What are boils, abscesses, and cellulitis?
Boils, abscesses, and cellulitis are bacterial infections of the skin that usually begin from a scratch or bug bite and may progress to a red nodule that fills with pus.
What are the signs or symptoms?
Abscesses and boils tend to be softer in the middle over the fluid or pus than at the edges. They may drain when the skin over the infected area opens and lets the fluid or pus out. Signs of cellulitis include areas of redness and skin tenderness. The skin over these infections is usually warmer than the surrounding normal areas of skin because of the body’s reaction to the infection. It is not necessary to distinguish among these skin infections because the steps to manage them are often similar.
What are the incubation and contagious periods?
The incubation period for these skin infections is unknown. Boils, abscesses, and cellulitis are typically caused by common skin bacteria such as
How are they spread?
Person-to-person contact with pus and skin bacteria and, to a lesser extent, contaminated environmental surfaces and objects
How do you control them?
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Use good hand-hygiene technique at all the times listed in Chapter 2 of
Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition . -
Skin conditions that cause breaks in the skin, such as eczema, increase the risk for having a skin infection and passing this on to others. Educators with eczema on their hands should maintain good eczema control. They should ask their health professional how to prevent dry or cracked skin while continuing to perform required frequent hand hygiene. Also, they should ask whether they need to wear gloves during activities that involve touching the skin of the children. For children who have eczema, use a care plan that involves the child’s family and pediatric health professional to control this skin condition.
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Cover lesions if they are draining.
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Obtaining cultures from children who do not have infections to determine whether they harbor MRSA in their noses or throats or on their skin is not indicated.
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Children who have a skin infection may need antibiotic treatment for tissue infections. Small abscesses may be drained surgically without antibiotics. If antibiotics are prescribed, they should be given according to the pediatric health professional’s instructions on the prescription label.
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If more than one child in the program experiences skin infections that require surgical drainage or antibiotics, contact the Child Care Health Consultant or local health department.
What are the roles of the educator and the family?
When changing bandages or dressings, use Standard Precautions (see Chapter 2 of
Exclude from educational setting?
No, unless
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The child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for the health and safety of the other children in the group.
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The child meets other exclusion criteria (see Conditions Requiring Temporary Exclusion in Chapter 4 of
Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition ). -
A draining lesion cannot be covered with a clean, dry dressing, or the covering cannot be maintained because the drainage comes through the covering to contaminate other surfaces.
Readmit to educational setting?
Yes, when all the following criteria are met:
When exclusion criteria are resolved, the child is able to participate, and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group
Comments
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Having a MRSA infection, or harboring MRSA bacteria (carrier), is not a reason for exclusion.
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Occasionally, multiple people within a family or early childhood education setting may become recurrently infected with boils or abscesses. This may be due to
S aureus (MRSA or other types). -
Using nasal antibiotic ointment and special cleansers (chlorhexidine or bleach in bathwater) may reduce repeated staphylococcal infections within families. However, reexposure can occur because
Staphylococcus commonly lives on the skin and in the noses of noninfected (colonized) individuals in the community. These treatments should only be used under the guidance of a health professional.
Disclaimer
Adapted from
The American Academy of Pediatrics (AAP) is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.
Any websites, brand names, products, or manufacturers are mentioned for informational and identification purposes only and do not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication. The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
