Transcript Healthy Skin and Skin Infections

Healthy Skin and
Skin Infections
Updated February 2015
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
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
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
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
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/national-childand-youth-clinical-networks/eczema
 HealthShare webpage when its sorted!