Impetigo—Child Care and Schools

What is impetigo?

Impetigo is a common skin infection caused by group A Streptococcus (see Strep Throat [Streptococcal Pharyngitis] and Scarlet Fever Quick Reference Sheet) or staphylococcal bacteria (see Staphylococcus aureus [Methicillin-Resistant (MRSA) and Methicillin-Sensitive (MSSA)] Quick Reference Sheet).

What are the signs or symptoms?

Small, red or dark pimples or fluid-filled blisters (pustules) with crusted yellow scabs found most often on the face or on abraded areas anywhere on the body

What are the incubation and contagious periods?

• Incubation period: Variable. Bacteria that could cause impetigo commonly live harmlessly on the skin. Minor skin trauma may result in skin infections like impetigo.

• Contagious period: Until treatment (topical or oral antibiotic) is started for skin sores or the crusting lesions are no longer present.

How is it spread?

• Contact with the sores of an infected person or from contaminated surfaces.

• Germs enter an opening on skin (eg, cut, insect bite, burn, eczema) and cause oozing, leading to honey-colored crusted sores.

• Occurs year-round but most commonly in warm weather. Also occurs in cold weather when the skin around the nose and face is damaged by runny nasal secretions and nose wiping that irritates the skin.

How do you control it?

• Cover lesions, after which infected individuals should be treated with an appropriate antibiotic regimen (oral or topical) at the end of the day.

• 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.

• Clean or sanitize surfaces that are touched by hands frequently, such as toys, tables, and doorknobs, according to the Routine Schedule for Cleaning, Sanitizing, and Disinfecting in Chapter 8 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition.

• Clip fingernails to reduce further injury of tissues by scratching and subsequent spread through contaminated fingernails.

• In the event of an outbreak (more than one infected child or staff member in a group). Report outbreaks to the Child Care Health Consultant, if available, and to the local health department.

Impetigo. Crusted lesions inside and around nostrils start as red bumps.

COURTESY OF H. CODY MEISSNER, MD, FAAP

Person's nostrils and lips showing crusted yellow clustering lesions and red bumps inside the nostrils and around the upper lip.

What are the roles of the educator and the family?

• Consult the child's health professional for a treatment plan.

• Clean infected area.

• Use medication recommended by the child's health professional.

• When possible, loosely cover infected area to allow airflow for healing and avoid contact with others in educational settings.

• Wear gloves. Perform hand hygiene after coming into contact with sores or when changing bandages in the educational setting and at home.

• Launder contaminated clothing articles daily.

• In an outbreak, follow the directions of the local health department.

Exclude from educational setting?

Immediate exclusion is not necessary. Wash the affected area and cover the sores. Notify the parents/guardians that the child should see a health professional. If impetigo is confirmed, treatment (topical or oral antibiotic) should begin before returning. If treatment is started before the next day, no exclusion is necessary, but the child may be excluded until treatment has started.

Readmit to educational setting?

Yes, when all the following criteria are met:

• As long as the lesions are covered, the child can return once appropriate treatment has started (topical or oral antibiotic). When possible, lesions should be kept covered until they are dry.

• When 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.