1. Healthy Skin and Skin Infections
Updated February 2015

2. 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

3. 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

4. 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

5. 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

6. 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

7. Inequities
Through the organised efforts of society…inequities are avoidable and fixable
‘differences which are unnecessary and avoidable, but in addition are consider unfair and unjust’ - Whitehead M The concepts and principles of equity and health.
International Journal of Health Services 22: 429–445. p. 431
Equity, like fairness, is an ethical concept based in a model of justice where distribution of resources ensures everyone has at least their minimum requirements.
It does not necessarily mean that resources are equally shared; rather, it acknowledges that sometimes different resourcing is needed in order that different groups enjoy equitable health outcomes. Robson B, Harris R. (eds). Hauora: Màori Standards of Health IV. A study of the years
2000–2005. Wellington: Te Ròpù Rangahau Hauora a Eru Pòmare. Pg 4

8. Incidence of SSI in children aged 0-14yrs in NZ and the Midland region – by DHB

9. Incidence of SSI in children aged 0-14 years in NZ and the Midland region – by DHB – Māori

10. Incidence of serious skin infection 0-14 years in NZ – Maori vs non-Maori

11. Incidence of serious skin infection in Maori children in the Midland Region

12. 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

13. 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

14. Cellulitis

15. 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

16. 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

17. Impetigo
Impetigo (or school sores) is characterised by small infectious blisters, which later develop a honey coloured scab like crust
Shared Services Conference 1997

18. Impetigo

19. 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

20. 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

21. 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

22. Boil and infected scratch
Shared Services Conference 1997

23. 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

24. 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

25. Scabies

26. Causes Almost always acquired by skin to skin contact
Occasionally acquired by bedding or furnishing – as mite can survive few days off human host

27. 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

28. 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

29. 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

31. 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

32. 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

33. 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

34. 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

36. 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

38. 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

39. 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

42. Further information…
Healthy skin resources are available to download from many different websites, some suggestions:
HealthShare webpage when its sorted!