Note:
Issue date
Standing Order Name:
Impetigo
Rationale:
To ensure prompt and appropriate treatment of impetigo to help prevent spread.
Scope (condition and patient group):
Adults and children who are diagnosed as having impetigo.
Red Flags:
Systemic infection and painful lesions
Assessment:
1. Bullous and non-bullous are the two types of impetigo. Non-bullous (most common) lesions begin as a vesicle that ruptures and the contents dry to form a gold-coloured plaque. These lesions are often 2 cm in diameter and most frequently affect the face (especially around the mouth and nose) and limbs.2. Systemic signs are usually not present however with extensive impetigo, fever and regional lymphadenopathy may occur.3. Impetigo is usually diagnosed clinically and treatment decisions are rarely based on the results of skin swabs. 4. Swabs may be required for recurrent infections, treatment failure with oral antibiotics or where there is a community outbreak and the cause needs to be identified. For recurrent impetigo nasal swabs can identify staphylococcal nasal carriage requiring specific management.
Indication:
Topical antiseptic cream for treatment of minor skin lesions
Medicine:
Hydrogen peroxide 1% (crystaderm)
Dosage instructions:
Apply to lesions 2-3 x daily for 7 days.
Route of administration:
Topical
Quantity to be given:
1 x original pack
Contraindications:
Hypersensitivity to hydrogen peroxide
Precautions:
Avoid in eyes and healthy skin. Bleaches fabric
Additional information:
If parents or patients want to remove crusts they may do so by soaking a clean cloth in a mixture of ½ cup of white vinegar in 1 litre of tepid water and apply cloth to area for 10 minutes before gently wiping away crusts. Advise of the following due to the highly contagious nature of impetigo: Wash hands after contact with lesions. Avoid close contact with others. Use separate towels and face cloths. Children should stay away from school or day care until lesions have crusted over or antibiotics have been given >24 hours.
Follow-up:
Patients or parents should be advised to return for re-assessment if: the lesions are not healing following the course of antibiotic treatment (healing lesions will be dry), the lesions continue to spread or become painful, development of systemic symptoms, such as fever.
Countersigning and auditing:
Countersigning is not required. Audited monthly. OR Countersigning is required within XX days
Competency/training requirements:
All nurses working under this standing order must be signed off as competent to do so by the issuer and have had specific training in this standing order.
Supporting documentation:
Healthpathways at www.healthpathways.org.nz
Definition of terms used in standing order:
None
Name:
______________________________
Signature:
__________________________
Title:
______________________________
Date:
_________________
Nurses operating under this standing order:
Only Registered nurses working within the above medical centre or clinic are authorised to administer medication under this standing order. We the undersigned agree that we have read, understood and will comply with this standing order and all associated documents.
