Download Alert Conditions – Human Infestations e.g. Scabies, human lice, ticks

Infection Prevention and Control Assurance Standard Operating
Procedure (IPC SOP 29)
Alert Conditions – Human Infestations e.g. Scabies,
human lice, ticks and worms
Why we have a procedure?
To ensure employees of the Black Country Partnership NHS Foundation Trust have a
standard procedure to follow when caring for patients known or suspected to have an
infestation for example head lice or scabies, to minimise and manage the risks of further
transmission to patients, staff and visitors.
The Health and Social Care Act 2008: Code of Practice for the NHS for the Prevention and
Control of Healthcare Associated Infections (revised January 2015) stipulates that NHS bodies
must, in relation to preventing and controlling the risk of Health Care Associated Infections
(HCAI), have in place appropriate core policies/procedures. Implementation of this procedure
will contribute to the achievement and compliance with the Act.
What overarching policy the procedure links to?
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This procedure is supported by the Infection Prevention and Control Assurance Policy
Which services of the trust does this apply to? Where is it in operation?
Group
Mental Health Services
Learning Disabilities Services
Children and Young People Services
Inpatients
Community
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Locations
all
all
all
Who does the procedure apply to?
This document applies to all staff employed by or working on behalf of the Black Country
Partnership NHS Foundation Trust caring for patients as part of their role and job description.
When should the procedure be applied?
Effective prevention and control of healthcare associated infection (HCAI) must be embedded
into everyday practice and applied consistently. This procedure must be applied to reduce the
risk of transmission when caring for patients with known or suspected infestations.
Additional Information/ Associated Documents
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Infection Prevention and Control Assurance Policy
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Hand Hygiene Policy
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Infection Prevention and Control Assurance - Standard Operating Procedure 1 (IPC SOP
1) - Standard Infection Control Precautions
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Infection Prevention and Control Assurance - Standard Operating Procedure 2 (IPC SOP
2) - Transmission Based Precautions
Infection Prevention and Control Assurance - Standard Operating Procedure 3 (IPC SOP
3) - Surveillance of Infection and Data Collection
Infection Prevention and Control Assurance - Standard Operating Procedure 5 (IPC SOP
5) - Management and Recognition of Outbreaks
Infection Prevention and Control Assurance - Standard Operating Procedure 6 (IPC SOP
6) - Isolation – Care of Patients in Isolation due to Infection or Disease
Infection Prevention and Control Assurance - Standard Operating Procedure 7 (IPC SOP
7) - Decontamination - Cleaning, Disinfection and Sterilisation
Infection Prevention and Control Assurance - Standard Operating Procedure 9 (IPC SOP
9) - A-Z of Infections – A Quick Reference Guide
Infection Prevention and Control Assurance - Standard Operating Procedure 14 (IPC
SOP 14) - Undertaking a Patient Infection Risk Assessment
Aims
To ensure that all Black Country Partnership NHS Foundation Trust staff working in our
hospitals and community settings:
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Have access to this procedure on the management of individuals who are suspected or
known to have an infestation with the aim of managing human infestations and reducing
the risk of transmission to others
Definitions
Fomites
Any material, such as bedding or clothing that may harbour pathogens
and therefore convey disease
Healthcare
Acquired Infection
(HCAI)
Healthcare associated infection (HCAI) refers to infections that occur as
a result of contact with the healthcare system in its widest sense – from
care provided in the patient’s own home, to general practice, hospital
and nursing home care
Hyperkeratotic
overgrowth and thickening of the outer layer of the skin
Infection
The presence of microorganisms on/in the body that is causing an
adverse effect or host- response – the person is unwell and has signs
and symptoms of an infection
Infection prevention Processes to prevent and reduce to an acceptable minimum the risk of
the acquisition of an infection amongst patients, healthcare workers and
and control
any others in the healthcare setting
Infestation
In general, the term "infestation" refers to parasitic diseases caused by
animals such as arthropods (i.e. mites, ticks, and lice) and worms, but
excluding conditions caused by protozoa, fungi, bacteria, and viruses,[3]
which are called infections
IPCT
Infection Prevention and Control Team
Risk Assessment
A process used to identify any potential hazards and analyse what could
happen, and to identify steps to be taken to reduce or minimise the risk
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Human Infestations
Mites
Scabies
There are two types of scabies, Classical Scabies and Norwegian Scabies. The scabies mite
is extremely small 0.2 to 0.4mm in length. A scabies infestation starts when a mite burrows
under the top layer of the skin. They may occur anywhere on the body and the burrows are
usually 5mm long.
