INFECTION CONTROL NEWSLETTER

The scabies prevention program begins with assessment of the resident's skin, hair and nail beds upon admission. Skin assessment should be repeated at least every month. Education of the nurses conducting skin assessments should be done on an on-going basis and should include identifiation of usual rashes, pruritis or skin lesions.

The program should be developed and approved by the infection control committee. A physician, such as the medical director should be given the authority to notify attending physicinas, perform diagnostic procedures and order prophylactic and therapuetic treatments. The infection control nurse should be responsible for identification of contacts of symptomatic cases, coordinating treatment, post-treatment assessment and assessment of treatment failures.

Some frequently asked qusetions are answered in the guideline. They are as follows:

What is a confirmed case of scabies?
A positive skin scaping, positive "burrow ink-test" in conjunction with a resident with complaints of itching and a new onset rash or physician diagnosis by direct examination.

Should the roommate be treated?
Roommates of a symptomatic case should be identified and assessed. This includes those discharged, moved to another room or healthcare facility within the past month. Those roommates who are symptomatic should be treated.

Which health care workers should be treated?
A list of workers who have had direct, physical contact with the symptomatic resident over the past month should be identified and assessed. Only symptomatic workers should be treated.

What precautions are necessary?
Contact Precautions are necessary, and should be discontinued following the bath to remove the scabicide. NOTE: This is different than the CDC recommendation of 24 hours.

What is an outbreak that should be reported?
Outbreaks should be reported to the local health department and the Department of Licensing and Certification. This would be 2 or more confirmed cases AND at least 2 suspect cases among resident, workers, visitors and volunteers during a 2 week period.

What about scabies resistant to treatment?
Most time treatment failure is due to improper application and not the medication itself. Treatment should begin with a bath, hair wash and clipping of the finger and toe nails.. Scabicide should be applied from the hairline to the soles of the feet. Use a brush under the finger and toe nails. Reapply the scabicide to the resident immeadiately after washing hands or cleansing the perineal/rectal area, or if the resdient perspires heavily. Teach the evening and night shift staff the importance of reappliaction. Change all bed linens after the initial appliaction and again when the scabicide is washed off.

What is the treatment of choice for scabies?
Permethrin (Elimite) 5% Cream, when applied as directed, is 90% effective after one application. After treatment, pruritis and rash should gradually resolve in 7-14 days.

Copies of the Guideline were sent to all Skilled Nursing Home Administrators in California. You can also request a copy from the California Department of Health Services, Division of Communicable Disease Control, 2151 Berkeley Way, Berkeley, CA 94704