Download Chapter 6 - Scabies 2014 V8 - St Helens and Knowsley Teaching

INFECTION CONTROL MANUAL
Chapter 6
Scabies policy
Version 8
Document Summary
This policy provides guidance for the appropriate actions and responsibilities
when a patient with scabies is identified.
DOCUMENT NUMBER
APPROVING COMMITTEE
DATE APPROVED
DATE IMPLEMENTED
NEXT REVIEW DATE
ACCOUNTABLE DIRECTOR
POLICY AUTHOR
TARGET AUDENCE
KEY WORDS
STHK0036
Patient Safety Council
10 September 2014
1 October 2014
1 October 2017
Sue Redfern, Director of Nursing, Midwifery &
Governance
Karen Allen, Director of Infection Prevention &
Control
All clinical staff
Scabies
Important Note:
The Intranet version of this document is the only version that is maintained.
Any printed copies should therefore be viewed as “uncontrolled” and, as such,
may not necessarily contain the latest updates and amendments
Infection Control Manual - Chapter 3 – Scabies policy – Version 8 (clinical)
Page 1 of 9
Issue Date: 1st October 2014
Policy Reference number: STHK0036
Document Version History
Date
Version
Summary of key changes
Author
Designation
1
DIPC
2
DIPC
3
DIPC
4
DIPC
5
DIPC
6
DIPC
7
Format changed.
DIPC
Page 6: More details on isolation
precautions.
Page 7: Patients own clothing
and hospital bed linen must be
placed in red alginate bags and
red outer bag.
Page 9: Contact details updated.
Minor formatting changes.
DIPC
Before 1989
1 October 1998
1 October 2001
1 December 2004
1 December 2006
1 November 2008
1 October 2011
1 October 2014
8
1 October 2017
Review
date
Infection Control Manual - Chapter 3 – Scabies policy – Version 8 (clinical)
Page 2 of 9
Issue Date: 1st October 2014
Policy Reference number: STHK0036
DIPC
St Helens & Knowsley Teaching Hospitals NHS Trust
CONTENTS
Item No.
Subject
Page No.
1.
Scope
4
2.
Introduction
4
3.
Statement of Intent
4
4.
Definitions
4
5.
Duties, Accountabilities and Responsibilities
4
6.
6.1
Scabies
General information
5
5
6.2
Diagnosis
5
6.3
Infection control precautions
5
6.4
Treatment
6
6.5
Further advice
8
7.
Training
8
8.
Monitoring compliance
8
8.1.
Key Performance Indicators of the Policy
8
8.2.
Performance Management of the Policy
9
9.
References and Bibliography
9
10.
Related Policies and Procedures
9
11.
Equality analysis
9
Infection Control Manual - Chapter 3 – Scabies policy – Version 8 (clinical)
Page 3 of 9
Issue Date: 1st October 2014
Policy Reference number: STHK0036
St Helens & Knowsley Teaching Hospitals NHS Trust
1. Scope
This policy applies to all clinical staff within St Helens and Knowsley Teaching
Hospitals NHS Trust to ensure that appropriate actions are taken when a patient with
scabies is identified.
2. Introduction
Scabies is an infestation caused by a burrowing mite (Sarcoptes scabei). It is readily
transmitted by skin to skin contact. Therefore it is essential that staff follow the
correct infection control procedures in order to prevent transmission to other patients
and to staff.
3. Statement of Intent
The objective of the policy is to provide information to staff on the management of
patients with scabies in order to reduce transmission of infestation. This policy aims
 to assist staff in the identification and control of scabies.
 to ensure appropriate diagnosis and treatment of cases.
 to prevent and contain spread of the condition amongst staff and patients
4. Definitions
The condition of “scabies” is caused by an allergic reaction to the mite Sarcoptes
scabei
5. Duties Accountabilities and Responsibilities
For full details of infection control responsibilities see Infection Control Policy,
Chapter 28B Infection Control Manual.
5.1. Staff
It is the responsibility of all clinical staff to:
 be aware of the current guidelines.
 put these guidelines into practice.
 bring to the attention of the Unit Manager or Infection Prevention and Control
Team any problems in applying these guidelines
Breaches of this policy may lead to disciplinary action being taken against the
individual.
5.2. Unit managers (person in charge of a ward or department) must ensure that
 The policy is readily accessible to all staff.
 The required facilities and equipment are available to enable compliance with
the policies.
 All staff within their area of responsibility have received training in the
appropriate procedures with respect to infection control.