The pregnant female mites burrows in the epidermis and lays about 2-3 eggs per day before
dying after 4-5 weeks. The eggs hatch after 3-4 days into larvae that move to hair follicles
before developing into adults after a further 7-10 days. Mating takes place and the female
embeds in a new burrow within one hour.
Burrows which appear as fine red wiggly lines and are generally up to 1cm long and may
occur anywhere on the body but are most commonly found between fingers and around wrists,
feet and genitalia. The associated rash is usually on the wrists, elbows, breasts, waist,
perineum and buttocks but in bed-bound patients may affect back, shoulders, neck and scalp.
Classically, the rash appears on both sides of the body, like a mirror image. They can be
transferred to other parts of the body through touch. (Fact sheet available in Appendix 2)
The scabies mite (magnified)
Classical Scabies
Classical Scabies
Clinical presentation
Scabies - areas commonly affected
Sarcoptes scabiei – a mite causing a contagious skin infestation
scabies
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Severe itching especially at night due to an allergic response to the
presence of the mite, however it may take 4-6 weeks for the itching to
start unless the person has had previous scabies, when the immune
response is rapid and itching develops within days
A rash consisting of tiny red spots and scratching the rash may cause
crusty sores to develop (see images below)
Incubation period
Mode of transmission
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Up to 8 weeks
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Scabies mites are not able to jump or fly. The usual method of
transmission is through direct and prolonged periods of contact (1020 mins or intimate skin-to-skin contact
Period of
communicability
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There may be no sign of infection for 2-4 weeks but Scabies remains
infectious until treated. Infectiousness depends on the number of
mites on the affected person. Usually there are only 10-20 mites
Groups susceptible to
Scabies
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All humans are susceptible to Scabies infestations
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Complications
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Treatment
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Repeated itching and scratching may break the skins surface which
can lead to a secondary skin infection
Exacerbation of pre-existing skin conditions e.g. eczema
A scabicidal treatment (lotion or cream) must be prescribed/applied to
the whole body, to cool skin (NOT to be applied after a hot bath).
Follow the manufacturer’s instructions provided with the product.
Treatment must be left on the skin for 8-24hrs (depending on which
product is prescribed), during which time the treatment MUST be reapplied to any areas which are washed during the period of
application. Treatment is usually repeated again after 5-7 days to
ensure any mites hatched from existing eggs are killed (Appendix 1)
On the day of the first treatment application, all bed linen, clothing, nightwear and towels must
be washed at a temperature above 50°C (treat as infected linen). If items cannot be washed
they should be placed in a plastic bag and left untouched for at least 72 hours. After this time,
the scabies mites will have died.
Contacts to typical/classical scabies cases are defined as persons who had ‘hands-on’
contact, handled infested clothing or bed linen, or slept in the same bed as the case-patient
during the exposure period. Contacts/family members and sexual contacts should be advised
to treat themselves at the same time. Affected persons can return to work or school after the
first treatment application.
It should be noted that the itching may take several weeks to resolve because the immune
system will still be reacting to the presence of dead mites and their droppings. –
antihistamines may help with the symptoms especially at night.
Recognising Classical Scabies
Classical scabies rash with burrows visible
Norwegian Scabies
Norwegian Scabies
Norwegian or crusted scabies is a hyper-infestation with thousands of
mites present in exfoliating scales, due to the host's insufficient immune
response
Clinical presentation
Crusted scabies is highly contagious because thousands of mites
are imbedded in the thick crusts and easily shed in scales and
flakes from affected skin. Crusted scabies is commonly
misdiagnosed by dermatologists, and patients with crusted scabies
may develop symptoms of typical scabies in as little as a few days
Incubation period
Mode of transmission
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Up to 8 weeks
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Scabies mites are not able to jump or fly. The usual method of
transmission is through direct and prolonged periods of contact (1020 mins) or intimate skin-to-skin contact
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Period of
communicability
Groups susceptible to
Norwegian scabies
Complications
Treatment
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There may be no sign of infection for 2-4 weeks but Scabies remains
infectious until successfully treated – this usually requires a
prolonged course of treatment
 Infectiousness depends on the number of mites on the affected
person. Usually there are only 10-20 mites but in Norweigain Scabies
there are many more
 Norwegian Scabies can survive outside the human body for up to 7
days as they are able to feed on skin scales in bedding, towels and
clothing and are therefore more easily spread
People who are immunocompromised are more susceptible Those at risk
include:
 The immunosuppressed (e.g., HIV infection, leukaemia or lymphoma)
 Elderly patients
 Those with decreased peripheral sensation
 Repeated itching and scratching may break the skins surface which
can lead to a secondary skin infection
 Exacerbation of pre-existing skin conditions e.g. eczema
 Inappropriate treatment due to poor diagnosis
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Prolonged course of scabicidal therapy – this may take several weeks
or months
Contacts to Norwegian/atypical (crusted) scabies also include persons who had
substantial contact with a crusted scabies case-patient’s environment, including HCWs who
worked (regular or bank assignment) on the same unit/area as the case-patient during the
exposure period. If the case-patient was housed on more than one unit before control
measures were initiated, each unit must be considered affected.
