Impetigo: prevention by good hygiene at home
Impetigo is a common, highly infectious, skin infection. It is usually not serious but
can be uncomfortable and irritating. Good hygiene can help to reduce the risk of
spread of infection. This briefing material has been produced for those who work in
healthcare professions, the media and others who are looking for background
understanding of hygiene and hygiene issues and/or those who are responsible for
providing guidance to the public on how to reduce the risks of spread of impetigo in
their homes.
What is impetigo?
Impetigo is a common, highly infectious, skin infection. In moderate climates impetigo
is most commonly caused by the bacterium Staphylococcus aureus. However, in
warmer, moister climates it is more likely to be caused by the bacterium
Streptococcus pyogenes. It may also be caused by a combination of both bacteria.
Impetigo usually develops between four and 10 days after exposure to the infection.
It first appears as a small scratch or itchy patch of eczema or skin inflammation on
the skin. This quickly develops into a blister containing a yellow substance. Later, the
top of the blister becomes crusty and weeps while new blisters develop in the same
place or on other parts of the body. Impetigo usually begins on the face, especially
around the corners of the mouth, the nose and back of the ears. The crusts
eventually dry out and heal to leave a red mark, which gradually disappears without
scarring.
There are two types of impetigo. Bullous impetigo causes larger fluid filled blisters to
develop which do not burst and tend to last for a few days. Bullous impetigo is more
common on the trunk (chest, back and abdominal area). Non-bullous impetigo is
more common on the face or limbs and causes smaller, less persistent pustules.
Complications of impetigo
There are usually no serious complications with impetigo, but complications when
they occur are more likely with bullous impetigo. Very rarely, the infection spreads
into the blood stream and causes septicaemia. Sometimes impetigo spreads to the
lower layers of the skin, causing cellulitis. This causes redness and swelling.
Impetigo infection can also lead to psoriasis - a type of skin condition that causes dry
scaly patches on the skin.
Long-standing infection can leave scars behind.
Who is at risk?
Impetigo is thought to be most common between the ages of two and six. About one
in 35 children under the age of four and one in 60 children under 15 develop
impetigo. In a survey of Dutch children it was the third most frequent skin condition. It
is thought to be more common in tropical and developing countries.
Children and adolescents suffering from eczema (atopic dermatitis) are especially
likely to develop impetigo. Since impetigo is easily spread through contact, it is
commonly seen in nursery or playgroup settings.
Individuals are also more likely to develop impetigo if they have poor personal
hygiene. Individuals with disease conditions which weaken the immune system such
as HIV/AIDS patients. Patients at home undertaking drug therapies such as cancer
chemotherapy, are also more vulnerable to impetigo infection.
Sometimes impetigo starts in an area of broken skin, for example, at the site of a
wound, or an area affected by another condition that breaks the skin, such as
eczema or scabies. This is called secondary impetigo.
How does impetigo spread?
Impetigo is highly contagious and easily spreads from person-to-person. This can
occur by direct contact. Alternatively the infection can be transmitted via hands and
surfaces including hand contact surfaces and the surfaces of clothing and household
linens.
How is impetigo treated?
If it is suspected that a member of the family has impetigo, it is important to visit the
GP as soon as possible to get treatment before the infection can spread to other
family members. Impetigo is usually treated with a bactericidal ointment, such as
fusidic acid or mupirocin, but in more severe cases oral antibiotics, such as
flucloxacillin or erythromycin are used.
The treatment also involves washing with soap and water and letting the impetigo dry
in the air. The affected area should be washed with warm soapy water to remove
crusty areas before applying cream or ointment. It is important to dissolve the scabs
with ointment because the bacteria that cause the disease live underneath them.
How to reduce the risks of spread of impetigo
Impetigo is highly contagious. This means it can spread to other people very easily.
This can happen either through direct skin-to-skin contact, or via hands and surfaces,
or from sharing towels or face flannels.
When a family member is infected, the following procedures are important to stop it
spreading to other family members:
 The most important hygiene measures are to keep the hands clean. Always
remember to wash your hands after having touched your own or your child’s
scabs. In “high risk” situations where there is an outbreak of infection in the home,
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it is suggested that handwashing followed by use of an alcohol rub/sanitiser
should be encouraged.
