Background
Cellulitis is a skin infection that causes pain, malaise, poor quality of life and impaired activities of daily living, with a life-threatening risk of sepsis if mismanaged. It represents a significant burden to the NHS causing around 7,500 Emergency Department contacts and over 35,000 bed days in Wales NHS. This data is for cellulitis alone and does not include lymphangitis, infections of the skin and ulcers that are all related and increase bed days to over double.
Research suggests that once you have one episode of cellulitis the recurrence rate of another infection ranges from 10-50%. This is dependent on existing risk factors such as obesity, lymphoedema, skin conditions, immobility, wounds and diabetes that if treated could reduce the rate of recurrence from 40-85%. Sadly, care provided during an acute episode of cellulitis is very reactive and not focussed on cellulitis recurrence prevention. Importantly, misdiagnosis occurs in 30% of cellulitis cases resulting in no value with unnecessary antibiotic treatment and time in hospital. Risk factors include lymphoedema or chronic oedema in the limbs, a wound or an ulcer, obesity, immobility and skin disorders like eczema, dry skin or fungal infections.
Positively, NCIP proactively supports patients in understanding and managing their risk factors such as lymphoedema, wounds and skin conditions thereby reducing the rate of cellulitis recurrence and decreasing the burden on unscheduled care.
Aims of NCIP
- Improve patients understanding of the risk factors which attribute to a cellulitis episode
- Increase awareness in identifying and management of cellulitis for healthcare professionals (HCPs)
- Decrease the incidence of repeated cellulitis episodes through education, assessment and prompt treatment
- Reduce the systemic pressure on Emergency Departments (ED), admissions & inpatient services through effective treatment of cellulitis
- Reduce pressures on Primary Care for cellulitis events
- Capture cellulitis patient-reported outcome measures to improve the pathway using CELLUPROM© and EQ5D5L and patient reported experience measures CELLUPREM©
Although we have impacted secondary care it is only now that we are focussing on primary care.
Cellulitis care is currently very reactive and focussed on antibiotics. Thus, for us to be proactive and at the forefront of early intervention we want to decrease and raise awareness of the patient risk factors and subsequently decrease cellulitis recurrence within primary care. In Wales around 200,000 GP events are for cellulitis. It should be noted that around 30% of patients reporting cellulitis and are given antibiotics do not actually have it- instead they have lymphoedema and an inflammatory red leg syndrome.
Capturing the data to make an impact
Many patients in Powys receive numerous courses of antibiotics for cellulitis in primary care. In the other Health Boards in Wales the National Cellulitis Team has worked with primary care and or antimicrobial pharmacists to capture the data of patients receiving two prescriptions of flucloxacillin in the last year. Surprisingly many of these patients have not had cellulitis and instead required compression garments for unmanaged lymphoedema. This enables improved antimicrobial prescribing and stewardship. In November 2024, Powys Teaching Health Board agreed to support this programme of work and we are now keen to capture the data to make an impact. GP practices/ pharmacists are being asked to support us with this work
Your GP has been asked to identify patients that might benefit from a review from the National Cellulitis Improvement Programme team which may mean more appropriate treatments such as compression can be used in the future.
Referrals
Our records show that you have been prescribed penicillin V for cellulitis/lymphoedema for six months or longer, and you may benefit from a referral to the National Cellulitis Team. The team will contact you by letter with an invitation to a telephone consultation, or, where appropriate, a face to face review.
In order to do this, we would like to ask for you consent to refer you to the team for an assessment. This will include providing the National Cellulitis Programme with the following details:-
- Your Name
- Date of Birth
- NHS number
- Address
If you consent to be referred to the team, please follow the instructions in the text message sent to you by the practice and they will make the arrangements.
Further information relating to the NCIP privacy notice can be found below.