Recognising Norwegian Scabies
Norwegian scabies rash with severe crusting of the skin – highly contagious
Outbreaks
The outbreak exposure period is the period between the admission date of a scabies case
and the date the condition is correctly diagnosed and control measures are implemented. If
the case-patient is a long-term care resident, this period extends from six weeks prior to onset
of symptoms. The identification of two or more symptomatic HCWs assigned to a particular
unit suggests that prophylaxis is indicated for all unit/area contacts, whether or not they were
direct contacts of a known scabies case - refer to Infection Prevention and Control Team.
(Contact list template available in Appendix 3).
Key Recommendations Caring for Patients with an Infestation due to Scabies
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On identification of a patient with an infestation in a clinical area, staff must ensure
prompt communications to the Infection Prevention and Control Team
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An assessment of the risks to other patients, staff and visitor contacts must be carried
out with assistance from the Infection Prevention and Control Team
Place patients with typical scabies on contact precautions during the treatment period; 24
hours after application scabicidal cream/lotion cream or 24 hours after last application of
scabicides requiring more than one application
HCWs must wear gloves and a long-sleeved gown for hands-on contact. Wash hands
after removal of gloves
Place bed linens, towels and clothing used by an affected person during the 4 days prior
to initiation of treatment in plastic bags inside the patient’s room, handled by gloved and
gowned healthcare workers without sorting, and washed in hot water (50°C) in the
washing machine for at least 10 minutes. The hot cycle of the dryer should be used for at
least 10-20 minutes. Non-washable articles can be placed in a plastic bag for 7 days; dry
cleaned or tumbled in a hot dryer for 20 minutes
Change all bed linens, towels and clothes daily
Disinfect multiple patient-use items, such as walking belts, blood pressure cuffs,
stethoscopes, wheelchairs, etc., before using on other patients
Discard all creams, lotions or ointments used prior to effective treatment
Vacuum mattresses, upholstered furniture and carpeting. There is no need for special
treatment of furniture, mattresses or rugs or fumigation of areas. General cleaning and
thorough vacuuming is recommended
Crusted (Atypical )Scabies
In addition to information above:
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(Maintain contact isolation until treatment is completed and/or case is determined by
dermatology consultant or other experienced designee to be non-infectious)
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Upholstered furniture containing any cloth fabric should be removed from the room and,
if necessary, replaced with plastic or vinyl furniture. Mattresses must be covered with
plastic or vinyl impermeable cover
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The patient’s room should be vacuumed daily with a vacuum cleaner designated or this
room alone, followed by routine room cleaning and disinfection. The vacuum cleaner bag
should be changed daily; removal and disposal of contaminated bags should be
performed in accordance with infection control protocol
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The room should be terminally cleaned upon discharge or upon transfer of the patient
from the room
Symptomatic Staff
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Symptomatic employees should be referred to Occupational Health and their GP so that
treatment can be promptly initiated and allowed back to work the morning following
overnight treatment with a scabicidal cream/lotion
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Disposable gloves should be worn 2-3 days by symptomatic staff who most provide
extensive hands-on care to their patients
Ticks
Ticks are small, blood sucking creatures which feed on many different types of birds and
animals, including humans. During feeding they can spread infections and cause disease.
They are found in woodland and moorland areas and are most common from April to October.
