Skin Infestations And Infections In Aged Care

Did you know that skin problems are incredibly common in aged care settings? It's an issue that often flies under the radar, yet it profoundly affects the well-being of aged care residents. These conditions, ranging from irritating infestations to serious infections, can lead to significant discomfort, pain, and even life-threatening complications. By highlighting this topic, we can work toward better care and healthier outcomes for our residents.

As individuals age, their skin undergoes several significant changes. The epidermis (outer layer) thins, reducing its function as a protective barrier against external aggressors. Sebaceous glands produce less oil, leading to dryness and increased susceptibility to cracking. The dermis (deeper layer) loses elasticity due to decreased collagen and elastin production, compromising its resilience. These changes, as highlighted by the Australian Department of Health, make our residents more vulnerable to irritants, allergens, and pathogens. Furthermore, underlying health conditions prevalent in older populations, such as diabetes, circulatory problems, and weakened immune systems, can further compromise skin health, and impair wound healing. Conditions such as malnutrition and nutritional deficiencies further compromise the skin's integrity and make older adults even more vulnerable to various skin conditions.

• Structural and metabolic changes in the skin include thinning, decreased antimicrobial protection, and reduced barrier function.
• Underlying conditions such as diabetes and poor circulation contribute to skin issues like stasis dermatitis- (fluid buildup in the lower legs causing inflammation).
• Photoaging from ultraviolet radiation exposure can also cause skin changes and increase the risk of certain conditions, particularly in exposed areas of skin.

Infections can be caused by bacteria, fungi, or viruses
Fungal Infections: These opportunistic infections thrive in warm, moist environments, making skin folds, feet, and groin areas particularly susceptible. Common examples include:

• Tinea Pedis (Athlete's Foot): Characterised by itching, burning, and scaling between the toes, often accompanied by cracking and fissures.
• Tinea Cruris (Jock Itch): Affecting the groin area, causing redness, itching, and burning. Treatment for tinea is with topical antifungal creams.
• Candidiasis: A yeast infection caused by Candida albicans, commonly manifesting as thrush (oral candidiasis), intertrigo (in skin folds), onychial (associated with the nails) or genital candidiasis. Treatment is with topical antifungal creams or systemic antifungal medication.

Bacterial Infections: These can range in severity:

• Impetigo: A highly contagious bacterial infection, typically caused by Staphylococcus aureus or Streptococcus pyogenes, characterised by honey-coloured crusting sores and blisters, often on the face. Treatment with antibiotics may be required.
• Cellulitis: A deeper skin infection involving the dermis and subcutaneous tissues, usually caused by bacteria entering through a break in the skin. It presents as redness, swelling, pain, warmth, and sometimes fever and chills. It can often present with erysipelas, an infection of the dermis and upper subcutaneous tissues. Cellulitis requires prompt medical attention due to the risk of serious complications. Treatment is often required with local or systemic antibiotics.

Viral Infections: Shingles is a viral infection caused by the reactivation of the varicella-zoster virus (the same virus that causes chickenpox), resulting in a painful rash with blisters, typically along a dermatome (a nerve pathway). Shingles can be prevented through vaccination, which is recommended for older populations.

Prevention is paramount when it comes to managing skin disorders in aged care. A multi-faceted approach is essential, implementing effective preventive measures is crucial for minimising the risk of skin infestations and infections. Preventive strategies include regular skin checks, good hygiene, and environmental controls. Here are some practical strategies:

Prevention Strategies: A Multi-Pronged Approach
Implementing effective preventative measures is crucial for minimising the risk of skin infestations and infections:

