A. Rashes / Acne / Skin Infections

1. When symptoms are observed, a complete skin assessment is necessary.
2. Review medication regimen, diet, and environmental factors.
3. Apply OTC ointments as indicated , observe for improvement
4. For acne, gently wash with anti-bacterial soap twice per day. Apply appropriate topical medication afterwards.
5. If assessment reveals impetigo or mild cellulitis, scrub area gently with antibacterial soap, apply antibiotic ointment BID and cover with a dry dressing. Instruct student and staff on necessary precautions to avoid spread of infection. Examine patient on a daily basis. Report findings to Physician.

B. Bites (Human)

1. Encourage bleeding if the skin is broken.
2. Cleanse with soap and warm water for 8 to 10 minutes.
3. Apply a dry sterile dressing.
4. Assess hepatitis status of both students involved
5. Report incident to the Physician and follow exposure procedure below:

1. The Campus Nursing Department will contact the Guardians of both students and inform them of the incident.
2. The Campus Nursing Department will attempt to obtain Consent from the Guardians for HIV testing as recommended by HEC pediatrician.
3. Documentation of the incident and notification of the physician, will be added to the student’s Progress Notes. The HIV testing report will be placed in a sealed envelope, labeled as confidential and placed in the “laboratory” section of the chart. Any medical follow-up will be coordinated by the physician.

C. Scratch; Break in Skin Integrity
Protocol following a break in skin integrity between students or student/staff.

Due to the possible complications from any break in skin integrity it is imperative that employees take appropriate measures to minimize exposures to blood for both students and staff.

Following a break in skin integrity:

Students:
4. Student should wash their hands with soap and water thoroughly if they were scratching, paying special attention to under the fingernails.
5. Check student for any broken skin areas; these areas should be cleaned with soap and water, and treated with a topical antibacterial cream/ointment.
6. Document the incident and any injuries to students.

Staff:
3. Staff should wash all abrasions, scratches, or broken skin areas thoroughly with soap and water, if available apply antibiotic cream.
4. Staff must complete an ART form to be filed with AO, regardless of the seriousness of the injury. This documents the injury in case a complication occurs.

When dealing with a student who is known to scratch as a defense or mode of aggression, staff should take appropriate precautions to protect themselves. Some suggestions would be to wear long sleeve shirts and pants, the use of gloves (vinyl or padded) or changing the positioning of student’s hands to minimize the ability to scratch skin.

D. Puncture Wounds

1. Assess bleeding, need for sutures or foreign body
2. Soak wound with antibacterial soap and water.
3. Apply antibiotic ointment with dressing.
4. Check status of Tetanus Immunization.
5. Monitor daily for possible signs of infection. Notify physician as needed.

E. Burns

1. 1st Degree- injury to top skin layer causing redness, pain and minor swelling healing in 3-6 days– cool compress / aloe or burn gel topically/ Tylenol or Motrin for pain
2. 2nd Degree- injury to skin layers beneath the top layer producing blisters, severe pain and redness with healing taking up to 2-3 weeks– cool compress / bacitracin or Silvadene topically followed by a sterile dressing. Do not puncture blisters. Monitor daily at dressing change for signs of infection. (SILVADENE SHOULD NOT BE USED FOR PATIENTS WITH SULFA ALLERGY ) Notify Physician.
3. 3rd Degree- injury to all the layers of the skin and underlying tissue making the skin appear waxy, leathery or brown– cool sterile compress. Transport to ER; notify Physician.

F. Eczema

1. Shower with tepid water once or twice a day.
2. Use mild soap (Dove unscented or generic equivalent).
3. Pat dry.
4. Apply topical prescription meds if any.
5. Apply hypo-allergenic moisturizer.
6. Notify physician if worse or no improvement in 2 weeks.