They can also be found in parks, or in gardens where there is wildlife. The most common tick
in the UK is the sheep or deer tick. Ticks feed for several days then drop off into the undergrowth where they grow and develop, until they are ready for their next blood meal or to lay
eggs. They vary from 1mm to 1cm long and have 6 or 8 legs.
Ticks can carry many diseases that can affect animals or humans or both. In the UK, Lyme
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Disease, also known as Lyme Borreliosis, is the most common disease transmitted by ticks.
There are also other diseases which in the UK mostly affect animals, but which (very rarely)
can also affect humans. In other parts of the world, including other areas of Europe, ticks carry
a variety of different diseases.
Stages of a Tick’s Life-Cycle
Tick feeding on wrist
Tick tweezer
Key Recommendations – Ticks
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If a tick has attached then it should be removed as soon as possible. This can be done
using a proprietary tick remover that is sold by many vets and pharmacies. Ticks can
also be removed using tweezers parallel to the skin or fingernails covered by a paper
tissue. Grip the head of the tick as close to the skin as possible and pull steadily. Be
careful not to squeeze the body of the tick
Do not cover the tick with oils, lotions or chemicals and do not burn it as this may
increase the likelihood of it passing on a disease
After the tick has been removed wash the area well
If the person becomes unwell or develops a rash around the tick bite then a doctor must
be consulted. A rash which spreads out from the bite could be a sign of Lyme disease
The disease responds well to treatment with antibiotics but it is better that it is treated
early. There is no need to see a doctor if you have been bitten but have no other
symptoms, however if a doctor is consulted remember to tell them that they have been
bitten by a tick
Human Lice
There are three kinds of lice which feed on man.
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The head louse ( Pediculus humanus capitus )
The body louse ( Pediculus humanus humanus )
The crab or pubic louse ( Pthirus pubis )
Head and body lice are very much alike; however, body lice are slightly larger. These lice have
abdomens longer than they are broad and their six legs are equal in size. In contrast, the
abdomen of the crab louse is about as wide or even slightly wider than its length, and the
second and third pairs of legs are thicker than the first pair. Crab lice are much smaller than
head and body lice.
Depending on temperature, lice eggs (nits) usually hatch into nymphs within ten days. There
are three nymphal stages, the third followed by the adult stage. All stages must have blood
meals if they are to survive and continue their development. Adult lice live about 30 days. Lice
cause much discomfort to humans due to their bites, which are irritating, causing
sleeplessness. Scratching often leads to secondary bacterial infections.
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Head Louse
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Nits
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Body Louse
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Infestations
The female head louse will deposit from 50 to l50 eggs or nits in
her lifetime
Head lice glue their eggs to the base of hairs. Only one nit is glued
to any one hair
Eggs hatch in five to ten days. Human hair grows about 1/2 inch
per month, any nits found on a hair 1/4 of an inch from the scalp
would be approximately 16-days old, and would have hatched
already, or will not hatch. These nits are glued tightly to the hair
shaft and can only be removed by combing. A special fine-toothed
comb must be used which has teeth 0.l mm apart
The life cycle for the head louse (from egg to adult) takes from 16
to 21 days
Head lice are transferred between persons who share items such
as hats, hairbrushes, combs, or wigs or have close head-to-head
contact
Treatment - There are several different products that can be
applied to the scalp and hair to kill head lice. Some treatments
need be done twice – seven days apart – to make sure any newlyhatched lice are killed. ALWAYS follow the manufacturer’s
guidelines
Detection combing should usually be done two or three days after
finishing treatment, and again another seven days after that, to
check for any live head lice
Body lice spend most of their time on the underclothing, next to the
body, particularly along the seams. From here they periodically visit
the hosts’ body for blood
They usually glue their eggs (up to 300 in a lifetime) to the fibers of
clothing, but may occasionally glue them to body hairs as does the
head louse
Body lice spread from clothing, particularly underclothing. If
infested clothing is left lying about, body lice can migrate and thus,
spread to other clothes and people
An infestation with body lice often causes intense itching, which is
