Download Serious skin infections

Healthy skin and
Skin infections
Objectives
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Introduction and background
Toi Te Ora goals and analysis
Serious skin infections
Key prevention messages and resources
Functions of skin
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Skin is an amazing organ:
Covers and protects
Helps to maintain correct temperature
Sense of touch
Skin also protects against infections
 However, the skin may become infected
leading to serious health problems
Serious skin infections
 Serious skin infections (SSI) are a significant
cause of avoidable hospitalisations in NZ
 SSI includes cellulitis, impetigo and
abscesses
 Can affect the blood, kidneys, bones, joints,
lymph nodes and brain
Toi Te Ora – Public Health Service
Goals
Reducing skin infections
3 key strategies:
1. Increasing community awareness
2. Increasing skills, capacity and
responsiveness of health professionals
3. Improving responsiveness and effectiveness
of primary and community health services
Area served by Toi Te Ora
Defining Serious Skin Infection
“A child aged 0-14 years, admitted to hospital
with a principal or additional diagnosis of
serious skin infection, with a diagnosis code
either within the ICD skin infection sub-chapter,
or within the categories of skin infection of an
atypical site or skin infection following primary
skin disease or external trauma.”
(O’Sullivan & Baker, 2010, p181)
Category A – Skin infections of typical sites
L01.0, L01.1
L02.0 to L02.9 inclusive
L03.01 to L03.9 inclusive
L04.0 to L04.9 inclusive
L05.0
L08.0
L08.1, L08.8, L08.9
Impetigo
Cutaneous abscess, furuncle and carbuncle
Cellulitis
Acute lymphadenitis
Pilonidal cyst with abscess
Pyoderma
Other infections of skin and subcutaneous tissue
Category B – Skin infections of atypical sites
A46
H00.0
H60.0 to H60.3 inclusive, H62.0, H62.4
Erysipelas
Hordeolum/cellulitis/abscess eyelid
Abscess/cellulitis external ear and infective otitis externa
J34.0
K61.0
Abscess/cellulitis nose
Anal abscess/cellulitis (excludes rectal, ischiorectal or intersphincteric
regions)
Acute inflammation/cellulitis/abscess of orbit
Other inflammatory disorders of penis, scrotum and unspecified male genital
organ(excludes deeper tissues)
Abscess/cellulitis of vulva
H05.0
N48.2, N49.2, N49.9
N76.4
Category C – Skin infections secondary to primary disease of the skin
B01.8
B86
L30.8,L30.9,L30.30
Varicella with other complications
Scabies
Dermatitis unspecified and other specified
(eczema) and infective eczema
Category D – Skin infections secondary to trauma
S10.13, S10.83, S10.93, S20.13, S20.33, S20.43, S20.83, S30.83, S30.93,
S40.83, S50.83, S60.83, S70.83, S80.83, S90.83, T00.9, T09.03, T11.08,
T13.03, T14.03, T63.3, T63.4
Insect/spider bites
T79.3
Post-traumatic wound infection not elsewhere classified
T89.01,T89.02
Open wound infection with foreign body (+ infection) and open wound with
infection
Data Analysis
 Hospital discharge data were obtained from the Ministry of Health
 The data included all children in New Zealand aged 0-14
 The same filters that O’Sullivan and Baker (2011) used were
applied to the data:
 Day cases were removed – (discharge that had a length of stay
of less than 1 day)
 Transfers – any discharge data that was classified as a transfer
was removed
 Readmissions – discharges within 30 days of previous
discharge with the same principle diagnosis were removed
 Overseas visitors – Data for non-residents were removed from
the dataset
Incidence of Serious Skin Infection
Incidence by Age
Incidence by Ethnicity
Incidence by Category
Incident Cases by CAU
Census Area Unit
Kawerau
District
Kawerau
Te Puke Community East
Whakatane North
Opotiki
Yatton Park
Whakatane West
Hairini
Gate Pa
Trident
Tauranga Central
Murupara
Greerton
Western BOP
Whakatane
Opotiki
Tauranga
Whakatane
Tauranga
Tauranga
Whakatane
Tauranga
Whakatane
Tauranga
Percentage
6.6
5.1
4.5
4.3
3.8
3.3
3.0
2.8
2.8
2.7
2.3
2.1
Tip of the Iceberg
 In Tairawhiti DHB it is estimated that for each
incident case of serious skin there are a
further 14 cases of skin infection seen in
primary care (O’Sullivan, 2011)
 It is likely to be a similar situation in Bay of
Plenty DHB
Summary
 Incidence of serious skin infection in Bay of
Plenty DHB is higher than the incidence of New
Zealand
 Younger children are more likely to have a
serious skin infection
 There is a large inequality between Maori and
Non-Maori
 We can identify the census area units where a
disproportionate number of the cases come from
