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Abstrak :
Pelayanan kesehatan mengalami pergeseran fokus pelayanan dari pengobatan penyakit dan trauma kulit ke arah pencegahan melalui penilaian rutin. Peralatan perawatan dan kondisi neonatus, termasuk berat dan usia bayi, status klinis, dan penyakit yang mendasari memiliki hubungan yang kuat pada risiko terjadinya trauma kulit. Instrumen penilaian trauma kulit yang digunakan dalam penelitian ini adalah instrumen SRAMT dan NSRAS plus. Penelitian ini menggunakan studi kohort prospektif, total responden 66 neonatus yang terdiri dari kelompok terpapar dan historical control. Hasil penelitian ini menunjukkan terdapat perbedaan tingkat risiko trauma kulit pada penilaian awal dan penilaian akhir pada kelompok terpapar (p value 0.001), terdapat perbedaan tingkat risiko trauma kulit antara kelompok terpapar dan kelompok tidak terpapar (X2 29.505 > 5.991) dan terdapat hubungan yang sangat lemah antara usia gestasi dan berat badan lahir terhadap tingkat risiko trauma kulit pada neonatus (rs 0.077 dan 0.004). Peneliti menyarankan agar peneliti selanjutnya melakukan penelitian yang mengintegrasikan pengetahuan perawat terhadap faktor penyebab trauma kulit dan pemantauan ulang sebagai upaya menurunkan tingkat risiko trauma kulit menggunakan instrumen SRAMT, memodifikasi instrumen sesuai dengan kondisi pelayanan yang ada di Indonesia sehingga instrumen ini dapat digunakan untuk menurunkan risiko trauma kulit pada neonatus khususnya bayi prematur. ......Health services have shifted the focus of services from treating skin diseases and skin injury to prevention through routine assessments. Treatment equipment and neonatal conditions, including the weight and age of the baby, clinical status, and underlying disease have a strong association with the risk of skin injury. The skin injury assessment instruments used in this study were the SRAMT and NSRAS plus instruments. This study used a short cohort study, totaling 66 neonates consisting of the exposed group and unexposed group (historical control). The results showed that there were differences in the risk level of skin injury first assessment and last assessment in the exposed group with a value (p value 0.001), there were differences in the risk level of skin injury between the exposed group and unexposed group (p value 0.001) and there was no correlation between gestational age and birth weight on the level of skin injury risk (p value 0.446 and 0.821). The researchers suggest that researchers should integrates nurses' knowledge of the factors that cause skin injury and re-monitoring as an effort to reduce the risk level of skin injury using SRAMT instrument, modify the instrument according to the existing service conditions in Indonesia so that the instrument can be use to reduce skin injury in neonates especially preterm.

Abstrak :
Penggunaan perekat medis dalam waktu yang lama pada pada prosedur pemasangan alat invasif dapat menyebabkan kejadian medical adhesive related skin injury (MARSI) pada anak. Sehingga dibutuhkan pelindung kulit skin barrier sebelum pemberian perekat agar dapat meminimalisir resiko kejadian MARSI. Tujuan penelitian ini adalah untuk mengetahui efektivitas skin barrier acrylate terpolimer terhadap kejadian medical adhesive related skin injury (marsi) pada anak yang dirawat di ruang intensif. Penelitian ini menggunakan design true experiment yang melibatkan 46 anak dibagi dalam kelompok intervensi 23 responden dan kelompok kontrol 23 responden yang dirawat menggunakan perekat medis karena prosedur pemasangan endotracheal tube dan nasogastric tube. Sampel diambil menggunakan teknik purposive sampling. Tingkat resiko skin injury dinilai menggunakan skala Braden Q dan kejadian MARSI di observasi menggunakan format observasi. Hasil penelitian menunjukan bahwa skin barrier acrylate terpolimer efektif menurunkan kejadian MARSI pada anak yang dirawat di ruang intensif dengan nilai p 0,03 (α < 0,05). Dengan demikian penggunaan skin barrier acrylate terpolimer dapat direkomendasikan untuk meminimalisir kejadian MARSI pada anak. Hasil penelitian ini dapat menjadi acuan bagi tenaga kesehatan dan fasilitas pelayanan Kesehatan untuk meminimalisir kejadian skin injury. ......he use of medical adhesives for a long time in invasive device installation procedures can cause medical adhesive related skin injury (MARSI) in children. So that a skin barrier is needed before applying the adhesive in order to minimize the risk of MARSI events. The purpose of this study was to determine the effectiveness of acrylate terpolymer skin barrier against medical adhesive related skin injury (MARSI) in children treated in the intensive care unit. This study used a true experiment design involving 46 children divided into an intervention group of 23 respondents and a control group of 23 respondents who were treated using medical adhesive due to the procedure for inserting an endotracheal tube and nasogastric tube. Samples were taken using purposive sampling technique. The risk level of skin injury was assessed using the Braden Q scale and the MARSI events were observed using the observation format. The results showed that the acrylate terpolymer skin barrier was effective in reducing the MARSI in children treated in the intensive care unit with a p-value of 0.03 (α <0.05). Thus the use of an acrylate terpolymer skin barrier can be recommended to minimize the incidence of MARSI in children. The results of this study can be a reference for health workers and health service facilities to minimize the incidence of skin injury, skin injury.

