Download STAPHYLOCOCCAL SCALDED SKIN SYNDROME

Starship Children’s Health Clinical Guideline
Note:
The electronic version of this guideline is the version currently in use. Any printed version can
not be assumed to be current. Please remember to read our disclaimer.
STAPHYLOCOCCAL SCALDED SKIN SYNDROME
•
•
Clinical Features
Management
•
•
Nursing protocol
References
Clinical Features
Certain strains of Staphylococcus aureus produce exfoliative toxins. In young infants, and in those
with renal impairment, these can accumulate and result in widespread exfoliation of the skin known
as Staphylococcal scalded skin syndrome (SSSS).
The initial infection is often minor or undetected.
Prodrome - malaise, irritability, fever, severe skin tenderness.
Erythema usually begins on the head and spreads, particularly involving the skin folds. The skin is
fragile and the superficial layers shear off easily with minor pressure. During this time the infant is
at risk of significant fluid loss though the skin, secondary infection and may experience severe pain
as with a burn.
After several days the skin desquamates and then heals without scarring.
Management
Infants with SSSS should be admitted for appropriate fluid administration & monitoring, antibiotic
and pain management.
Fluids: IV, NG or oral fluids should be administered as needed to provide to maintenance
requirements and allow for excess losses through the skin. Close attention should be paid to urine
output and weight.
Antibiotics: Swabs should be taken from areas of suspected infection. Anti-staphylococcal
antibiotics (e.g. flucloxacillin) should be administered. It is unusual for these infants to have
septicaemia.
Analgesia: regular analgesia should be administered to maintain the infant in a comfortable state.
This may include paracetamol, oral opiates or opiate infusions.
Some infants require admission to intensive care for fluid and analgesia management.
Caregivers should be asked about skin infections and be swabbed and treated as necessary to
eradicate carriers of toxin-releasing Staph.
Author:
Editor:
Dr Diana Purvis
Dr Raewyn Gavin
Staph Scalded Skin Syndrome
Service:
Date Issued:
Paediatric Dermatology.
March 2010
Page:
1 of 3
Starship Children’s Health Clinical Guideline
Note:
The electronic version of this guideline is the version currently in use. Any printed version can
not be assumed to be current. Please remember to read our disclaimer.
STAPHYLOCOCCAL SCALDED SKIN SYNDROME
Nursing protocol
protocol for SSSS
Action
On admission
Nose, throat and skin swabs for culture
and antibiotic sensitivities, include a
specific request for an MRSA screen
Baseline temperature, pulse, respiratory
rate and blood pressure, increase
frequency as indicated
Height and weight
Assess skin and record
Skin care
Daily bathing/washes; dependent on
mobility and fragility of the skin
Use an oily emollient in the water
Use a soap substitute such as aqueous
cream or emulsifying ointment
Dress denuded areas with Vaseline
Gauze soaked liberally in a 50:50 mixture
of white soft paraffin/liquid paraffin.
These are changed every 12-24hr
Secure with a loose tubegauz suit
Apply the 50:50 paraffin mix to all
exposed areas, in particular the face and
napkin area
As the dressings dry out, reapply the
50:50 paraffin mix to the Vaseline gauze
Eyes: at least 4-hourly eye care in the
acute period; apply eye ointment/drops
as prescribed
Mouth: 2-hourly mouth care if limited oral
intake and in the presence of mucosal
and lip involvement
Pressure area: nurse on a pressurerelieving mattress, monitor pressure
areas and position patient appropriately
Author:
Editor:
Dr Diana Purvis
Dr Raewyn Gavin
Staph Scalded Skin Syndrome
Rationale
For early detection of infection
To obtain the normal range and detect
deterioration of condition
To assess fluid loss, monitor weight loss
and calculate drug doses
To assess extent of condition and
monitor progress
To clean the skin
To prevent dryness
Normal soap too astringent
For comfort, to promote healing and to
protect denuded areas from infection and
further trauma
To keep dressings in situ
To protect these areas and prevent
further trauma
To maximize effectiveness of dressings
To prevent damage, infection and longterm complications
To prevent and/or improve mucosal and
lip involvement
To relieve pressure on the skin and
alleviate pain
Service:
Date Issued:
Paediatric Dermatology.
March 2010
Page:
2 of 3
Starship Children’s Health Clinical Guideline
Note:
The electronic version of this guideline is the version currently in use. Any printed version can
not be assumed to be current. Please remember to read our disclaimer.
STAPHYLOCOCCAL SCALDED SKIN SYNDROME
Action
Fluid and electrolyte balance
Administer IV replacement fluid as
prescribed
Secure cannula with non-adhesive
tape/dressing and bandage well
Careful fluid balance monitoring essential
Consider urinary catheter for painful
micturition and/or urine retention
Nutrition
Encourage/initiate enteral feeding
If a nasogastric tube is required, secure
with a tubular bandage or non-adhesive
tape
Involve dietician for assessment and
guidance
Pain relief
Ensure adequate analgesia is
administered, consider i.v. analgesics
with extensive skin involvement
General measures
Minimal handling
Provide constant environmental
temperature where possible (30-32° is
optimum)
Monitor core temperature closely
Nurse under strict infectious and
protective precautions in a cubicle
Give practical and emotional support to
the child and family
Discharge planning
Teach the parents/carer the skin care
regimen to be continued at home
Rationale
To correct fluid, electrolyte and protein
loss and prevent dehydration, renal
failure and shock
Adhesive tapes/band-aid plasters will
damage fragile skin
To ensure correct fluid balance and to
observe for urinary retention
To normalise urine output and reduce
pain on micturition
To prevent weight loss, protein loss and
promote wound healing
Adhesive tape will damage fragile skin
To ensure optimum dietary intake
To ensure child is pain free, extensive
skin loss causes high levels of pain that
may be difficult to control with oral
analgesics alone
To prevent pain and damage to the skin
Temperature regulation is compromised
due to extensive skin loss
Skin temperature is unreliable; at risk of
hypothermia because of excess heat loss
To protect against further sepsis
Child and family may experience high
levels of distress
To sustain recovery
References
Textbook of Pediatric Dermatology, 2nd edition, Blackwell Science, 2006. Editors: JI Harper, A
Oranje, N Prose.
Author:
Editor:
Dr Diana Purvis
Dr Raewyn Gavin
Staph Scalded Skin Syndrome
Service:
Date Issued:
Paediatric Dermatology.
March 2010
Page:
3 of 3