Water-related skin infections

Existing cuts, abrasions, wounds and any skin injuries occurring in water often get infected, eg injuries from coral or fish spines

Do not

  • Do not close puncture wounds

Check 

  • Calculate age-appropriate REWS
    • Adult — AVPU, RR, O2 sats, pulse, BP, Temp
    • Child (less than 13 years) — AVPU, respiratory distress, RR, O2 sats, pulse, central capillary refill time, Temp
  • Weight, BGL
  • Immunisation status — tetanus

Do

  • Thoroughly clean wound and remove embedded material if present
    • May need local anaesthetic
  • Collect swab for MC&S.  Specify ‘marine infection’
  • Treat — Table 7.26

Table 7.26 Treatment for water-related skin infections

Follow-up — review after 24 hours

Moderate infection — fresh or brackish water

  • If not improving or getting worse — medical consult to send hospital
  • If getting better — continue antibiotics for 5 days
  • Review again with swab result

Moderate infection — salt water

  • If getting worse or not getting better — medical/specialist consult to send to hospital
  • If getting better and MRSA risk is low
    • Change ceftriaxone dose to cefalexin oral — doses — adult 500mg, child 12.5mg/kg/dose up to 500mg, 4 times a day (qid)
    • Continue antibiotics for 5 days
    • If allergy — medical consult
  • If getting better and MRSA risk is high — continue antibiotics for 5 days
  • Review again with swab result