an allergic reaction to their saliva. The reaction to the bites may
appear as small welt-like marks and, possibly, redness and
swelling, particularly around the neck and on the torso. A heavy,
long-lasting infestation may produce a darkening and thickening of
the skin, fatigue and other symptoms
Although a few body lice may be seen clinging to body hairs, most
are on the clothing of an infested person. Body lice and their eggs
are most abundant along the seams of clothes worn close to the
body
Someone infested with body lice typically will have 10 or fewer
active lice on their skin at any one time. But the clothing may
contain many dozens or hundreds
Scratching the bites can lead to infection
Washing clothes in hot water, 60°C. or higher, will kill any body lice
and their nits. Clothes which can’t be laundered should be dry
cleaned. Body lice can often be controlled by frequent changes and
washings of clothes
Treatment - The affected person needs to be washed from head to
toe. The main way to eliminate body lice is by removing and
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Crab or pubic louse
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washing or throwing away infested clothing and bedding
Body lice and their eggs can be killed by washing clothing in very
hot water, followed by drying these items in a clothes dryer set on
high heat (for at least 30 minutes). Dry cleaning or pressing the
clothing with a hot iron will also kill the lice and eggs. Because body
lice usually do not remain on the host, changing and/or washing
clothes and bedding may be enough to eliminate these pests
People with a lot of body hair may need to be treated with a
pesticide that can be applied to the body to make sure lice are
eliminated completely. Over-the-counter products containing
permethrin can be effective. Other insecticides are available on
prescription
These lice are found mostly in the hair of the pubic area. They may
also be found under the armpits, in the beard or mustache and on
the eyebrows and eyelashes
Their development from egg to adult normally requires from 30 to
41 days. Adult crab lice live about 30 days. Females deposit 30-50
eggs (in her lifetime)
Crab lice usually are transmitted from person to person by sexual
contact, however, they can be found on toilet seats and in beds,
and from there, spread to people
They are tan to grey or white in colour. Females lay nits and are
usually larger than males. To live, lice must feed on blood. If the
louse falls off a person, it dies within 1-2 days
The lice lay their eggs (nits) in sacs that are stuck firmly to hairs
and are a pale brownish colour. When the eggs hatch, the empty
egg sacs are white
The main symptoms of infection are itching and burning of the
pubic area. The itching may spread as the pubic lice move to other
moist areas of the body such as the armpit. For many people the
itching is worse at night. Intense or prolonged scratching may lead
to skin injuries that may become infected by bacteria
Pubic lice on the eyebrows or eyelashes of children may be a sign
of sexual exposure or abuse
Treatment - There are several different products that can be
applied to kill pubic lice. Some treatments need be done twice –
seven days apart – to make sure any newly-hatched lice are killed.
ALWAYS follow the manufacturer’s guidelines. To prevent reinfestation, anyone they have had close bodily contact with,
including any sexual partners in the past three months, should also
be treated, even if they don't have symptoms
Wash clothing, towels and bedding in a washing machine. This
should be on a hot cycle (50°C or higher) to ensure the lice are
killed and to prevent reinfection
Worms
Human parasitic infections are very common and widespread in both developed and undeveloped
countries.
Tapeworm – The commonly called Tapeworm (Cestoda) implants larvae into cattle and fish muscles,
which transfer and hatch inside humans if the meat is eaten in an undercooked, rare, or even mediumrare state.
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Tapeworms on average grow to about 1-3 feet in length but the longest ever recorded were 90
feet long, and they can produce over a million eggs per day! One small slice of meat or fish can
contain thousands of eggs
Tapeworm larvae also exist in the raw fish used to make sushi
Tapeworms in humans may even include death as Tapeworms may attack the central nervous
system at the spinal cord and brain causing paralysis or brain damage
Personal hygiene is even more important if you are in close contact with animals, or
travelling in a country where tapeworm infections are more common
See Infection Prevention and Control Assurance - Standard Operating Procedure 1
(IPC SOP 1) - Standard Infection Control Precautions and Infection Prevention and
Control Assurance - Standard Operating Procedure 2 (IPC SOP 2) - Transmission
Based Precautions
Roundworm - Roundworms can infest the human gut, where they live, feed and reproduce.
They don't often cause any symptoms, but are more likely to in large numbers.
