Scabies

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Scabies

• Community Infection Control Nurses
• LNR PCTs
• Health Protection Agency Nurses
• LNR
• Social Care Providers LNR

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• Aims
• To raise awareness of the diagnosis, treatment
  and control of scabies
• Objectives
• To enable staff to recognise signs and
  symptoms of scabies
• To identify the different types of scabies
• To give an overview of how scabies is
  transmitted and treated

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What is Scabies ?

• Scabies is a condition caused by a mite.
• Mites burrow down into the deeper layers of the
  skin where the female lays eggs which hatch in
  50-72 hours
• Development from egg to adult takes about 10-15
  days and mites die after 4 to 6 weeks
• Mites are dependent on humans for their survival

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The Scabies Mite

• Oval in shape and measures 0.2-0.4mm in length
• The body is covered with fine lines and long
  hairs
• Is blind
• Has eight legs when an adult
• Usually live 30-60 days

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How is it transmitted ?

• Scabies is passed from one infected person to
  another via prolonged direct skin contact (10
  minutes or more, often through hand holding)
• An infected person who has no itching can pass
  the mite onto other people
• Scabies is rarely transmitted via clothing and
  bedding

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What is the Incubation Period?

• You have caught scabies as soon as the mite has
  burrowed beneath the skin.
• The length of time between contact with an
  affected person and developing signs of scabies
  (itching/rash) is between 2-6 weeks
• For re-infection symptoms can appear within 48
  hours
• If a person becomes re-infected it may only take
  48 hours for symptoms to appear

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How is Scabies diagnosed ?

• Ask a GP to diagnose
• Ascertain if any other residents/staff are
  affected with similar symptoms
• A history of itching usually worse at night or
  following a warm bath/shower
• Pimple-like irritations, burrows or rash on the
  skin
• Webbing between the fingers
• Skin folds on the wrist, elbow, knee or
  auxiliary areas
• The penis and scrotum
• The breast (particularly the nipples)
• Shoulder blades
• Occasionally skin scrapings for microscopic
  examination (looking for mite, eggs or faeces)

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Who should be contacted ?

• Infection Control Group/Health and Safety Team
• If in doubt contact the HPA or
• your local Infection Control Nurse
• (insert ICN number)

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Scabies Egg
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Types of Scabies

• Classical
• Is the form usually found in healthy people with
  a normal immune system
• Spread is usually confined to breasts, waist,
  genitalia, buttocks, knees and ankles
• Typically there are fewer than 10 mites on the
  entire body of an infested person
• Symptoms are caused by an allergic reaction to
  the mites saliva, faeces or egg hatching fluid

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Classical Scabies
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Types of Scabies

• Crusted
• Also known as Norwegian Scabies
• Occurs in people where the immune systems is
  impaired
• Eventually small areas of thickening and crusting
  of the skin appears (usually on the hands, feet
  and scalp) and may be itchy
• Average number of mites can be thousands
• Is a common cause of outbreaks
• Clothing and linen are risk factors due to skin
  scales
• Clients with learning disabilities are more prone
  to this type of scabies

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Crusted Scabies
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What is the Treatment?

• Lyclear Dermal Cream
• Apply all over the whole body and wash off after
  8-12 hours
• Derbac M
• Apply all over the body and wash off after 24
  hours
• Pregnancy and Breastfeeding
• Derbac M is the treatment of choice during
• Young Children
• Lyclear Dermal Cream is the treatment of choice
  for children over 2 months but under 6 months

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Treatment Application

• Dont apply treatment after a hot bath. Treatment
  should be applied to cool, dry skin.
• Apply to the whole body
• Nails should be short and clean
• If the hands or any other part of the skin are
  washed (during the treatment period) re-apply the
  treatment.
• If using cream - rub it in lightly to the skin
• If using a lotion pour it into a bowl for ease
  of application, then use a sponge for even
  coverage

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Treatment Application

• Repeat the application a week later to complete
  the treatment
• After the first application or treatment has been
  completed you are no longer infectious
• Itching commonly persists for up to 3 weeks
  following successful treatment (although this
  will decrease in severity)
• In cases of Crusted Scabies that do not respond
  to above treatment, always seek advice from the
  Health Protection Agency [phone]

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Who Should be Treated ?

• All cases check contacts and seek advice
• Contacts include
• Those with prolonged skin to skin contact e.g.
  bed partners, grandchildren
• When the problem affects more than 25 of
  residents and staff in a communal healthcare
  environment, seek advice from the Health
  Protection Agency

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Infection Control Precautions

• Staff should wear gloves and aprons when applying
  treatment
• Linen should be washed at the hottest temperature
  the garment allows
• Linen should be place directly into the washing
  machine when changed
• Linen should be placed in a plastic bag to
  prevent contamination of the environment if it is
  not possible to place directly into a washing
  machine

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Infection Control Precautions

• Freshly laundered clothing should be worn once
  the lotion has been washed off
• Freshly laundered bed linen/night wear should be
  worn once the lotion has been washed off
• All fabric surfaces should be hovered at the time
  of treatment application
• All non-porous surfaces should be wiped with a
  disposable cloth soaked in warm water and
  detergent

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Treatment Failure

• Treatment failure is likely if
• treatment was not applied correctly or twice (one
  week apart)
• Itching persists (without signs of improvement)
• Not all contacts were treated at the same time
• Cleaning is not carried out effectively

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Outbreaks(Nursing/Residential Homes)

• Where there are two or more cases, inform the
  Infection Control Nurse and/or the Health
  Protection Agency
• If treatment is to go ahead then the treatment
  should be planned carefully
• Do not be in a hurry to treat, ensure the
  treatment is co-ordinated and planned well
• Decide on a 24-hour period for the treatment and
  inform staff
• Treat everyone at the same time to prevent
  re-infection

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Outbreak Prevention(Nursing/Residential Homes)

• Promote good surveillance of new residents
• Observe for rashes on arrival at the home, then
  at 3 weeks and 6 week intervals
• Maintain a high level of suspicion if patients
  present with undiagnosed rashes
• Educate staff on presentation and transmission of
  scabies
• Encourage staff to report rashes (including on
  themselves and their family)

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Outbreak Management(Nursing/Residential Homes)

• Confirm diagnosis
• Record and list
• Number of residents in home
• Number of residents with suspect rash
• Number of staff employed
• Number of staff with rash
• Any staff families with rash
• Relatives and other visitors with a rash
• Number of staff working at other
  institutions/agencies

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Outbreak Management(Nursing/Residential Homes)

• For each person detail
• Name, date of birth and GP
• Date any rash appeared and its visual appearance
• Symptoms e.g. itching
• Areas affected
• Any scabicidal products already in use
• Number of times used and when
• Please inform
• Infection Control Nurse (insert own number)
• HPA 0116 263 1400