 Serious skin infection represents the tip of the
iceberg
Common SSIs
Cellulitis
 Cellulitis is an acute bacterial infection
of the soft tissues of the skin. The
infection spreads causing the skin and
layers underneath to become red,
swollen and tender
Cellulitis
Causes
 Any area of skin can become infected if skin
is broken, e.g. from a sore, insect bite, boil,
rash, cut, burn or graze
 Most common pathogens Staph.aureus,
Strep.pyogenes, Group C and G strep
Management
 Cellulitis is a serious infection that needs to
be treated with antibiotics
 Keep area elevated
 Periorbital / severe cellulitis refer to hospital
 Consider swab of moist lesion if high risk of
recurrence or MRSA
Impetigo
 Impetigo (or school sores) is characterised
by small infectious blisters, which later
develop a honey coloured scab like crust
Impetigo
Causes
 May be caught from other person with
impetigo or boils or may ‘appear out of the
blue’
 Often starts at sight of minor injury
 Most common pathogens Strep.pyogenes,
Staph.aureus
Management
 Consider swab of moist lesion if risk of
recurrence or complicated factors
 Localised staph infections may be managed
using wound care and antiseptics for local
application
 Routine use of topical antibiotics e.g. fucidic
acid or mupirocin is not advised due to
increasingly resistant forms of staph
Boils / abscess
 Boils are a deep infection of the hair follicles
and present as one or more tender red spots,
lumps or pustules
 An abscess is a cavity containing pus which
may also have surrounding cellulitis of the
skin and tissue
 Staph aureus is common pathogen
Boil and infected scratch
Management
 Swab at least one moist lesion
 Localised infections can be managed with
wound care (including I&D of large boils &
abscesses)
 Routine use of topical antibiotics e.g. fucidic
acid or mupirocin is not advised due to
increasingly resistant forms of staph
 Use a/bs if fever, cellulitis or co-morbidity e.g.
eczema
Scabies
 Scabies is a skin infestation that can be
passed easily between people
 Caused by tiny mites
 The mites burrow into the upper layers of the
skin and lay eggs along the way
 Small blisters, red spots and itchy red
patches form on the skin above the burrows
Causes
 Almost always acquired by skin to skin
contact
 Occasionally acquired by bedding or
furnishing – as mite can survive few days off
human host
Symptoms
 Rash small areas of red, itchy bumps and
blisters most often noticed:
 Between the fingers
 On the wrist
 On the elbow
 Around the waist
 On the bottom and private parts
 Can lead to secondary infection
Scabies
Treatment
 Scabicides – chemical insecticides used to
treat scabies
 In NZ most common are:
 5% Permethrin cream
 0.5% Aqueous malathion lotion, left for 24
hours
 See scabies fact sheet
Treatment and prevention
 All people living in the household, and other
close contacts, should be treated at the same
time whether or not they have symptoms of
scabies
 On the same day as applying the treatment,
all clothes worn against the skin in the last 3
days must be washed in hot water and dried
Bedding and towels
 Sheets, pillowcases, towels and face-cloths
should also be washed in hot water
 It is not necessary to wash blankets, duvets
or quilts, you can just hang them out in the
sun for a day
Key prevention messages
 Skin infections are preventable
 If left untreated skin infections can lead to
serious health problems
 Serious skin infections are a major cause of
avoidable hospitalisations in New Zealand
Healthy skin messages
 Wash and dry hands with soap and water
often
 Keep skin clean with regular showers
 Clean wounds and hands, Cut fingernails
and Cover injuries
Healthy skin messages
 Healthy food and adequate sleep is important
for healthy skin
 Skin infections often start with an insect bite –
treat animals for fleas regularly
 Wear clean clothes
 Keep house clean inside and out
 Wash sheets and towels regularly
Action messages
 Families / whanau / individuals should be
advised to seek medical attention if a sore or
area of redness has any of the following
features….
Action messages
 Is greater than the size of a ten cent coin
(approximately 1.5cm)
 Increasing size
 Has pus
 Has red streaks coming from it
 Is not getting better within two days
 Is located close to the eye
www.healthshare.health.nz/public/skin-conditionsresources
Further information…
 Healthy skin resources are available to
download from :
 http://www.ttophs.govt.nz/healthyskin_resourc
es
 http://www.healthliteracy.org.nz/researchand-projects/
 www.healthshare.health.nz/public/skinconditions-resources