Abstrak :
Pelepasan perekat medis pada lanjut usia (lansia) berisiko tinggi menyebabkan medical adhesive-related skin injury (MARSI). Pemberian bahan topikal, NaCl 0,9%, vaselin album, dan alkohol 70%, dalam proses pelepasan diduga dapat mengurangi adhesi kulit dengan plester. Untuk mengetahui apakah penambahan bahan-bahan tersebut dalam prosedur pelepasan perekat medis berbahan dasar akrilat efektif mengurangi kejadian MARSI pada lansia, suatu uji klinis acak tersamar tunggal dilakukan pada penghuni sebuah panti werdha di Jakarta. Subjek yang dipilih berdasarkan kriteria penerimaan (usia 3 60 tahun) dan penolakan (tidak memiliki kelainan kulit, tidak menggunakan obat antiinflamasi, imunosupresan, antihistamin, atau tidak ada riwayat alergi terhadap plester dan bahan uji) serta bersedia berpartisipasi menjalani penempelan perekat medis akrilat pada empat lokasi di kedua tungkai atas sisi ekstensor. Sejumlah 75 orang subjek penelitian (SP) dengan 300 lokasi uji terpilih berdasarkan teknik convenience sampling dan mengikuti seluruh rangkaian prosedur hingga penelitian selesai. Pada hari ketiga, perekat dilepas dengan atau tanpa penambahan bahan topikal sesuai dengan kode randomisasi yang tidak diketahui oleh peneliti (blinding). Perubahan skor skin irritation scoring systems (SISS), nilai transepidermal water loss (TEWL), dan indeks eritema pada mexameter yang merupakan parameter MARSI diukur pada tiap-tiap lokasi uji. MARSI teramati pada 52% SP atau 20,7% lokasi perlakuan (26,7% NaCl 0,9%, 20% vaselin album, 17,3% alkohol 70%, dan 18,7% kontrol; p=0,501). Perubahan skor SISS dan indeks eritema antar kelompok tidak bermakna secara statistik. Perubahan nilai TEWL lebih kecil pada kelompok perlakuan NaCl 0,9% (1 g/m2/jam; p<0,001) dan vaselin album (1 g/m2/jam; p<0,001) dibandingkan kontrol. Disimpulkan bahwa penambahan bahan topikal dalam proses pelepasan perekat medis akrilat di hari ketiga pada kulit lansia tidak terbukti mengurangi kejadian MARSI. Tetapi, penambahan NaCl 0,9% dan vaselin album secara bermakna mengurangi kerusakan sawar kulit yang ditimbulkannya. Waktu pengamatan penelitian ini sangat pendek karena dilakukan dalam masa pandemi Covid-19 untuk membatasi interaksi dengan lansia sebagai populasi rentan. Penelitian lebih lanjut diperlukan karena MARSI umumnya terjadi setelah pemakaian jangka panjang dan berulang. ......The removal of medical adhesives in the elderly risks causing medical adhesive-related skin injury (MARSI). Application of topical agents, 0.9% NaCl, vaseline album, or 70% alcohol, could possibly reduce adhesion between the skin and the tape. To determine if application of 0.9% NaCl, vaselin album, or 70% alcohol while removing medical adhesives was effective in reducing MARSI in geriatrics, a randomized, single- blind trial was conducted in a nursing home in Jakarta. Subjects were recruited based on inclusion (age 360 years old) and exclusion criteria (having no skin disorder, not taking anti-inflammatory drugs, immunosuppressants, or antihistamines, and not known allergy to adhesives and the topical agents). Seventy-five subjects gave consent to this study. Acrylic medical adhesives were applied on four areas on extensor thighs. On day three, they were removed with or without using the topical agents based on randomized allocation code unknown to the investigators. Changes in MARSI parameters, i.e. skin irritation scoring systems (SISS), transepidermal water loss (TEWL), and erythema index by mexameter were measured in each of trial area. MARSI was observed in 52% subjects or 20.7% areas (26.7% 0.9% NaCl, 20% vaselin album, 17.3% 70% alcohol, and 18.7% control; p=0,501). Change in SISS score and erythema index among experimental groups were not statistically significant. The change of TEWL value was significantly smaller in 0.9% NaCl group (1 g/m2/hour; p<0,001) and