Last fall at the Rothenberg SBHC, many patients were treated during a local outbreak of bullous impetigo. This is a bacterial skin infection that presents as fluid filled blisters which rupture and ooze a clear yellow fluid before finally crusting over. It is spread easily between kids through direct contact with the bacteria. In total, there were 38 cases seen locally, 22 of which were treated at the SBHC.
During this time, there was close communication between the provider and the school nurse to help determine which antibiotics were effective in treating this particular bacteria. If the school nurse noticed that there were new lesions on a patient that the SBHC had already prescribed antibiotics, this information was given to the provider, which prompted a change in the antibiotic prescribed. When possible, cultures were obtained on oozing lesions, both at the school and at Children’s Hospital ED. The cultures confirmed that a few antibiotics commonly used to treat impetigo were not effective in treating this strain.
Because of the access to Children’s records that local providers have through EPIC and the daily communication between the provider at the SBHC and the school nurse, the best possible treatment for this outbreak of impetigo was determined. This information, along with other pertinent case information, was compiled by the school nurse at Rothenberg and reported directly to epidemiology at the Cincinnati Health Department. This resulted in informational letters being sent to local pediatricians and urgent cares/emergency rooms. The information given encouraged providers to presume resistance to commonly prescribed antibiotics that had shown resistance and, instead, treat patients with the most effective antibiotic for this outbreak.
Having the SBHC present at Rothenberg facilitated communication between the school nurse and the provider. It allowed daily regrouping and analysis of the outbreak which ultimately may have prevented many more cases from occurring. This fall, we have seen 7 cases of bullous impetigo at the Rothenberg SBHC. Because of our experience last year, we could more quickly and effectively identify and treat these patients – hopefully limiting the spread this year.