Introduction

Impetigo is a bacterial infection that primarily affects the superficial layer of the epidermis. It causes sores or blisters on the skin. It is one of the highly contagious common bacterial infections that appears as erythematous plaques that have a yellow crust-like blisters. It is usually itchy and painful.

It usually affects children, but it can also occur in adults. It is caused by gram-positive bacteria. It usually occurs in the summer season.¹

Hygiene is a practice or a habit that an individual follows to  maintain his/her health and also to stop progressing the infections. So, good hygiene is a defense mechanism against infections by limiting the exposure to causative agents that can spread through the skin, respiratory system, or food.

As impetigo is a highly contagious bacterial infection, maintaining proper hygiene will help in limiting the transmission of the bacteria that is responsible for the infection. Thus, we can see in the article how proper hygiene helps in preventing impetigo.²

Causes of Impetigo

There are two types of impetigo. 

• Non-Bullous Impetigo: This accounts for about 70% of all cases. This is usually caused by Staphylococcus aureus and Staphylococcus pyogenes. It appears as red sores or blisters that burst open and give a yellow or honey-colored crust on the skin. It usually affects people of 2–5 years of age but can also affect adults. It can occur on any part of the body but most commonly affects the skin around the nose and mouth. The infection usually spreads through direct contact with the infected area or through contaminated objects³
• Bullous Impetigo: This type is a less common but very distinct form of impetigo. This is usually caused by Staphylococcus aureus. They appear as larger fluid-filled blisters, and it is more common with infants but can also occur on individuals of any age. In adults, males are more commonly affected than females. This spreads similarly to non-bullous impetigo through direct skin contact with affected areas. The bacteria entering the skin produce a toxin, which actually disrupts the barrier of the skin and enters access to the superficial layers of the epidermis, thereby affecting it¹

Symptoms of Impetigo

Non-Bullous Impetigo: It usually begins as a small erythematous macule, which gradually progresses into a pustule. When these blisters/pustules break, they release serous contents, which disrupts the skin’s integrity. When it dries, it forms a honey-colored crust, which also looks like cornflakes present on the skin.³

There might be the presence of erythema around the affected area. Auto-inoculation allows for the rapid spread of these lesions. It also causes ‘kissing lesions’ when two skin surfaces come into contact. Patients also have itchy skin, but it is rarely painful. Other symptoms include fever, swollen glands, and regional lymphadenopathy.⁴

Bullous Impetigo: It usually begins with fluid-filled blisters, which are formed on the central area of the body between the waist, neck, arms, or legs.³ These blisters are 1-2 cm in size. They grow quickly within a few days, which then bursts into a yellow-colored crust on the skin that also heals gradually without any scars. Unlike non-bullous impetigo, the blisters caused by bullous impetigo are painful. Other symptoms include fever and swollen glands.⁴

Why is early recognition important?

• Impetigo is extremely contagious, particularly among children, and spreads via direct contact or shared things. By detecting the infection early, actions can be taken to isolate the infected person and prevent the bacterium from spreading to others
• Without prompt treatment, impetigo can spread to other parts of the body, exacerbating the infection. In some situations, untreated impetigo can progress to more serious complications, such as deeper skin infections or, rarely, renal problems
• Early detection enables rapid medical intervention, whether with topical antibiotics or oral medications, which can help treat the infection swiftly. This shortens the duration of symptoms and discomfort while also lowering the chance of spreading the infection
• In communal environments, a single case of impetigo may quickly spread to several people. Early detection and enabling effective hygiene measures, such as cleaning surfaces and isolating affected individuals, prevent extensive epidemics¹

Role of Hygiene in Preventing Impetigo

Personal Hygiene Practices

• The most important thing you can do to avoid impetigo is to wash your hands with soap and water immediately after coming into contact with someone who has the condition, or an alcohol-based hand rub will suffice
• Sharing private items like towels, razors, or clothes can be avoided because of the presence of impetigo-causing organisms
• Bed linens and towels can be washed in hot water and dried under heat
• Also, covering the infected surfaces is advised because scratching or touching another person can increase the potential risk of spreading the infection
• Nails can be kept short and clean to prevent scratching the infected areas
• The infected patients must bathe regularly to reduce the bacterial load on the body²

Environmental Hygiene

• Even with high personal hygiene, an unsanitary atmosphere might operate as a reservoir for microorganisms. Maintaining a clean living or working environment supplements personal efforts, resulting in a safer, generally healthier environment
• Commonly used places, such as door handles, counters, and desks, have to be regularly cleaned with anti-bacterial disinfectants. This is especially important in communal environments such as schools, offices, and residences
• Washing clothing, bed linens, and towels regularly at higher temperatures helps kill the bacteria that linger
• The clothing that covers the infected area of the impetigo-affected individuals has to be disposed of properly so that it does not spread to other individuals
• Keeping rooms well-ventilated and cleaning air conditioning equipment on a regular basis might help lower the amount of bacteria in the air. While impetigo is primarily transmitted through contact, keeping a clean, well-ventilated environment can improve general health and lower the risk of other illnesses⁵

Practices for Managing the Infection

The infection can be primarily treated with antibiotics. If it is a non-bullous impetigo, then the infection can be treated by applying antibiotic ointment for 5 days. If it is a bullous impetigo type and has infection all over the body, then an antibiotic tablet or liquid is advised for 7-10 days.⁶

Ignoring the antibiotic medication by the children can cause deeper skin infections and further worsen the condition. While the infected area starts to heal, gently washing with antiseptic soap is recommended.

As the healed areas look like a crust on top of the skin, those areas can be soaked in warm, soapy water to help remove the layers of crust.⁵

Educational and community efforts

Communal efforts are important in preserving hygiene and reducing the spread of infections like impetigo, especially in common areas such as schools and companies. By working together to clean and disinfect common places, people may help limit the prevalence of hazardous bacteria on commonly touched surfaces. This collaborative approach not only cleans the environment but also reduces the chance of cross-contamination, especially when everyone follows good hygiene standards like handwashing and not sharing personal belongings.⁷

Promoting hygiene awareness in communities instills a sense of shared responsibility for public health. Regular cleaning routines, proper waste disposal, and safe food handling are all simple but efficient measures to avoid the spread of infection. When everyone takes care to keep their surroundings clean, the entire community benefits from a healthier, safer environment. These efforts are important in controlling outbreaks and protecting both individuals and the general public from dangerous conditions.⁸

Summary

Impetigo, a highly contagious bacterial skin infection, is directly associated with good hygiene practices. Impetigo, caused by Staphylococcus aureus and Streptococcus pyogenes, is easily transmitted by direct contact with infected skin or contaminated surfaces and objects. Impetigo spreads quickly in unsanitary conditions, particularly among children.

Thus, maintaining good hygiene is important for avoiding and treating impetigo. Handwashing on a regular basis, cleaning and maintaining wounds, sanitizing commonly touched surfaces, and avoiding sharing personal things can all help to minimize the spread of infection-causing bacteria. Improving hygiene standards in social environments can reduce the spread of impetigo, emphasizing the clear relationship between hygiene and controlling the transmission of the infection.