Protocol for Assessment and Control of Scabies Outbreaks in Long Term Care Facilities
Protocol For Assessment And Control Of Scabies Outbreaks in Long Term Care Facilities
The following protocol provides guidance for surveillance, diagnosis, and treatment of cases and contacts in LTCFs and management of outbreaks.
General Actions
Make a line list of all cases and contacts. Include roommates, staff members (permanent and rotating), providing care, and regular visitors as contacts
Confirm the diagnosis when possible; refer to dermatologist or physician for diagnostic evaluation.
. Institute mass education regarding scabies outbreaks. Educate staff; consider community meetings for residents and family members, printed fact sheets (see attachment), and newsletters to families of staff and residents.
4. Educate staff and residents (if possible) on:
Mode of transmission
Communicability
Potential for widespread epidemic if prompt action not begun
Need for prophylactic treatment of even asymptomatic contacts
Need for coordinated timing of treatment
Proper application of treatment medication
Environmental control measures: Laundry, dry cleaning, or isolation of clothing in plastic bags for seven days
Categorize cases and contacts for treatment assignment as follows:
Management: Group I: Confirmed or Suspected Scabies and Contacts
1. Action:
Isolate case (Contact precautions) for 24 hours after start of effective therapy.
Perform environmental control measures:
Laundry, dry cleaning, or isolation of clothing in plastic bags for seven days.
Exclude case from work (or school, day care center, if applicable) until the day after treatment.
Do not transfer patient without notifying the accepting facility of the diagnosis of scabies.
2. Treatment:
Day 1 (PM) Clip nails. Bathe or shower. Apply 5% permethrin cream to all skin areas from the neck down and under nails. (Staff member should apply permethrin to the skin of the resident.)
Day 2 (AM) Bathe or shower to remove the cream. Inform person that itching
The following protocol provides guidance for surveillance, diagnosis, and treatment of cases and contacts in LTCFs and management of outbreaks.
General Actions
Make a line list of all cases and contacts. Include roommates, staff members (permanent and rotating), providing care, and regular visitors as contacts
Confirm the diagnosis when possible; refer to dermatologist or physician for diagnostic evaluation.
. Institute mass education regarding scabies outbreaks. Educate staff; consider community meetings for residents and family members, printed fact sheets (see attachment), and newsletters to families of staff and residents.
4. Educate staff and residents (if possible) on:
Mode of transmission
Communicability
Potential for widespread epidemic if prompt action not begun
Need for prophylactic treatment of even asymptomatic contacts
Need for coordinated timing of treatment
Proper application of treatment medication
Environmental control measures: Laundry, dry cleaning, or isolation of clothing in plastic bags for seven days
Categorize cases and contacts for treatment assignment as follows:
Management: Group I: Confirmed or Suspected Scabies and Contacts
1. Action:
Isolate case (Contact precautions) for 24 hours after start of effective therapy.
Perform environmental control measures:
Laundry, dry cleaning, or isolation of clothing in plastic bags for seven days.
Exclude case from work (or school, day care center, if applicable) until the day after treatment.
Do not transfer patient without notifying the accepting facility of the diagnosis of scabies.
2. Treatment:
Day 1 (PM) Clip nails. Bathe or shower. Apply 5% permethrin cream to all skin areas from the neck down and under nails. (Staff member should apply permethrin to the skin of the resident.)
Day 2 (AM) Bathe or shower to remove the cream. Inform person that itching
References: Maryland Electronic Reporting and Surveillance System (Unpublished data). Jimenez-Lucho VE, Fallon F, Caputo C, Ramsey K. Role of prolonged surveillance in the eradication of nosocomial scabies in an extended care Veterans Affairs medical center. Am J Infec Control 1995; 23:44-49. Benenson, AS, ed. Control of Communicable Diseases Manual. Washington, D.C.: American Public Health Association, 1995: 415-417. Maguire JH, Spielman A. Ectoparasite Infestations. In: Isselbacher KJ, Braunwald E, Wilson JD, Martin JB, Fauci AS, and Kasper DL, eds. Harrison 's Principles of Internal Medicine. New York: McGraw-Hill, Inc., 1994: 934-935. Centers for Disease Control. Scabies in health care facilities-Iowa. MMWR 1988; 37: 178- 179. Degelau, J. Scabies in Long-Term Care Facilities. Infect Control Hosp Epidemiol 1992; 13: 421-425. Wilson, BB. Scabies. In: Mandell GL, Bennett, JE, and Dolin R, eds. Mandell, Douglas and Bennett 's Principles and Practice of Infectious Diseases. New York: Churchill and Livingstone, Inc., 1995: 2560-2562. Yonkosky D, Ladia L, Gackenheimer L, and Schultz MW. Scabies in nursing homes: an eradication program with permethrin 5% cream. J Amer Acad Derm 1990; 16: 1133-1136. Collier, C. Guidelines for Scabies Prevention and Control . Missouri Epidemiologist Nov-Dec 1994: 14