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

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.