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A roundworm infection – also sometimes known as ascariasis or ascaris – is usually
easy to treat Roundworms are parasites. They use the human body to stay alive, feed
and reproduce
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A roundworm infection doesn't usually cause any noticeable symptoms. People usually
see their GP because they've seen a worm in their stools (faeces)
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Less commonly, symptoms can include a high temperature and dry cough 4-16 days
after swallowing the eggs
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If a large number of eggs have been ingested, or if the worms move from the small
intestine to other parts of the body, they can cause serious complications, such as a
bowel obstruction. However, in England, these types of complications are rare
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Roundworm infections can usually be successfully treated with medication
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Regularly washing your hands can help prevent the spread of a roundworm infection
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You should take additional precautions if you're travelling to a part of the world where
roundworm is common, such as only drinking bottled water and avoiding raw fruit and
vegetables
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See Infection Prevention and Control Assurance - Standard Operating Procedure 1
(IPC SOP 1) - Standard Infection Control Precautions and Infection Prevention and
Control Assurance - Standard Operating Procedure 2 (IPC SOP 2) - Transmission
Based Precautions
Hookworm - Hookworms in humans Hookworms are parasitic worms that can infect humans
in countries with poor sanitation and a warm, moist climate.
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The hookworm larvae (immature worms) are found in soil that's been contaminated with
human faeces. The larvae can infect people if their bare skin comes into contact with the
soil – for example, if you're walking barefoot
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Most hookworm infections occur in Africa, the Americas, China and southeast Asia
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The main way people become infected with hookworm is through direct skin contact with
contaminated soil, typically when walking barefoot. Children can also become infected
after playing in the soil and putting their hands in their mouth
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Other ways to become infected include eating raw, unwashed vegetables that are
contaminated with hookworm eggs or by drinking contaminated water
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Once the larvae have entered the body, they move through the bloodstream into the
lungs, airways and throat, where they're swallowed and enter the small intestine
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After reaching the small intestine, the larvae mature into adult worms and attach
themselves to the intestinal wall, where they can cause blood loss
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Most adult worms are expelled from the small intestine after one to two years, although
they can sometimes remain for longer
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Medications are usually effective and have few side effects
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See Infection Prevention and Control Assurance - Standard Operating Procedure 1
(IPC SOP 1) - Standard Infection Control Precautions and Infection Prevention and
Control Assurance - Standard Operating Procedure 2 (IPC SOP 2) - Transmission
Based Precautions
Training
Staff may receive training in relation to this procedure, where it is identified in their appraisal
as part of the specific development needs for their role and responsibilities. Please refer to the
Trust’s Mandatory and Risk Management Training Needs Analysis for further details on
training requirements, target audiences and update frequencies.
Monitoring / Review of this Procedure
In the event of planned change in the process(es) described within this document or an
incident involving the described process(es) within the review cycle, this SOP will be reviewed
and revised as necessary to maintain its accuracy and effectiveness.
Equality Impact Assessment
Please refer to overarching policy
Data Protection Act and Freedom of Information Act
Please refer to overarching policy.
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Appendix 1
Application of Scabicides: General Principles
1.
Gowns and gloves are worn when applying scabicides to patients
2.
Bathe/shower patients as usual and change bed linens. Allow skin to cool completely
3.
Apply scabicide to every square inch of skin, from the posterior ear folds down over the
entire body. Include intergluteal cleft, umbilicus, skin folds, palms and soles, and webs
between fingers and toes. If scabicide is washed off during handwashing, toileting, or
perineal care, it must be reapplied
4.
In infants and young toddlers, the elderly, and the immunocompromised, the head
(forehead, temples, and scalp) requires application of scabicide. Pay close attention to
the area behind the ears. Do not get the scabicide near the eyes or mouth. Prior
treatment failure may be an indication to include the head upon retreatment
5.
Fingernails and toenails should be clipped and scabicide applied under nails
6.
Follow directions and precautions outlined in the package insert accompanying scabicide
paying particular attention to the time the treatment must be left on the skin – this will
vary depending on the product prescribed (between 8-24 hours)
7.
A cleansing bath/shower is taken when scabicide is to be removed
8.
Linens and clothing are changed after treatment. Contaminated clothing and linens may
be 1) dry-cleaned or 2) washed in the hot cycle of the washing machine (above 50°C)
and dried in the hot cycle of the dryer for 10-20 minutes
9.
Provide detailed written instructions for scabicide use when dispensing scabicide for
home application by employees and household members
10. Treatment as above is usually repeated again after 5-7 days
Scabicides
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The usual adult dose is 30 grams. A 60 gram tube should treat two adults
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For adults and children, the cream should be massaged into the skin from below the the
chin to the soles of the feet. Scabies rarely infests the scalp of adults, although the
hairline, neck, temple, and forehead may be infested in infants and geriatric patients.
