Management of Skin and Soft-Tissue Infections in the Emergency Department

Abrahamian, Fredrick M.; Talan, David A.; Moran, Gregory J.

doi:10.1016/j.idc.2007.12.001

Cited by 55 publications

(35 citation statements)

References 115 publications

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“…126 The most common causes of uncomplicated skin and soft tissue infections are group A bhemolytic Streptococcus and Staphylococcus aureus bacteria. [197][198][199][200][201][202] Data from the SENTRY Antimicrobial Surveillance Program monitoring skin and soft tissue infections indicated that S aureus was the most common pathogen among complicated and hospitalized patients, followed by Pseudomonas aeruginosa, Enterococcus, Escherichia coli, Enterobacter, Klebsiella, and Streptococcus.…”

Section: Identification Of Infection and Adverse Reactionsmentioning

confidence: 99%

National Athletic Trainers' Association Position Statement: Management of Acute Skin Trauma

Beam

Buckley

Holcomb

et al. 2016

Journal of Athletic Training

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Objective: To present recommendations for the cleansing, debridement, dressing, and monitoring of acute skin trauma in patients.Background: Acute skin trauma is common during participation in athletic and recreational activities. Clinical decisions and intervention protocols after injury vary among athletic trainers and are often based on ritualistic practices. An understanding of cleansing, debridement, and dressing techniques; clinical features of infection and adverse reactions; and monitoring of acute skin trauma is critical for certified athletic trainers and other allied health and medical professionals to create a local wound environment that promotes healing and lessens the risk of complications.Recommendations: These guidelines are intended to provide the certified athletic trainer and others participating in athletic health care with specific knowledge about and recommendations for the management of acute skin trauma.Key Words: abrasions, avulsions, blisters, incisions, lacerations, punctures, cleansing, debridement, nonocclusive dressings, occlusive dressings, infection, adverse reactions T raumatic injury to the skin is common among athletes participating in all sports.1 The exact frequencies of abrasions, avulsions, blisters, incisions, lacerations, and punctures are difficult to calculate because many patients do not seek medical attention after injury; for others, their activity level is initially unaffected, and the injury is not recorded on surveillance reports. Unreported skin trauma and inappropriate wound management can result in delayed healing, cross-contamination, bacterial colonization, and infection, adversely affecting the overall health and playing status of the patient. Managing acute skin trauma through appropriate cleansing, debridement, and dressing techniques can create an environment conducive to healing and lessen the risk of complications. 2,3Wound-management techniques have undergone drastic changes over the last 50 years, and other allied health care professions, organizations, and facilities have developed guidelines that serve as standards of care. [4][5][6] However, guidelines for the management of acute skin trauma by athletic trainers (ATs) are limited in the literature.1,7 The development and implementation of cleansing, debridement, and dressing techniques for acute skin trauma are critical for ATs to successfully deliver health care services to patients. The following review and recommendations provide information on the management of acute skin trauma and guidelines for ATs and other allied health and medical professionals who care for patients. RECOMMENDATIONSThis position statement is based on current research and literature with regard to the cleansing, debridement, dressing, and monitoring of acute skin trauma. We independently categorized the studies and literature using the Strength of Recommendation Taxonomy (SORT) developed by the American Academy of Family Physicians. 8 The taxonomy grades the quality of the data from the literature (level of evidence) and p...

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Section: Identification Of Infection and Adverse Reactionsmentioning

confidence: 99%

National Athletic Trainers' Association Position Statement: Management of Acute Skin Trauma

Beam

Buckley

Holcomb

et al. 2016

Journal of Athletic Training

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“…4,5 We found no clinical data on the validity or reliability of documenting response to therapy despite many recent published reviews on the topic of SSTIs. [6][7][8][9][10][11] There is a paucity of data to guide physicians on when to switch to oral therapy, 12 and the only available guidelines are based on expert opinion from the Clinical Resource Efficiency Support Team (CREST) in 2005. 13 These guidelines suggest switching to oral therapy under the following conditions: diminishing pyrexia, less intense erythema, falling inflammatory markers, and stable comorbidities.…”

Section: Ré Sumémentioning

confidence: 99%

“…All subjects in both arms of the trial received six-and seven-item satisfaction questionnaires Photodocumentation to document soft tissue infection in the ED 2013;15 (6) 347 CJEM N JCMU at their initial assessment (at institution of OPAT) and at the final assessment (discharge from OPAT and/or transition to oral step-down therapy), respectively. These were administered either by the nurse taking care of the patient or the research assistant.…”

