Scabies

Community Infection Control NursesLNR PCT’s

Health Protection Agency NursesLNR

Social Care Providers LNR

Aims

To raise awareness of the diagnosis, treatment and control of scabies

ObjectivesTo enable staff to recognise signs and

symptoms of scabiesTo identify the different types of scabiesTo give an overview of how scabies is

transmitted and treated

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

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

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

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

How is Scabies diagnosed ?Ask a GP to diagnoseAscertain 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 fingersSkin folds on the wrist, elbow, knee or auxiliary areasThe penis and scrotumThe breast (particularly the nipples)Shoulder blades

Occasionally skin scrapings for microscopic examination (looking for mite, eggs or faeces)

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)

Scabies Egg

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

Classical Scabies

Types of ScabiesCrusted 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

Crusted Scabies

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

Treatment Application

Don’t 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

Treatment ApplicationRepeat 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 (0116) 263 1400

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

Infection Control PrecautionsStaff should wear gloves and aprons when

applying treatmentLinen should be washed at the hottest

temperature the garment allowsLinen should be place directly into the

washing machine when changedLinen 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

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

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 timeCleaning is not carried out effectively

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 wellDecide on a 24-hour period for the treatment and

inform staffTreat everyone at the same time to prevent re-

infection

Outbreak Prevention(Nursing/Residential Homes)

Promote good surveillance of new residentsObserve for rashes on arrival at the home,

then at 3 weeks and 6 week intervalsMaintain a high level of suspicion if patients

present with undiagnosed rashesEducate staff on presentation and

transmission of scabiesEncourage staff to report rashes (including on

themselves and their family)

Outbreak Management(Nursing/Residential Homes)

Confirm diagnosisRecord and list:

Number of residents in homeNumber of residents with suspect rashNumber of staff employedNumber of staff with rashAny staff families with rashRelatives and other visitors with a rashNumber of staff working at other

institutions/agencies

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