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Appendix 6.1: Scabies Outbreak Pack
(To be completed by Health Care Professional)
Location of Outbreak:
Date Outbreak Identified:
Brief History:
Name of Index Case:
Date of confirmed diagnosis:
Classical or Crusted Scabies:
Please tick
Classical
Date & Time
IPCT informed:
Name of staff member informing
IPCT
Crusted
Signature of IPCN :
Initial Assessment of potential scabies cases
Name of
Person
affected
Service
user
or
Staff
DOB
Description of
Symptoms
Investigations of Possible
Source (include date symptoms
(include details of
rash, itching, dry flaky
skin, previous
diagnosis or
treatment)
first noticed, recent admission to
hospital, attendance at day
centres, contact with others with
symptoms)
Scabies Management
Author: Angela Roberts Infection Prevention and Control Nurse
Version: 2
September 2014
Communication, Diagnosis & Treatment
Action
Date & Time
Signature
Infection Prevention and Control Team informed
Name of IPCN:
Name of staff member who contacted IPCT:
Manager/Senior Nurse informed
Name:
Medical staff/GP(s) informed
Name(s):
Dermatology advice sought: YES/NO
Name of Dermatologist:
Scabies Diagnosed: YES/NO
Diagnosed by:
Skin Scrapings Taken: YES/NO Results:
Wessex Public Health England Centre informed
Name:
Other:
Treatment
Treatment to be used: (as advised by medical doctor/GP/dermatologist)
Approach to Treatment: (As agreed between IPCT, Medical Dr, GP(s), Dermatologist (if
involved) and the WESSEX PUBLIC HEALTH ENGLAND CENTRE)
Treatment Options
Advised
by:
Advice
recorded by:
(Name, date and
sign)
Planned
date of first
treatment:
Planned
date
of second
treatment:
Targeted Treatment
For symptomatic service users and staff
only e.g. 1 identified service user or staff
member and no other cases.
Observe closely for any other cases
Mass Treatment
2 or more cases of classical scabies
1 case of Crusted/Atypical scabies
All service users’ and all staff contacts of
diagnosed scabies case i.e. those that
help out with personal care or have
Scabies Management
Author: Angela Roberts Infection Prevention and Control Nurse
Version: 2
September 2014
2
prolonged hand holding / skin to skin
contact.
Scabies Management
Author: Angela Roberts Infection Prevention and Control Nurse
Version: 2
September 2014
3
Complete List of Symptomatic Cases: Those diagnosed with scabies
Name
DOB
Bay /
Room No.
Date
Admitted
Date of
Onset of
Rash
Diagnosis
Confirmed & By
Whom
Date 1st
Treatment
Received
Date 2nd
Treatment
received
Date declared
symptom free
Monitoring Record for treated diagnosed cases of scabies.
Name
Detail rash
&
start date
Type of 1st
treatment
&
date
Type of 2nd
treatment
&
date
Week 1
Date:
Week 2
Date:
Week 3
Date:
Week 4
Date:
Week 5
Date:
Week 6
Date:
Checked by – sign &
progress comment
Checked by – sign &
progress comment
Checked by – sign &
progress comment
Checked by – sign &
progress comment
Checked by – sign &
progress comment
Checked by – sign &
progress comment
Mon
Mon
Mon
Mon
Mon
Mon
Wed
Fri
Wed
Fri
Wed
Fri
Wed
Fri
Wed
Fri
Wed
Fri
Progress Comment Key
Rash and/or Itching are:
W – Worse
I – Improving
A – Absent
NC – No Change
Please NB: If symptoms DO NOT settle within 4 weeks, inform medical doctor / GP who may wish to re-treat or refer to a dermatologist.
5
Complete Service User Contact Tracing List:
Those without a rash who have had prolonged skin to skin contact with affected
case/s.
Name of Index Case:
Date of confirmed
diagnosis:
Location:
Please record names of service users’ that have been in contact (prolonged skin-to-skin
contacts of several minutes in past 8 weeks) with the index case.
No
1
2
3
4
5
6
7
8
9
10
Name
DOB
Bay /
room
no.
Date of 1st
Treatment
Date of 2nd
Treatment
(7 days later)
Comments
Complete Staff Contact Tracing List:
Those without a rash who have had prolonged skin to skin contact with affected
case/s.
Name of Index Case:
Date of confirmed
diagnosis:
Location:
Please record names of service users’ that have been in contact (prolonged skin-to-skin
contacts of several minutes in past 8 weeks) with the index case.
No
1
2
3
4
5
6
7
8
9
10
Name
DOB
Date of 1st
Treatment
Date of 2nd
Treatment
(7 days later)
Comments
Checklist: Targeted Treatment
ACTION
Date
completed
Put up notice for visitors (Important Notice for Visitors) – Refer to
outbreak pack appendix 6.1
Ensure all staff are aware of the outbreak, the infection control
measures required and the symptoms to observe for in themselves,
service users or family members.