• Hygiene: Regular bathing with mild, pH-balanced soap, paying particular attention to skin folds and thorough drying afterwards, is essential. Assist as needed to ensure proper hygiene practices are followed.
• Moisturising: Regular application of emollients helps prevent dry skin and cracking, reducing the risk of infection. Choose fragrance-free and hypoallergenic moisturisers.
• Infection Control: Strict adherence to infection control protocols is vital, including regular cleaning and disinfection of shared equipment and surfaces, proper hand hygiene for staff and residents, and prompt isolation of individuals with suspected or confirmed infections.
• Early Detection: Regular skin assessments are necessary to identify any changes such as redness, itching, rashes, or other abnormalities. Make visual inspections during personal care routines. Early intervention can prevent the spread of infestations and infections. Ensure residents receive regular skin checks.
• Sun Protection: Protecting residents from excessive sun exposure is important, even on cloudy days. This includes the use of broad-spectrum sunscreen with a high SPF, hats, and protective clothing. Seek shade during peak sun hours.
• Nutrition and Hydration: Adequate nutrition and hydration play a vital role in maintaining skin health. Ensure residents have access to a balanced diet and sufficient fluids.
• Environmental Cleaning: Regular and thorough cleaning of bedding, rooms, kitchens, and communal areas helps to minimise the spread of microorganisms.
• Linen Handling: Correct handling and washing of linen is essential to prevent cross-contamination.
• Standard Precautions: These practices must be always used and include hand hygiene, use of appropriate personal protective equipment (PPE), aseptic technique, and waste management.
• Transmission-Based Precautions: Used in addition to standard precautions when a resident is suspected of or diagnosed with an infection. These will be based on the organism and how it will spread within a facility.
• Immunisations: Ensuring residents and staff receive recommended vaccines to protect against various infections.

When skin issues arise, prompt medical consultation is essential for accurate diagnosis and effective treatment. Treatment plans should be individualised and may include:

• Medications: Depending on the specific condition, medications such as topical or systemic antibiotics for bacterial infections, antifungals for fungal infections, and antiviral medications for viral infections.
• Adherence to Treatment Plans: Following prescribed treatment regimens, including medications (e.g., topical creams, antibiotics, antivirals) and wound care instructions, is critical for effective management and preventing recurrence.
• Wound Care: Proper wound management is critical for preventing infection, promoting healing, and reducing pain. This includes keeping wounds clean, applying appropriate dressings, and, when necessary, removing non-viable tissue.
• Antimicrobial Stewardship: It’s crucial to use antimicrobials appropriately to avoid antimicrobial resistance. This includes only using antibiotics when necessary for bacterial infections, not viral infections. A correct diagnosis is therefore important for treatment.
• Communication: Open communication between staff, residents, families, and healthcare providers is vital for coordinated care.
• Individualised Skincare Plans: These should address specific needs and might include emollients, moisturisers, and barrier creams, as well as appropriate care for conditions like xerosis (dry skin).
• Nutritional Support: Ensuring proper nutrition is vital for maintaining healthy skin and promoting healing.

Taking care of the skin in aged care requires a proactive, collaborative approach involving staff, residents, and families. By implementing the strategies outlined in this post and referencing the Aged Care Infection Prevention and Control Guide and the Australian Guidelines for the Prevention and Control of Infection in Healthcare, we can significantly reduce the incidence and impact of skin infestations and infections. This includes developing policies and guidelines that reflect national standards. Regular staff training, consistent skin checks, and prompt medical intervention are key to protecting the health and well-being of residents.

For further information and resources on skin health in aged care, please consult the relevant Australian/New Zealand health authorities e.g., the Australian Department of Health, the New Zealand Ministry of Health, or relevant dermatological associations. We encourage you to subscribe to our newsletter for regular updates and best practice guidelines on aged care. Sharing this information with your team is essential for ensuring consistent and effective skincare for all residents. Consider:

• Reviewing and Updating Policies: Ensure your aged care facility's current infection control policies reflect best practices. If challenging, subscribe to the HUB for information and assistance to update your policies.
• Staff Training: Provide ongoing training for all staff on the early identification and management of skin issues.
• Family Involvement: Engage families in understanding and supporting the skin care plans of their loved ones.

HAPPY SKIN, HAPPY RESIDENT
HAPPY RESIDENT, HAPPY FACILITY!