressure and shear forces 2
• The pH changes from MASD (toward alkaline range of 7.5-8.5) promote bacterial growth and impair wound healing 4
• Chronic bacterial colonization and potential biofilm formation further impede healing 4
• The combination of moisture and pressure significantly increases the risk of tissue breakdown 4

Prevention and Management Strategies

Assessment

• Perform systematic risk assessment using validated scales (Braden, Norton, or Waterlow) for all patients 4, 3
• Conduct thorough skin integrity assessment on admission and monitor at least daily 4
• Use tools such as the Skin Moisture Alert Reporting Tool (S.M.A.R.T.) to identify MASD etiology 2

Prevention of MASD and Pressure Injuries

• Implement proper positioning, turning, and transferring techniques 4
• Use barrier ointments, liquid polymers, and cyanoacrylates to create a protective layer 5
• Establish a standardized skin care protocol including adequate cleaning and hydration 3
• Choose advanced static mattresses or overlays for patients at increased risk 4, 3
• Implement regular repositioning every 2-4 hours based on individual risk 3

Management of Existing MASD

• Address the underlying cause of moisture (incontinence management, wound exudate control) 2
• Implement a structured skin care regimen using appropriate barrier products 2
• Protect the skin from further moisture exposure while maintaining optimal hydration 5
• Monitor for early signs of pressure injury development 4

Special Considerations for High-Risk Settings

In intensive care units and other high-acuity settings:

• Patients are at particularly high risk for both MASD and pressure injuries 6
• Nurses should prioritize skin inspection and preventive care 6
• Use preventive dressings in high-risk areas such as heels and sacrum 3
• Consider protein supplementation for patients with nutritional deficiencies 3

Common Pitfalls and How to Avoid Them

• Failure to recognize early MASD: Conduct regular, thorough skin assessments, especially in skin folds and areas exposed to moisture 1
• Inadequate differentiation between MASD and pressure injury: MASD typically presents with inflammation and occurs in areas exposed to moisture, while pressure injuries occur over bony prominences 2
• Focusing only on pressure relief without addressing moisture: Use a comprehensive approach that addresses both pressure and moisture management 3
• Overlooking the role of pH in skin damage: Consider pH-balanced skin care products to maintain the skin's acid mantle 4
• Neglecting nutritional status: Address nutritional deficiencies that can compromise skin integrity 3

By understanding the relationship between MASD and pressure injuries and implementing appropriate preventive measures, healthcare providers can significantly reduce the risk of pressure injury development in patients with or at risk for MASD.