Multiple Cases

Local and/or state health departments may be able to provide guidelines for preventing and controlling scabies outbreaks.

Below are suggestions for developing guidelines for preventing, detecting, and responding to multiple cases of non-crusted scabies in an institution. (For information specific to a single or multiple cases of crusted scabies, please see Crusted Scabies Cases.)

Surveillance

Establish surveillance.

• Have an active program for early detection of infested patients and staff.
• Maintain a high index of suspicion that scabies may be the cause of undiagnosed skin rash; suspected cases should be evaluated and confirmed by obtaining skin scrapings.
• Screen all new patients and staff for scabies.
• Notify local health department of outbreak and determine if any evidence of increased scabies in the general community; notify other institutions to or from which infested or exposed patients may have transferred.

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Diagnostic Services

Ensure that adequate diagnostic services are available.

• Consult with an experienced dermatologist for assistance in differentiating skin rashes and confirming the diagnosis of scabies.
• Ensure someone on-staff is trained and experienced in obtaining and examining a skin scraping to identify scabies mites.

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Control & Treatment

Establish appropriate procedures for infection control and treatment.

• Maintain records with patient name, age, sex, room number, roommate(s) name(s), skin scraping status and result(s), and name(s) of all staff who provided hands-on care to the patient before implementation of infection control measures: symptoms can take up to 2 months to appear in exposed persons and staff.
• Use epidemiologic data about distribution of confirmed cases by building, room, floor, wing, occupation (for staff), dates of admission, and onset of scabies-like condition to determine: 1) levels of risk for patients and staff; 2) extent of the outbreak (e.g. confined or widespread in the facility; and 3) temporal relationship among cases.
• Avoid direct skin-to-skin contact with any patient who is suspected or confirmed to have scabies.
• Use gloves when giving hands-on care to any patient who is suspected or confirmed to have scabies; wash hands thoroughly after providing care to any patient.
• Avoid skin-to-skin contact with person with scabies for at least 8 hours after application of scabicide treatment.
• Identify and treat all persons (e.g. staff, relatives, patients, etc.) having prolonged, direct skin-to-skin contact with an infested person before he/she was treated.
• Offer treatment to household members (e.g. spouses, children, etc.) of staff who are receiving scabies treatment.
• Staff generally can return to work the day after receiving a dose of treatment with permethrin or ivermectin; however, symptomatic staff who provide hands-on care to any patient may need to use disposable gloves for several days after treatment until sure they are no longer infested.
• Use procedures that minimize risk of transmission of secondary bacterial infections that may develop with scabies.

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Environmental Disinfection

Establish appropriate procedures for environmental disinfection.

• Machine wash and dry bedding and clothing of scabies patients using the hot water and hot dryer cycles.
• Environmental disinfestation is neither necessary nor warranted. Routine cleaning and vacuuming of the room should be done if and when a patient with non-crusted scabies leaves the facility or moves to a new room.

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Communication

• Establish procedures for identifying and notifying at-risk patients and staff who are no longer at the institution.
• Ensure a proactive employee health service approach to scabies including providing information about scabies to all staff and providing dermatologic consultation for employees and, when appropriate, their household members.
• Maintain an open and cooperative attitude between management and staff.

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