Boil/Abscess/Cellulitis—Child Care and Schools

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. Boils are superficial infections with a thin layer of skin over fluid. Abscesses are generally larger and deeper with redness and painful swelling over an area filled with pus. Cellulitis is an infection within the skin and the area just beneath it; the skin is red and tender to touch. The area of cellulitis can spread quickly.

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 Staphylococcus and Streptococcus. These bacteria are present on the skin of most children and usually do not cause a problem. However, skin bacteria may cause infection when there is a break in the skin or the bacterial infection overpowers normal defenses against infection. People who carry the bacteria in their noses and throats and on their skin may pass the bacteria on to others. Having a methicillin-resistant Staphylococcus aureus (MRSA) skin infection is no more serious than other staphylococcal skin infections (see also Staphylococcus aureus [Methicillin-Resistant (MRSA) and Methicillin-Sensitive (MSSA)] Quick Reference Sheet). Regardless of the bacteria, these skin infections are considered contagious when the infected area is open and draining.

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?

• 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.

• Cover lesions if they are draining.

• 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.

• 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.

• 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 Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition ) and practice good hand hygiene.

Exclude from educational setting?

No, unless

• 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.

• 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