Section: Data Collectionmentioning

confidence: 99%

Photodocumentation as an emergency department documentation tool in soft tissue infection: a randomized trial

Lund

Joo

Lewis

et al. 2013

CJEM

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Objectives: Current documentation methods for patients with skin and soft tissue infections receiving outpatient parenteral anti-infective therapy (OPAT) include written descriptions and drawings of the infection that may inadequately communicate clinical status. We undertook a study to determine whether photodocumentation (PD) improves the duration of outpatient treatment of skin and soft tissue infections. Methods: A single-blinded, prospective, randomized trial was conducted in the emergency departments of a community hospital and an academic tertiary centre. Participants included consecutive patients age $ 14 years presenting with noninvasive skin and soft tissue infections requiring OPAT. Patients in the intervention arm were treated with standard of care plus PD at each emergency physician assessment. Control subjects received care provided at the discretion of the treating physician and non-photographic documentation. The primary outcome was duration of therapy measured in half-days. The required sample size to detect a difference of one half-day was 253 patients per group (a 5 0.05). Secondary outcomes included (1) completion and therapeutic failure rates, (2) patient satisfaction, and (3) physician and nurse satisfaction. Results: Enrolment was slower and follow-up rates lower than anticipated, and the trial was terminated when funds were exhausted. A total of 468 subjects with similar age and gender characteristics were enrolled, with 244 receiving the intervention and 224 in the control arm. The mean OPAT duration was similar in the two groups (3.6 days v. 3.5 days, p 5 0.73). No differences in the rate for completion and therapeutic failure were observed (71% v. 68% and , 1% for both, respectively). Survey response rates varied significantly: patients, 65%; nurses, 17%; and physicians, 87%. Physicians endorsed more comfort with their assessment and OPAT judgment with PD (65% and 64%, respectively).Physicians cited too much time lost with technological challenges, which would affect implementation in a busy ED. Conclusions: PD as an intervention is acceptable to patients and has reasonable endorsement by the majority of physicians. This trial had significant limitations that threatened the integrity of the study, so the results are inconclusive. RÉ SUMÉObjectif: Les moyens actuels de documentation des infections de la peau et des tissus mous chez les patients soumis à un traitement anti-infectieux parenté ral ambulatoire (TAIPA) comprennent les descriptions é crites et les croquis des tissus infecté s, mais ces moyens peuvent ne pas rendre pleinement l'é tat clinique. Aussi avons-nous mené une é tude visant à dé terminer si la photodocumentation (PD) pouvait amé liorer la duré e du traitement des infections de la peau et des tissus mous chez les patients externes. Mé thode: Un essai prospectif, à ré partition alé atoire, et à simple insu a é té mené au service des urgences d'un hô pital communautaire et d'un centre hospitalier universitaire de soins tertiaires. Ont participé à l'essai des pati...

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“…La flora transitoria posee microorganismos patógenos, como Staphylococcus aureus (S. aureus), Streptococcus pyogenes (SBHGA), especies de Candida, etc. 1 De acuerdo con el compartimiento de la piel involucrada en las infecciones de piel y partes blandas (IPPB), se clasifican en impétigo y foliculitis (epidermis), erisipela y forúnculo (epidermis y dermis), celulitis (celular subcutáneo) y celulitis necrotizantes (celular subcutáneo hasta fascia muscular) (Gráfico 1).…”

Section: Introductionunclassified

“…1,5,6 Por lo tanto, es importante considerar, frente a un paciente con una infección de piel y partes blandas, los siguientes aspectos para su correcto manejo: 1) historia de contacto con animales, viajes, etc. ; 2) antecedentes o presencia de infecciones en contactos familiares; 3) estado clínico e inmunológico del huésped; 4) síntomas del paciente; 5) apariencia general del sitio de infección; 6) agentes infecciosos más frecuentes y sus patrones de sensibilidad antibiótica.…”

Section: Introductionunclassified

Infecciones de piel y partes blandas en pediatría: consenso sobre diagnóstico y tratamiento

Infectología¹

2014

Arch Argent Pediat

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Management of Skin and Soft-Tissue Infections in the Emergency Department

Cited by 55 publications

References 115 publications

National Athletic Trainers' Association Position Statement: Management of Acute Skin Trauma

National Athletic Trainers' Association Position Statement: Management of Acute Skin Trauma

Photodocumentation as an emergency department documentation tool in soft tissue infection: a randomized trial

Infecciones de piel y partes blandas en pediatría: consenso sobre diagnóstico y tratamiento

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