Registered nurse assessment and treatment of skin sepsis in New Zealand schools: the development of protocols.

Abstract

BACKGROUND:

Skin infection is the commonest medical cause of hospitalisation in school children. Disadvantaged children, usually Maori or Pacific, have high rates of preventable diseases.

AIM:

To improve access to early treatment for skin infections using nurse-led school clinics in South Auckland, including provision of antibiotics under delegated standing orders.

METHOD:

Evidence-based protocols for the recognition and treatment of skin sepsis were developed following a literature search. A training package was developed for health professionals involved and outcome data were collected from a pilot study in which the protocols were trialled.

RESULTS:

An algorithm for diagnosis of skin infections was adapted from Steer et al (Bull World Health Organ. 2009;87:173-9). Fusidic acid ointment was recommended as first-line treatment for localised impetigo. Twice daily oral cephalexin was recommended for extensive impetigo and cellulitis, for palatability and simplicity of dosing. Fifty-six episodes of skin infection received treatment under standing orders in the first 15 weeks of the pilot study.

CONCLUSION:

Robust evidence to determine optimal choice, dosage and duration of antibiotic therapy for skin sepsis in children is lacking. The algorithms described are consistent with available evidence and provide a pragmatic approach for use in registered nurse (RN)-led school clinics.

• Authors: Alison M Vogel, Diana R Lennon, Sarah Gray, Elizabeth Farrell, Philippa Anderson
• Journal: The New Zealand medical journal (N Z Med J) Vol. 126 Issue 1380 Pg. 27-38 (Aug 16 2013) ISSN: 1175-8716 [Electronic] New Zealand
• PMID: 24126747 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Infective Agents

Topics

• Adolescent
• Algorithms
• Anti-Infective Agents (therapeutic use)
• Child
• Child, Preschool
• Clinical Protocols
• Evidence-Based Medicine
• Female
• Humans
• Infant
• Infant, Newborn
• Male
• New Zealand (epidemiology)
• Nursing Assessment
• Pilot Projects
• Practice Guidelines as Topic
• Prevalence
• School Nursing
• Skin Diseases, Infectious (epidemiology, nursing)