Healthy Skin and Skin Infections Prepared by the Midland Region Child Health Action Group Skin Subgroup
Objectives of this presentation This presentation will: Support health professional knowledge development Provide an introduction and background into healthy skin and skin infections Discuss recent Midland Region skin infections report, analysis and recommendations Discuss serious skin infections, causes and management Provide key prevention messages and resources Shared Services Conference 1997
Functions of Skin Skin is an amazing organ: It covers and protects Helps to maintain correct temperature Provides a sense of touch Skin also protects against infections However, the skin may become infected leading to serious health problems Shared Services Conference 1997
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
Midland SSI analysis (2001-2012) Preliminary work has demonstrated that Midland DHBs have very high rates of skin conditions/infections in comparison to the rest of NZ SSIs are a significant component of the Ambulatory-Sensitive Hospitalisation (ASH) rates This represents significant disease burden and cost for our populations Shared Services Conference 1997
Midland SSI analysis (2001-2012) There are compelling reasons for the focus on skin conditions in the Midland region The following graphs illustrate the high levels of skin infections in the Midland region in relation to NZ rates And the significant inequity between Māori and non-māori Shared Services Conference 1997
Inequities Through the organised efforts of society inequities are avoidable and fixable
Incidence of SSI in children aged 0-14yrs in NZ and the Midland region by DHB
Incidence of SSI in children aged 0-14 years in NZ and the Midland region by DHB Māori
Incidence of serious skin infection 0-14 years in NZ Maori vs non-maori
Incidence of serious skin infection in Maori children in the Midland Region
Recommendations SSI prevention and management be prioritised in relevant organisational work plans Intervention should focus on Māori children aged 0 4 years Prevention and earlier detection, intervention and treatment should be part of any care pathway Resources provided assist organisations to decrease the incidence of 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, dry or cracked e.g. from a sore, insect bite, boil, rash, cut, burn, graze or eczema 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 Shared Services Conference 1997
Impetigo Impetigo (or school sores) is characterised by small infectious blisters, which later develop a honey coloured scab like crust Shared Services Conference 1997
Impetigo
Causes May be caught from other person with impetigo or boils or may appear out of the blue Often starts at site 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 Shared Services Conference 1997
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 Shared Services Conference 1997
Scabies
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
Symptoms Itch - the scabies rash is usually intensely itchy The itch is typically more severe at night, sometimes making it difficult to sleep Can lead to secondary infection
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 Shared Services Conference 1997
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. Shared Services Conference 1997
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
Further information Healthy skin resources are available to download from many different websites, some suggestions: http://www.ttophs.govt.nz/healthyskin_resources http://www.healthliteracy.org.nz/research-and-projects/ www.healthnavigator.org.nz/health-topics/skin-infections/ https://www.starship.org.nz/for-health-professionals/nationalchild-and-youth-clinical-networks/eczema HealthShare webpage when its sorted!
Shared Services Conference 1997