You may wish to distribute the information leaflets in this policy
appendix 6.2 & 6.3
Identify all potential cases - check all service users for symptoms of
scabies
Inform any other care area that symptomatic service users or staff may
have visited, so they can check for possible cases (include any staff
agencies used)
Ensure symptomatic staff obtain 2 treatments for themselves.
Symptomatic household contacts only,can obtain treatment from their
own GP.
Obtain 2 treatments for symptomatic service users’
Treat symptomatic cases as soon as possible and retreat 7 days later
1st Treatment:
2nd Treatment:
Observe and record progress of each case following treatment (at least
3 times a week) until they no longer have symptoms
If symptoms do not settle within 4 weeks, inform medical doctor / GP
who may wish to retreat or refer to a dermatologist
Report any new cases to medical doctor /GP to be diagnosed and
treated as for previous cases
If there are a number of new cases, a mass treatment approach may
need to be considered in liaison with the IPCT SHFT and WESSEX
PUBLIC HEALTH ENGLAND CENTRE if appropriate.
Ensure the list of cases is completed and keep records in case of
further outbreak.
Signature
Checklist: Mass Treatment
MASS TREATMENT
Put up notice for visitors (Important notice for visitors) – refer to
outbreak pack appendix 6.1
Ensure all staff are aware of the outbreak, the infection control
measures required and the symptoms to observe for in themselves,
service users or family members.
You may wish to distribute the information leaflets in this policy
appendix 6.2 & 6.3
Identify all potential cases - check all service users for symptoms of
scabies
Inform any other care area that symptomatic service users or staff may
have visited, so they can check for possible cases (include any staffing
agencies used).
Identify a date and time (usually evening) when the first treatment will
take place, allowing enough time to obtain the treatments and organise
staff rotas (approximately a week in advance)
Organise staff rotas to ensure that there are sufficient staff on duty on
the treatment days, to be able to apply treatments to the service users’
and assist with washing treatments off at the specified time – see
further down regarding how staff on duty will need to undertake their
own treatments.
Inform all staff and service users (and any visitors with very close
contact i.e. those that undertake personal care) about the outbreak, the
proposed action, how to obtain treatment and the dates planned for
treatment.
Ensure all staff (and any very close contacts of residents) obtain 2
treatments for themselves and ensure symptomatic staff have also
obtained 2 treatments for each of their household contacts from a
pharmacy or via their own GPs.
Alternatively, identify the required amount for everyone and place an
order with a local pharmacy.
Obtain 2 treatments for all service users via medical doctor/GP.
Ensure staff on duty on the treatment days (during the application of
the treatment) are aware of the need to undertake their own treatment
at home at the end of their shift.
Ensure staff on duty during the removal of the treatment are aware of
the need to complete their own treatment at home before starting their
shift.
Ensure there are sufficient amounts of clean clothes, linen and towels
Date
Completed
Signature
to use following treatment.
Ensure everyone is treated on the treatment day (apart from those on
duty during the application of treatment who will treat themselves at the
end of their shift) and ensure this is repeated 7 days later.
1st Treatment:
2nd Treatment:
Observe and record progress of each case following treatment (at least
3 times a week)
If symptoms do not settle within 4 weeks, inform GP who may wish to
retreat or refer to a dermatologist
Report any new cases to GP(s) to be diagnosed and treated as a single
case
If there are a number of new cases, liaise with the GP(s) and WESSEX
PUBLIC HEALTH ENGLAND CENTRE
Ensure the list of affected people is completed and keep records in
case of further outbreak.
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PLEASE READ: IMPORTANT NOTICE FOR VISITORS
Case(s) of scabies have been identified within this health care facility.
Scabies is a skin problem caused by tiny mites that burrow into the skin, it is spread by
prolonged skin to skin contact. Scabies is not a serious disease and the affected
individuals will receive the appropriate treatment to eradicate the infestation.
We would like to assure all visitors and relatives that expert advice has been sought
and all appropriate actions are being undertaken.
Scabies should be suspected if an itchy rash develops anywhere on the body, often
symmetrical (present on both sides of the body) and particularly itchy at night and
after bathing. Should you develop signs of scabies, you should inform the nurse /
manager in charge, and make an appointment to see your GP.
If you would like to know more about scabies infection, an information leaflet is
available from staff who are happy to discuss any concerns you may have.
Please continue to wash your hands on arrival and before leaving as a matter of
routine.
We assure you that we are taking all necessary action to prevent further cases.
Thank you for your assistance.`
11
Appendix 16.2: Scabies Information Leaflets
An Information Leaflet
Advice about Scabies!
What is Scabies?
