COMMON BACTERIAL INFECTIONS – IMPETIGO (Clinical Manifestations, Nursing Manifestations)

IMPETIGO

Impetigo is superficial skin infection caused by staphylococci, streptococci or multiple bacteria. It involves exposed areas of body, face, hands, neck and extremities. It is often called school sores because it most often affects children. It is quite contagious.

Primary impetigo occurs due to poor hygiene and malnutrition. Secondary impetigo occurs due to pediculosis capitis (head lice scabies, herpes simplex, insect bite or eczema)

Pullous Impetigo: staphylococcus aureus cause this superficial infection. It is characterized by formation of bullae from original vesicles. They rupture and leave a raw, red area.

 

CLINICAL MANIFESTATIONS

Impetigo presents with pustules and round, oozing patches which grow larger day by day. They may be clear blisters (bullous impetigo) or golden yellow crusts.

Vesticulopustular lesions develop. Lesions are small, red macules, which becomes discrete, thin walled vesicles. They rupture and covered with honey-yellow crust. They are easily removed and reveal smooth, red, moist surface on which new crust develops soon. It most often occurs on exposed areas such as the hands and face, or in skin folds particularly the armpits

 

TREATMENT

1. Soak moist or crusted areas: soak a clean cloth in a mixture of half a cup of white vinegar in a litre of tepid water. Apply the compress to moist areas for about ten minutes several times a day. Gently wipe off the crusts.
2. Antiseptic or antibiotic ointment: If an antiseptic (povidone iodine, hydrogem peroxide cream, chlorhexidine and others) or antibiotic ointment (fusidic acid, mupirocin or retapamulin) is prescribed, apply it two or three times a day to the affected areas and surrounding skin. Look carefully for new lesions to treat. Continue for several days after healing.
   
3. Oral antibiotics: Oral antibiotics are recommended if infection is extensive, proviing slow to respond to topical antibiotics, or if impetigo is recurrent. The preferred antibiotic is penicillin antibiotic flucloxacillin. The complete course should be taken, usually at least 7 days.
   
4. Treat carrier sites: If impetigo is proving hard to get rid of, following measures may be useful:
   

• Apply an antibiotic ointment to the nostrils three times daily for 7 days.
• Wash daily with antibacterial soap/cleanser. Soak in bath containing small amount of bleach.
  
• Take a prolonged course of oral antibiotics
  
• Identify and treat the source of re-infection i.e. another infected person or carrier.
  
• The nostrils of a household contact may be a carrier site for pathogenic bacteria, without the person having any sign of infection.
  

NURSING MANAGEMENT

1. Instruct the family and patient to bathe daily at least once with soap.
2. Every person should have separate towel.
   
3. Infected child should be kept away from other family members to prevent spread of disease.
   
4. Cover the affected areas.
   
5. Avoid close contact with others.
   
6. Affected children must stay away from school unti; crusts have dried out.
   
7. Use separate towels and flannels.
   
8. Change and launder clothes and linen daily.
   
9. Keep fingernails short and clean. Glove or mitt hands as necessary to prevent scratching.
   
10. Patient must remain home until all lesions are healed.
    
11. Teach proper disposal or washing of any material that comes in contact with lesions.
    
12. Good hygiene must be practiced to prevent skin to skin or person to person spread.
    

COMMON BACTERIAL INFECTIONS – IMPETIGO (Clinical Manifestations, Nursing Manifestations)