vaselin album (1 g/m2/hour; p<0,001) than control. We concluded that application of topical agents in aiding acrylic medical adhesive removal on day three in the elderly was not proven to reduce MARSI. However, the addition of 0.9% NaCl or vaselin album was shown to confer significantly less damage to the skin barrier. The observation time was very short due to Covid-19 pandemic to limit interaction with the elderly as vulnerable population. Further research is needed to confirm these preliminary findings before they can be generalized because MARSI prevention generally occurs after long-term use and repeated removal.

Abstrak :
Bayi baru lahir memiliki kebutuhan fisiologis khusus untuk beradaptasi dengan lingkungan ekstrauterin dan seringkali membutuhkan perawatan khusus. Rutinitas perawatan di ruang rawat dapat membuat bayi baru lahir berisiko mengalami gangguan integritas kulit. Tujuan dari penelitian ini adalah untuk mengetahui efektifitas edukasi integritas kulit terhadap kompetensi perawat dalam pemantauan risiko cedera kulit neonatus. Studi menggunakan metoda Pre- experimental dengan rancangan pre and post-test without control design. Sampel penelitian berjumlah 62 perawat yang bekerja di ruang Perinatologi sebuah rumah sakit rujukan di Jakarta. Sampel diambil secara purposive. Intervensi penelitian yang dilakukan yaitu memberikan edukasi secara blended learning dengan memberikan informasi melalui link video presentasi integritas kulit dan diskusi secara langsung saat praktik pemantauan kulit. Hasil penelitian didapatkan rerata nilai pengetahuan responden naik sebesar 3,93, rerata nilai sikap naik sebanyak 32,1 dan rerata keterampilan naik sebanyak 14,41. Hasil analisis statistik menunjukkan bahwa terdapat kenaikan nilai rerata secara bermakna dengan p value <0,001, sehingga ada pengaruh intervensi edukasi integritas kulit mampu meningkatkan pengetahuan, sikap dan keterampilan perawat dalam pemantauan risiko cedera kulit. Untuk mencapai kualitas kompetensi perawat yang optimal, sebaiknya dilakukan mentoring, supervisi, pendampingan dan pengarahan secara terintegrasi. Pembuat kebijakan diharapkan dapat membuat standar pemantauan integritas kulit yang terkini sesuai dengan kondisi neonatus yang memerlukan perawatan intensif. ......Newborns are physiologically adapted to the extrauterine environment and often require special care. Routine care in the ward has the risk of increasing skin integrity disorders. The purpose of the study was to determine the effectiveness of skin integrity education on the competence of nurses in monitoring the risk of skin injury. The study used a quasi-experimental method with pre and post-test without a control design. Sampling was done by purposive sampling, where 62 nurses worked in the Perinatology section of a hospital in Jakarta. The interventions carried out were education via video links presentations on skin integrity, and direct discussions during practice. The results of this study are the average score of respondents' knowledge values increased by 3.93, the average score of attitude scores increased by 32.1, and the average score of skills increased by 14.41. The results of the analysis showed a positive average increase, with a p-value <0,001 so there was an effect of skin integrity education intervention, being able to increase the knowledge, attitudes, and skills of nurses in monitoring the risk of skin injury. The implementation of an educational program for five days can improve the competence of nurses in monitoring the prevention of skin injuries. To achieve optimal quality of nurse competence, mentoring, supervision, mentoring and guidance must be carried out in an integrated manner. Hospital policymakers are also expected to develop new standards for monitoring skin integrity according to the condition of neonates in intensive care.