Scabies is an infestation of the skin with tiny mites called Sarcoptes scabei var
hominis. The pregnant female mites burrow into the top layer of skin and lays about
2 -3 eggs per day before dying after 4 -5 weeks. Eggs hatch and develop into adults,
mating occurs the male mite dies and the female life cycle repeats itself.
The scabies mite has been associated with humans for thousands of years, and is no
more unusual or frightening than head lice, an infestation can be unpleasant until it is
treated.
What are the symptoms?
There may be no symptoms for 2 – 8 weeks in people who have normal immunity
after infection, but then an allergy develops to the presence of the mites and their
waste products. Usually there are 10 – 20 mites on an affected person.
If a person has had scabies before a rash may appear within a few days.
The rash is quite variable, but tiny raised red spots / pimples, often occur around the
webs of the fingers, armpits, waist and groin. The scabies mites are attracted to thick
folded skin but other areas of the body can also be affected. This is associated with
intense itching, which is often worse at night or following a hot bath or shower.
Sometimes you may be able to see the tiny mite burrows in the skin, seen as a fine
dark or silvery line about 2 – 10 mm long commonly seen between the webs of the
fingers. If scratching has occurred, the burrows may no longer be visible, reddening
and secondary infection may occur.
If the service user has an impaired immune system, neurological condition or altered
skin sensation, they may develop a condition known as “atypical” or “crusted” scabies
(sometimes called Norwegian scabies). They may not have shown any of the typical
signs and symptoms of an infestation, but may harbour thousands of mites. This form
of scabies is very contagious via direct skin to skin contact and through contact with
contaminated clothing, bedding, soft furnishings. The sufferer’s skin thickens and
becomes scaly, many mites can be shed on the skin scales, making spread to others
much more likely.
How might I have caught scabies?
Scabies only lives on humans it is passed from person to person, usually by
prolonged close skin to skin contact with a person who is infected with scabies e.g.
holding hands or helping a resident to stand or walk, it is also spread via sexual skin
to skin contact, please note – a quick handshake or hug is unlikely to spread the
infection. If a member of your close family or a resident that you have close contact
with has a scabies infection, it is possible you could catch it from them.
What should I do if I think I have scabies?
If you have symptoms that seem to indicate that you or someone you have close
contact with may have scabies, you or the affected person should consult a doctor to
have the diagnosis confirmed.
Scabies Management
Author: Angela Roberts Infection Prevention and Control Nurse
Version: 2
September 2014
12
How is scabies treated?
 Use a suitable lotion or cream. LYCLEAR cream or DERBAC-M lotion are
recommended. These can be prescribed by a hospital doctor your GP or local
chemist shop. You will need two lots of cream or lotion per person as the treatment
must be repeated after 7 days.
 Apply the lotion thinly over the whole body from the top of the head downwards.
Don't get it in the mouth, nose or eyes. Make sure you include areas between the
toes and fingers, underneath fingernails and around the genitals.
 Leave the lotion on as advised in the manufacturer’s instructions (usually 8-14
hours) and then wash it off. While the lotion is on, avoid washing, this is easier if the
lotion is applied at night. If you wash your hands put on some more lotion
afterwards.
After the recommended time, have a bath or shower and put on clean clothes and
change bed sheets. If you apply the medication correctly and leave it on for the
correct length of time, it will kill all the mites after the first treatment.
 A second application of the lotion or cream is recommended after seven days.
 The treatment will kill the mites but itching may continue for 2-3 weeks afterwards.
Your doctor will be able to advise on a suitable cream to reduce the irritation.
 There is no need for any special precautions with clothing or bedding other than
washing on a hot washing machine cycle. Any items that cannot be washed in this
way should be set aside and not used for seven days. Under these conditions mites
will quickly become dehydrated and die.
In a hospital setting the laundry will be treated as infectious.
 In crusted or atypical scabies more intensive treatment is necessary which may be
continued for some time. Normal hygiene and vacuuming of chairs, beds and soft
furnishings will minimise environmental contamination with skin scales.
Should I stay away from work
Stay away until the first treatment is completed, then return as normal.
Service users if isolated can be taken out of their side rooms, if crusted scabies
contact the hospital IPCT for further advice.
Staff can return back to work.
Will scabies spread among family members?
It is important that all close family members in the same house are treated even if they
do not have any symptoms. Everyone should be treated at the same time to ensure
that they do not re-infect each other.
As a carer, it is very important that you make sure your matron or manager is aware,
if you are diagnosed with scabies as they will need to check if other staff or service
users are affected.
If you are worried that you may have become re-infected, discuss with your doctor so
that if necessary you can be given further treatment.
Where can I obtain more information about scabies?
Talk to the nursing/medical staff on your ward or your GP if at home.
For Infection Prevention and Control nurse advise contact us on: Tel: 02380 87 4291.
Scabies Management
Author: Angela Roberts Infection Prevention and Control Nurse
Version: 2
September 2014
13