Transmission occurs through direct skin-toskin contact . Skin to skin contact needs to be long enough for the mite to leave one body and burrow under the skin of another person .
It takes about an hour for this to occur . Mites need their host ( human beings ) to survive ! For people that have never had Scabies , it may take two to six weeks for symptoms to appear , thus providing ample opportunity for transmission to continue .” observed . However , outbreaks of Scabies are more common in long-term care facilities and aggregateliving facilities than you might imagine . Scabies outbreaks extend beyond the patients / residents to healthcare personnel , their families and visitors . In searching for information related to the incidence of Scabies in LTC facilities in the United States , I went to the Centers for Disease Control and Prevention ( CDC ) website and found that the Scabies page had not been updated since November 2010 . Some of the more recent peer-reviewed literature comes out of South Korea and Japan , so my suggestion is that you should contact your state health department .
You may be asking yourself , “ Is it time to go into outbreak mode ?” You may still be determining if you have a problem and wondering if it is time to kick into an active outbreak mode . Since there are many different things that can cause itching in the elderly , it is important to approach things in an organized manner .
First , a review of Scabies is in order . Scabies is essentially a parasite . It does not cause any type of disease . According to the Control of Communicable Diseases manual , 20th edition , the Sarcoptes scabiei mite can live on humans but cannot reproduce . These mites burrow down into the layers of the skin with papule , vesicles and linear burrows presenting in the webs of the fingers , around wrists , around the waist , under breasts , the abdomen and the buttocks . This is different than what you will observe with shingles . Itching is caused by a histamine reaction to the fecal droppings of the mite . Itching can be very intense , especially at night . The incidence of Scabies is worldwide , and they have been in existence forever .
Transmission occurs through direct skin-to-skin contact . Skin to skin contact needs to be long enough for the mite to leave one body and burrow under the skin of another person . It takes about an hour for this to occur .
Mites need their host ( human beings ) to survive ! For people that have never had Scabies , it may take two to six weeks for symptoms to appear , thus providing ample opportunity for transmission to continue . For those individuals that have previously had Scabies , symptoms can start one to four days after exposure .
In addition to the residents in a long-term care facility being at risk , so are healthcare personnel as well as their household members and the family members / visitors of the resident ( s ).
When a resident or even a healthcare worker reports itching , don ’ t dismiss it , assess and start a line listing , which is one type of epidemiologic database and is organized like a spreadsheet with rows and columns . Typically , each row is called a record or observation and represents one person or case of disease , per the CDC .
This link provides a good overview of how to conduct an epidemiologic investigation .
Establish the case definition . “ Ex . 2 or more cases within a 2 – 6-week period ” ( see transmission ). Keep one line listing for residents and one for healthcare personnel .
The line listing should include the following at a minimum :
● Name / case ID
● Room number / unit
● Date of onset of symptoms
● Caregivers
● Chart review and assessment of the resident . This will include a review of the medication and any recent lab work . If it is a healthcare worker , do a skin assessment and be sure to include questions about the family , where do adults work , do they work at more than one long-term care facility
● Skin scraping performed , date , by whom and results
● Treatment
Regarding managing the situation , at first suspicion , I always suggest having a meeting with the facility ’ s chief nursing officer , director of nursing , administrator and the chief medical officer to provide an overview of the potential situation . Review with them the results of your research related to the patient / resident ’ s medical history , medications , etc . and explain why you believe that an outbreak is suspected . Be sure to communicate with the ancillary department heads . Be sure to have a dermatologist involved to assess the patients / resident ( s ) involved and be sure that they perform skin scrapings for confirmation . It will be necessary to determine if you are dealing with ( regular ) Scabies or Norwegian ( crusted ) Scabies . Any healthcare personnel with symptoms should be evaluated by the employee health representative and skin scaping performed , as well as providing treatment .
What is the difference ? Regular Scabies rash is generally not seen above the neckline and Norwegian Scabies can be seen on the neck and scalp of the individual and looks crusty . The dermatologist can assist with this .
Determine if the outbreak is contained to one unit . To do this , you will need to assess staffing on all the shifts for at least six weeks . Look to see if any healthcare personnel rotated to another unit . Also investigate if the resident ( s ) had physical therapy or other therapies , participated in activities , or were exposed to healthcare personnel in other departments . If a resident in a longterm care facility experienced a recent hospital admission , be sure to contact the infection preventionist at the hospital and vice versa .
Have a staff meeting to alert all healthcare personnel about what they should be looking for and to notify you as soon as possible of potential new complaints by patients / residents of itching or observing a patient / resident itching . Note : itching is more prevalent during the evening and nighttime . Do not have them ask “ are you itching ?” as that plants a subjective thought into the person ’ s mind . Instead , ask the patient / resident to describe what it feels like and if they notice it at certain times .
If a resident ( s ) has gone to any outside appointments , be sure to notify that office ( s ) as well once the outbreak has been confirmed .
jan-feb 2025 • www . healthcarehygienemagazine . com •
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