Infection Control Manual - Chapter 3 – Scabies policy – Version 8 (clinical)
Page 4 of 9
Issue Date: 1st October 2014
Policy Reference number: STHK0036
St Helens & Knowsley Teaching Hospitals NHS Trust
6. SCABIES
6.1 GENERAL INFORMATION
Scabies is a common skin disease which is caused by an allergic reaction to the
excreta and saliva of a small mite (Sarcoptes scabiei) which burrows into the top
layer of the skin. Burrows may occur anywhere but are usually found on the hands
(particularly the finger webs), wrists, elbows, genitalia, buttocks and breasts. An
associated hypersensitivity rash occurs mainly across the abdomen, on the inner
thighs and in the groins. This is extremely itchy, particularly at night or when the
body is warm. This is the presentation of classical scabies. Some patients develop
crusted (Norwegian) scabies with heavy infestation, extensive scaling and dermatitis
but itching may be absent. Crusted scabies is more common in patients with
immunosuppression, and institutionalised adults. Crusted scabies is highly infectious.
Atypical scabies may occur in the very young, elderly and those treated with topical
steroids. They may not have an itch (but their contacts often do). Other atypical
forms of scabies include scalp scabies in infant and children and nodular scabies in
sexually active adults (more commonly in men who have sex with men) presenting as
pruritic nodules predominantly localised to genitalia.
Transmission
Transmission is by fairly prolonged physical skin-to-skin contact when the mites pass
from person to person. Mites cannot jump from one person to another and are not
generally transferred on clothing or bedding but (particularly in crusted scabies)
clothing and bedding should be laundered.
Incubation period
Following invasion by the mite it can take up to eight weeks (usually 2-4 weeks)
before any symptoms appear, so that scabies can be easily passed on to other
persons unknowingly. This can make the source of the infestation very difficult to
identify. In people who have previously had scabies, the symptoms will appear more
rapidly, sometimes within hours of infestation, due to prior sensitivity.
6.2 THE DIAGNOSIS OF SCABIES
If the admitting team are confident in the diagnosis of scabies, straightforward cases
do not need to be seen by a Dermatologist. In cases of diagnostic uncertainty,
contact the Dermatology Secretary on Ext 6613 or Fax 6331 for an in-patient
consultation or a staff clinic visit.
Staff must NOT attend the Emergency Department for the diagnosis of scabies.
Confirmed diagnosis
If staff or patients are confirmed as having scabies, a member of the Infection
Prevention and Control Team MUST be notified (see final page for contact numbers).
6.3 INFECTION CONTROL PRECAUTIONS
Isolation precautions
The patient should be isolated in a single room with contact precautions until
treatment has been completed.
Personal Protective Equipment
Gloves and aprons must be worn for direct contact with the patient until treatment
has been completed.
Infection Control Manual - Chapter 3 – Scabies policy – Version 8 (clinical)
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Issue Date: 1st October 2014
Policy Reference number: STHK0036
St Helens & Knowsley Teaching Hospitals NHS Trust
Hand Hygiene
Hands must be washed with soap and water after gloves and apron are removed.
This will help to reduce the risk of transmission.
Linen
Patients own clothing and hospital bed linen must be placed in red alginate bags and
red linen bag, until treatment has been completed.
Environmental decontamination
Routine cleaning is sufficient.
6.4 TREATMENT
Once diagnosed, the patient and all household and close contacts (even if
asymptomatic) must be treated simultaneously to prevent re-infestation.
Treated staff who have had symptoms can return to work after one overnight
application.
Mass treatment
If a patient is confirmed as having scabies but he/she has not been isolated,
treatment of all patients and staff on the ward may be necessary. This will only be
undertaken on the advice of a Consultant Dermatologist or a member of the Infection
Prevention and Control Team. If mass treatment is required, the ward manager will
contact Pharmacy to ensure that extra supplies of anti-scabetics are ordered. A list
of staff having close physical contact with patients should be forwarded to
Occupational Health.
Medication
There are several agents that can be used for the treatment of scabies e.g.
permethrin (Lyclear dermal cream), malathion (Derbac-M) and benzyl benzoate. The
latter is irritant, less effective and should be avoided in children.
For this Trust, the currently recommended treatment is Lyclear dermal cream
(permethrin). Malathion (Derbac-M) is used for pregnant contacts.
Instructions for using permethrin (Lyclear dermal cream)
It is advisable for someone else to apply the treatment to ensure that all parts of the
body are covered.
Always wear gloves when applying a cream to someone else to prevent unnecessary
contact with the scabicide and to avoid acquiring mites. Wash hands after removal of
gloves.
Children under two should only be treated under medical supervision.
The cream should be applied to dry, cool, clean skin and left on for 12 hours (usually
overnight). The patient must NOT be given a hot bath prior to application as this
increases systemic absorption (toxicity) and may result in treatment failure.