 Avoid scratching the infected area as this will contaminate the hands, which can
then spread the infection to other areas of the body, or to other people
 The infected person should not share towels, facecloths, and other personal
hygiene items such as bars of hand soap with other family members.
 Clothing, sheets, pillows and linens from an infected person should be kept
separate from the rest of the family laundry and should be laundered in a manner
that kills micro-organisms. This entails:
- for preference, washing at 60C or above, using a powder or tablet
detergent containing active oxygen bleach (see ingredients on back of
pack).
- alternatively washing at 40C with a powder or tablet detergent containing
active oxygen bleach (see ingredients on back of pack)
Note: washing at 40oC without the addition of bleach will not destroy microbes
 Hygienically clean baths and wash basins regularly. This can be achieved by
cleaning with a detergent cleaner followed by thorough rinsing with running water.
Alternatively use a disinfectant cleaner which is effective against the bacteria**.
 Cleaning cloths can easily spread the microbes that cause impetigo around the
surfaces of the home. They should be hygienically cleaned after each use. This
can be done in any of the following ways:
- wash in a washing machine at 60C (hot wash)
- clean with detergent and warm water, rinse and then immerse in a
disinfectant solution which is effective against bacteria for at least 20 minutes
or as prescribed
- clean with detergent and water then immerse in boiling water for 20 minutes.
Preferably use disposable cloths.
If the infected member of the family is a child:
 cut the child’s nails short and encourage them not to scratch their scabs, pick their
nose, bite their nails or suck their fingers.
 teach your child to wash his/her hands regularly and always give them their own
facecloth and towel.
 explain to the child why they need to pay special attention to hygiene and avoid
touching their scabs.
If a child has impetigo, he/she should not return to school or nursery until treatment is
finished, the area is no longer weeping and the scabs have fallen off.
*How to wash hands:
Handwashing “technique” is very important. Rubbing with soap and water lifts the
germs off the hands, but rinsing under running water is also vital, because it is this
process which actually removes the germs from the hands. The accepted procedure
for handwashing is:
 ensure a supply of liquid soap, warm running water, clean hand towel/disposable
paper towels and a foot-operated pedal bin
 always wash hands under warm running water
 apply soap
 rub hands together for 15–30 seconds, paying particular attention to fingertips,
thumbs and between the fingers.
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 rinse well and dry thoroughly.
In situations where soap and running water is not available an alcohol- based hand
rub or hand sanitiser should be used to achieve hand hygiene:
 apply product to the palm of one hand.
 rub hands together.
 rub the product over all surfaces of hands and fingers until your hands are dry.
Note: the volume needed to reduce the number of germs on hands varies by product.
In high risk situations where there is an outbreak in the home, handwashing followed
use of an alcohol rub/sanitiser should be encouraged.
**Disinfectants and disinfectant cleaners
Use a disinfectant or disinfectant/cleaner which is active against bacteria. For more
details on choosing the appropriate disinfectant, see the IFH information sheet
“Cleaning and disinfection: Chemical Disinfectants Explained”. Consult the
manufacturers’ instructions for information on the “spectrum of action”, and method of
use (dilution, contact time etc). For bleach (hypochlorite) products, use a solution of
bleach, diluted to 0.5% w/v or 5000ppm available chlorine. Household bleach (both
thick and thin bleach) for domestic use typically contains 4.5 to 5.0% w/v (45,00050,000 ppm) available chlorine. Bleach/cleaner formulations (e.g. sprays) are
formulated to be used “neat” (i.e. without dilution). It is always advisable however to
check the label as concentrations and directions for use can vary from one
formulation to another.
IFH Teaching and Self-learning Resources on Home Hygiene
 Home hygiene - prevention of infection at home: a training resource for carers and
their trainers. (2003) International Scientific Forum on Home Hygiene. Available
from:
http://www.ifh-homehygiene.com/best-practice-training/home-hygiene%E2%80%93-prevention-infection-home-training-resource-carers-and-their
 Home Hygiene in Developing Countries: Prevention of Infection in the Home and
Peridomestic Setting. A training resource for teachers and community health
professionals in developing countries. International Scientific Forum on Home
Hygiene. Available from: www.ifh-homehygiene.org/best-practice-training/homehygiene-developing-countries-prevention-infection-home-and-peri-domestic. (Also
available in Russian, Urdu and Bengali)
This fact sheet was last updated in 2014
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