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 ‘differences which are unnecessary and avoidable, but in addition are consider unfair and unjust’ - Whitehead M. 1992. 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

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-child-and-youth-clinical-networks/eczema HealthShare webpage when its sorted!