Protocol for Assessment and Control of Scabies Outbreaks in Long Term Care Facilities

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  • Topic: Scabies, Permethrin, Rash
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  • Published : October 20, 2010
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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 may persist for weeks. Day 14 Reexamine; retreat if persistent or recurrent lesions. Day 28 Reexamine; retreat if persistent or recurrent lesions. Group II: Crusted Scabies or Norwegian Scabies (Hyperinfestation)

Note: These individuals have a long term rash and are very heavily infested. They are very contagious. Repeat treatments with 5% permethrin cream are usually necessary.

1. Action:

Isolate case (Contact precautions) until dermatology consult determines that case's rash is no longer transmissible. Perform environmental control measures:
Laundry, dry cleaning, or isolation of clothing in plastic bags for seven days. Cohort staff so that only one group cares for a resident/in-patient case until case is no longer transmissible. Exclude symptomatic cases (those with a rash) from work (or school, day care center, if applicable) until dermatologist, in consultation with Health Officer approves resumption based on lack of risk of transmission. 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 including scalp, temples, forehead, and under nails. (Staff member should apply permethrin to the skin of the resident.) Day 2 (AM) Bathe or shower to remove the cream after permethrin has been on skin for 8-14 hours). Inform person that itching may persist for weeks. Day 7 (PM) Repeat bath or shower. Repeat application of 5% permethrin cream from the neck down. Day 8 (AM) Bathe or shower to remove cream. Day 14 Reexamine; retreat if persistent or recurrent lesions. Day 28 Reexamine; retreat if persistent or recurrent lesions. Institutional Treatment Plan: Selective vs Mass Treatment

Although scabies frequently presents as a widespread outbreak within a LTCF, there are circumstances in which a more selective treatment plan may be utilized. Selective Treatment Protocol If a single case of scabies (Group I, above)...
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