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The medical director , epidemiologist , infection preventionist , dermatologist and the pharmacist should discuss the treatment . Orders will need to be written by the epidemiologist or the medical director for treatment .
Once the orders are written , the pharmacy should let infection prevention know how soon they will have the medication available .”
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In good conscience , can you state that the outbreak is isolated to one unit ? If yes , you may be able to only treat the residents and staff on that unit . A word of caution , if you do this , you may end up having to retreat .
Once confirmation is established by the dermatologist performing the skin scrapings , convene the management team mentioned earlier and add the dermatologist as well as the pharmacy to discuss the action plan . The plan should include how to effectively treat all the patients / residents and staff in a timely manner . Include how staff should treat members of their household .
Another staff meeting should be held to share the plan with the staff . My recommendation is to identify a team of staff on each unit to be designated to apply the treatment to all the patients / residents on that unit . Patients / residents should be bathed / showered , their body allowed to cool to room temperature prior to the application of the treatment . Clean clothing is to be donned , as well as changing bed linens .
It is also important that you notify your local health department , as their experts can be an excellent resource . Check your state ’ s reportable disease list , too .
Consult with risk management as to the necessity of sending a letter to the power of attorney or the family member responsible for the patient / resident to notify them of the situation . This should be written by the medical director , chief nursing officer , director of nursing , and infection preventionist .
Facility administration will need to determine if they will cover the cost of treatment for family members of the residents as well as the cost to treat the healthcare workers ’ family members .
The medical director , epidemiologist , infection preventionist , dermatologist and the pharmacist should discuss the treatment . Orders will need to be written by the epidemiologist or the medical director for treatment . Once the orders are written , the pharmacy should let infection prevention know how soon they will have the medication available .
See Treatment of Scabies
Per the CDC , a prescribed scabicide lotion or cream should be used .
As noted earlier , a team on each unit should be designated to bathe the residents and apply the prescribed treatment lotion ,
following the prescriptions instructions for use . Note : You may need morning and afternoon teams based upon the
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number of patients / residents on each unit . Team members should utilize Contact Precautions , gown and gloves . Completion of treatment of all patients / residents and staff should be aimed for the same day or at least the next day . This is a huge task , but it can be done .
See Contact precautions
Contact precautions can be discontinued 24 hours after treatment .
Since itching can persist for several weeks , daily assessment of the resident ’ s skin should continue to be sure that no further burrows appear . If they do ,
re-treatment shall be needed .
Leadership should help to convey the necessity that each HCWs household members be treated is highly recommended with documentation that it was done . Healthcare workers may need to contact their pediatrician if they have very young children .
It is more difficult to be sure that family members or visitors of the residents have been compliant so you will need to identify what process shall be used .
Regarding reporting , as mentioned earlier , be sure to notify your local health department as this may be reportable in your state .
The management process of the outbreak should be reported and documented in the facility ’ s Infection Prevention and Control Committee as well as adding to the Infection Prevention and Control Risk Assessment and Plan .
Do not be surprised if you have a visit from the state or the ombudsman .
After all impacted patients / residents have been treated and about six weeks have passed without a new case , you should be in the clear .
Carol Calabrese , RN , BS , CHESP , CIC , is an independent consultant and principal of Calabrese Consulting Services , LLC .
References :
Fourzali KM , Yosipovitch G . Management of Itch in the Elderly : A Review . Dermatol Ther ( Heidelb ). 2019 Dec ; 9 ( 4 ): 639-653 . doi : 10.1007 / s13555-019- 00326-1 . Epub 2019 Sep 23 . PMID : 31549284 ; PMCID : PMC6828892 .
DermNet – dermnetnz . org / topics / drug-induced-puritis
Huang A . Pruritus Associated with Commonly Prescribed Medications in a Tertiary Care Center , Medicines ( Basel ) 2019 Sep ; 6 ( 3 ): 84 . Published online Aug . 4 , 2019 . Doi : 10.3390 / medicines6030084
Control of Communicable Disease Manual , 20th Edition . Pages : 550-552 .
Centers for Disease Control and Prevention ( CDC ). https :// www . cdc . gov / csels / dsepd / ss1978 / lesson2 / section1 . html
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Regarding reporting , as mentioned earlier , be sure to notify your local health department as this may be reportable in your state . The management process of the outbreak should be reported and documented in the facility ’ s Infection Prevention and Control Committee as well as adding to the Infection Prevention and Control Risk Assessment and Plan .” |