Infants should be treated on the scalp, temple and forehead

The patient should be instructed to remove the medication by thoroughly bathing 8 to 24
hours after application (see manufacturers information leaflet for exact time). Contact
with the eyes and mouth should be avoided. If contact with the eyes occurs, they should
be immediately flushed with water
Treatment Regimens for Crusted (Norwegian) or Severe Atypical Scabies
1.
Cases of crusted scabies and other variants of severe atypical scabies are best
managed with the assistance of a dermatologist. They often require repeated courses of
topical treatment combined with the oral treatment Ivermectin. (Ivermectin is a broadspectrum antiparasitic agent usually limited to cases that prove to be resistant to topical
treatments or that present in an advanced state)
Infestations
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Appendix 2
Scabies Fact Sheet
What is scabies?
Scabies is an infestation of the skin caused by a mite. The female mite burrows into the top
layer of the skin. This forms a slightly raised tunnel where the mite lays eggs and leaves
waste.
Who gets scabies?
Anyone can get scabies.
How is scabies spread?
The mite is passed from person to person by skin contact or sharing bedding, clothing or other
linens with a person who has scabies.
What are the symptoms and when do they appear?
The most common symptom is an itchy rash. Often the rash itches most at night. It can appear
anywhere on the body but is usually on the hands, wrists, elbows, breasts, armpits, waistline,
and groin. Persons who have never had scabies before usually notice symptoms about 4 to 6
weeks after their contact with someone with scabies. Persons who have had scabies before
may notice their symptoms sooner, often within a few days to 1 week. Elderly persons,
persons in institutions, and persons whose immune system is weak may not have itching. Any
unusual skin problem should be checked by a doctor.
How long is a person able to spread scabies?
A person is probably able to spread scabies from the moment of contact until after all
treatment is complete. Scabies is diagnosed by a doctor or nurse looking at the rash and/or by
taking a scraping from the skin.
What is the treatment?
A medicated cream/lotion will be prescribed by your doctor. It is put on the skin, left on for
several hours, and then washed off. You must put on clean clothes and use freshly laundered
bed and bath linens. An oral medication may also be prescribed.
Can a person get scabies again?
Yes. In fact, the symptoms (itching and rash) will appear more quickly.
Should infested persons be excluded from school or work?
Yes, until treatment has been finished, but generally this is less than one day.
What are the health problems associated with scabies?
Usually none. Occasionally, secondary skin infections may occur from scratching.
What can be done to prevent its spread?
Persons with symptoms should be checked and treated by their doctor as quickly as possible.
Household members and other persons with skin-to-skin contact should be preventively
treated. Clothing, bedding, and bath linens used within the 4 days before initiation of therapy
should be washed in a washer using hot water and dried using the hot drier cycle. Clothing
and other items that cannot be laundered should be stored in a closed plastic bag for one
week.
Infestations
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Appendix 3
Scabies Case/Contact List Form - Staff
Date 1st Reported:
Ward/Dept:
Date IPCT notified:
Print Name
Infestations
DOB
Role
Date of
symptom
onset
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Diagnosed
by
Staff
permanent
or bank
Dates of
scabicide
treatments
Version 1.0 July 2016
Follow up
comments
Family
members
symptomatic
Family
members
treated
Appendix 3
Scabies Case/Contact List Form - Patients
Date 1st Reported:
Ward/Dept:
Date IPCT notified:
Print Name
Infestations
DOB
NHS No.
Date of
symptom
onset
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Diagnosed
by
Bed/room
No
Dates of
scabicide
treatments
Version 1.0 July 2016
Follow up
comments
Family
members
symptomatic
Family
members
treated
Standard Operating Procedure Details
Unique Identifier for this SOP is
BCPFT-COI-POL-05-29
State if SOP is New or Revised
New
Policy Category
Control of Infection
Executive Director
whose portfolio this SOP comes under
Policy Lead/Author
Job titles only
Executive Director of Nursing, AHPs and
Governance
Infection Prevention and Control Team
Committee/Group Responsible for
Approval of this SOP
Infection Prevention and Control Committee
Month/year consultation process
completed
June 2016
Month/year SOP was approved
July 2016
Next review due
July 2019
Disclosure Status
‘B’ can be disclosed to patients and the public
Review and Amendment History
Version
1.0
Infestations
Date
July 2016
Description of Change
New Procedure established to supplement Infection Control
Assurance Policy
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