Infection Control Manual - Chapter 3 – Scabies policy – Version 8 (clinical)
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Issue Date: 1st October 2014
Policy Reference number: STHK0036
St Helens & Knowsley Teaching Hospitals NHS Trust
Treatment should be applied to the whole body including the scalp, neck, face and
ears. Particular attention should be paid to the webs of the fingers and toes and
lotion brushed under the ends of the nails
Ideally the skin should not be washed during the 12 hour treatment period. If any
skin surfaces are washed e.g. hand-washing the cream should be re-applied to that
area. After the treatment period, bathe or shower as normal.
The treatment should be repeated after 7 days.
With crusted scabies the product may not penetrate the crust adequately, therefore
treatments on 3 consecutive days are needed.
Approximate amounts of Lyclear dermal cream to use (per application):
Adults and children over 12 years: 30 g (1 tube).
Larger patients may require two 30g packs for adequate treatment.
Children aged 5-12 years: up to 15g (1/2 tube)
Children aged 1-5 years: up to 7.5 g (1/4 tube)
Children 2 months to 1 year: up to 1/8 tube
Persistent itching after treatment
The patient should be warned that although the medication will kill the mite
immediately, the itching may persist for several weeks. An anti-pruritic emollient
with/without oral antihistamines may be necessary to relieve the itch. Cool cotton
clothing may also help as itching may be worse when the body is warm or in contact
with man-made fibres e.g. nylon.
The recommended number of applications should NOT be exceeded.
persists for more than four weeks after the treatment, consult the doctor.
If itching
Failure of treatment
This may occur because of:




Failure to treat the entire skin surface
Failure to treat all close contacts
Failure to give the correct number of applications for Norwegian scabies
(requires 3 applications on consecutive days)
Occasional resistance to scabicide
In treatment failures and in patients with crusted scabies it is sometimes necessary to
use oral ivermectin. This is particularly the case in immunocompromised patients e.g.
AIDS. A suggested regime is 200 micrograms/kg orally as a stat dose or on two
occasions 7 – 10 days apart. A dermatology opinion would be necessary prior to the
use of ivermectin.
Infection Control Manual - Chapter 3 – Scabies policy – Version 8 (clinical)
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Issue Date: 1st October 2014
Policy Reference number: STHK0036
St Helens & Knowsley Teaching Hospitals NHS Trust
Reassurance
Reassure the patient that scabies is a common community disease so that they do
not feel stigmatised by the diagnosis.
6.5 FURTHER ADVICE
Please contact the Infection Prevention and Control Team if you need any further
advice or if there is a case of scabies on the ward:
Lead Nurse Infection Prevention and Control
Ext. 1193
Clinical Nurse Specialist, Infection Prevention and Control
Ext. 2452
Clinical Nurse Specialist, Infection Prevention and Control
Ext. 1384
Consultant Microbiologist/DIPC
Ext. 1834 or duty microbiologist via switchboard out of hours
Consultant Microbiologist
Ext. 1836/1622 or duty microbiologist via switchboard out of hours
7. Training
Training required to fulfil this policy will be provided in accordance with the Trust’s
Induction Mandatory and Risk Management Training Policy - Training Needs
Analysis.
8. Monitoring compliance with this document
8.1 Key performance Indicators of the Policy
Describe Key Performance Frequency
Indicators (KPIs)
Review
of Lead
None specific to this policy (see
related Infection Control Manual
chapters):
Chapter 21
Hand decontamination policy
Chapter 5:
Personal protective equipment
8.2 Performance Management of the Policy
Infection Control Manual - Chapter 3 – Scabies policy – Version 8 (clinical)
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Issue Date: 1st October 2014
Policy Reference number: STHK0036
St Helens & Knowsley Teaching Hospitals NHS Trust
Aspect
of Monitoring Individual
Frequency Group
/
compliance
method
responsible of
the committee
or
for
the monitoring which will
effectiveness
monitoring activity
receive the
being
findings /
monitored
monitoring
report
N/A
N/A
N/A
N/A
N/A
Group
/
committee /
individual
responsible
for
ensuring
that
the
actions are
completed
N/A
9. References/ bibliography
British National Formulary (current version).
http://www.bnf.org/bnf/index.htm
10. Related trust policy/procedures
Associated Infection Control Manual chapters:
Chapter 21
Hand decontamination policy
Chapter 5:
Personal protective equipment
11. Equality analysis
Please refer to the overarching document which covers all chapters of the Infection
Control Manual.
http://nww.sthk.nhs.uk/MANAGE/library/documents/EqualityAnalysisforICM.pdf
Infection Control Manual - Chapter 3 – Scabies policy – Version 8 (clinical)
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Issue Date: 1st October 2014
Policy Reference number: STHK0036