2.5 Cellulitis hospitalisations

Cellulitis is an infection of the tissue under the skin. It can be caused by many factors, including:

• Injuries that break the skin
• Insect bites
• Other skin wounds.

People who have a higher risk of hospitalisation for cellulitis include those who:

• Are older and frail
• Have certain conditions, such as diabetes, obesity, heart failure
• Live in crowded conditions
• Experience socioeconomic disadvantage.

Cellulitis is caused by bacteria. It can be treated with antibiotics.

In 2017–18, cellulitis was the fourth most common cause of potentially preventable hospitalisations in all Australians. In Aboriginal and Torres Strait Islander people, it was the second highest cause of potentially preventable hospitalisations.

In 2017–18:

• There were 68,663 hospitalisations for cellulitis, representing 256 hospitalisations per 100,000 people of all ages (the Australian rate)
• The number of hospitalisations for cellulitis across 330 local areas ranged from 90 to 1,393 per 100,000 people
• The rate of hospitalisation was 15.5 times as high in the area with the highest rate compared with the area with the lowest rate
• The rate for Aboriginal and Torres Strait Islander people (727 per 100,000 people) was 3.0 times as high as the rate for other Australians (242 per 100,000 people)
• Rates of hospitalisation were much higher in remote areas than in other areas.
• Rates increased with socioeconomic disadvantage in all areas except outer regional areas.

Between 2014–15 and 2017–18:

• The rate of cellulitis hospitalisation nationally increased by 9%
• The rate of cellulitis hospitalisation among Aboriginal and Torres Strait Islander people nationally increased by 18%.

Rates are standardised to remove age and sex differences between populations.

Variation in rates of cellulitis hospitalisation is likely to be due to differences in:

• Prevalence of chronic conditions – diabetes, obesity, heart failure and other chronic conditions can increase the risk of cellulitis
• Prevalence of infections – community-associated methicillin-resistant Staphylococcus aureus (MRSA) is higher in more remote areas than in major cities and inner regional areas. Streptococcal infections are more prevalent in some Aboriginal and Torres Strait Islander communities
  • Life and work factors – the risk of hospitalisation for cellulitis increases with overcrowded housing, higher temperature and humidity, and a person’s risk of skin injury at work
• Access to services – people in some areas may not have good access to services such as dermatologists. Aboriginal and Torres Strait Islander people may not have good access to culturally appropriate care. Integrated care that links patients to social services and programs varies geographically
• Diagnostic differences – clinicians may be over-diagnosing or under-diagnosing cellulitis
• Hospital care models – some areas have schemes to help people avoid going to hospital. Some hospitals code patient stays as hospitalisation rather than emergency department visit.

Address the social determinants of skin health, such as crowded living conditions.

Improve prevention and management of chronic conditions that increase the risk of cellulitis. This includes improving access to services such as podiatry and lymphoedema management.

Improve diagnostic accuracy to reduce unnecessary hospitalisations and antibiotic use. This could include early consultation with an infectious diseases specialist or dermatologist.

Use models of care in the community, rather than inpatient care in hospital.

Promote skin health among Aboriginal and Torres Strait Islander people.

The Commission consulted widely, but is solely responsible for making the recommendations; as such, the recommendations may not reflect the views of all contributors to the Atlas.

2a. Consistent with the commitments made under the National Health Reform Agreement and building on the activities set out in the 2017 Bilateral Agreement on Coordinated Care, Local Hospital Networks, Primary Health Networks and the Aboriginal Community Controlled Health Service sector to implement the following principles in developing chronic disease management programs consistent with the National Strategic Framework for Chronic Conditions:



i. Patients, families and carers as partners in care, where patients are activated to maximise their knowledge, skills and confidence to manage their health, aided by technology and with the support of a healthcare team



ii. A risk stratification approach that supports identification of patients with high coordination and multiple provider needs, to ensure personalisation of service provision 



iii. Flexible service delivery and team-based care that supports integrated patient care across the continuum of the health system through shared information and care planning



iv. A commitment to care that is of high quality and safe, including care planning and clinical decisions that are guided by evidence-based patient healthcare pathways, appropriate to the patient’s needs 

v. Data collection and sharing by patients and their healthcare teams to measure patient health outcomes and improve performance.

2b. The Commission, the Independent Hospital Pricing Authority and the Administrator of the National Health Funding Pool to identify and develop alternative approaches to funding for chronic disease and infection that could be applied to the National Health Reform Agreement Pricing and Funding model so that pricing and funding are aligned with best-practice guidelines. The alternative models could include bundled payments, capitation payments or regionally coordinated service responses.

Download the cellulitis hospitalisations section of the Atlas below, to read more about the context, data, key findings, interpretation, and addressing of variation for this clinical item:

Contents:

Context

About the data

What do the data show?

• Magnitude of variation
• Analysis by remoteness and socioeconomic status
• Analysis by Aboriginal and Torres Strait Islander status
• Trends over time

Interpretation

• Impact of MRSA

Addressing variation

• Improving diagnostic accuracy
• Ambulatory care
• Managing predisposing conditions and recurrent cellulitis
• Individualising treatment
• Treatment for patients with suspected MRSA or risk factors
• Promoting skin health among Aboriginal and Torres Strait Islander people

Resources

Australian initiatives

References