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Introduction ⬇

The most common bacteria implicated in skin infections are S. aureus and Streptococcus pyogenes (group A). The common abnormal skin conditions include:

  1. Pyoderma

    1. Staphylococcal impetigo, characterized by bullous lesions with thin, amber, varnish-like crusts

    2. Streptococcal impetigo, characterized by thick crusts

  2. Erysipelas

  3. Folliculitis

  4. Furuncles

  5. Carbuncles

  6. Secondary invasion of burns, scabies, and other skin lesions

  7. Dermatophytoses, especially athlete’s foot, scalp and body ringworm, and jock itch

Procedure ⬆ ⬇

To obtain scrapings from vesicular lesions or skin:

  1. Observe standard precautions.

  2. Clean the affected site with sterile saline solution, wipe gently with alcohol, and allow it to air-dry.

  3. Aspirate a fluid sample from fresh, intact vesicles with a 25-gauge needle attached to a tuberculin syringe and transfer the specimen to the transport medium by ejecting it from the syringe.

  4. If fluid cannot be aspirated, open the vesicles and use a cotton-, rayon-, or Dacron-tipped applicator to swab the base of the lesion to collect infected cells. Place the swab directly into transport medium (e.g., self-contained foam pad with Stuart media).

  5. To make smears for stains, use a scalpel blade to scrape the base of the lesion, taking care not to macerate the cells. Spread scraped material in a thin layer on a slide.

  6. Label specimen with the patient’s name, date, and tests ordered and place the specimen in biohazard bag; do not refrigerate. Immediately transport the specimen to the laboratory for bacterial, fungal, or viral cultures.

Clinical Alert

The most useful and common specimens for detection of fungal infection are skin scrapings, nail scrapings, and hair.

Clinical Implications ⬆ ⬇

When present on the skin in significant quantities, the following organisms may be considered pathogenic and indicative of an abnormal condition:

  1. Enterobacteriaceae

  2. Fungi (Sporotrichum, Actinomyces, Nocardia, C. albicans, Trichophyton, Microsporum, Epidermophyton)

  3. S. aureus

  4. S. pyogenes

  5. P. aeruginosa

  6. Varicella-zoster virus

  7. Herpes simplex virus

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain purpose of and procedure for skin culture.

  2. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed. Monitor site of infection. Counsel the patient appropriately about treatment. Report rashes and fever.

  2. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Reference Values ⬆

Normal

The following organisms may be present on the skin of a healthy person. When present in low numbers, some of these organisms may be considered normal commensals; at other times, when they multiply to excess, these same organisms may become pathogens.

  1. Clostridium spp.

  2. Enterobacteriaceae

  3. Corynebacterium spp.

  4. Enterococci

  5. Mycobacteria

  6. Staphylococci

  7. Streptococci

  8. Yeasts and fungi