Scabies management in care facilities

Scabies is a skin infestation with a mite called Sarcoptes scabiei. Cases and outbreaks of scabies are common in health and residential care facilities. SA Health has developed the Scabies management in care facilities, 2012 (PDF 382KB) guideline to assist operators of care facilities to take a rational approach to the prevention and control of scabies.

Once diagnosed, most scabies infestations can be easily treated using anti-scabie medications called scabicides.

Initial diagnosis should be confirmed by a medical practitioner using proper diagnostic techniques.

Isolated scabies case

An isolated case of scabies is not an immediate risk to the health of staff and residents; however it must be managed correctly to prevent the infestation spreading. See page 9 of the guideline (PDF 382KB) for detailed information on the following:

• precautions to be taken to limit contact with infested individuals
• treatment of clothing, towels, mattresses, bed linen and personal effects
• treatment of people who have had prolonged skin to skin contact with a diagnosed case
• post-intervention monitoring to confirm the infestation is eradicated
• inform staff of control measures implemented
• topical scabicide treatment procedures

Crusted scabies are managed differently, refer to page 14 for detailed management requirements.

Multiple or recurring scabies cases

Multiple cases of scabies may arise due to transmission of the scabies mite within the care facility. These situations must be managed carefully to ensure the infestation does not turn into a full scale outbreak. See page 11 of the guideline (PDF 382KB) for detailed information on the following:

• precautions to be taken to limit contact with infested individuals
• common causes for multiple or recurring infestations
• treatment of potentially infested furniture and other surfaces
• monitoring known and potential cases, coordinating treatment and record keeping
• management of case contacts
• communication with staff and residents to ensure they are properly informed
• administering coordinated treatment plans.

The most common cause of a scabies outbreak in a care facility is an unidentified or misdiagnosed case of crusted scabies.

Crusted scabies

Crusted scabies can occur in debilitated, immunocompromised, institutionalised, or elderly persons. It is extremely contagious and special precautions must be taken to minimise the risk of scabies spreading throughout the facility. Crusted scabies is often not obvious as there may be no itch and crusting may be misdiagnosed or hidden beneath clothing or hair. See page 14 of the guideline (PDF 382KB) for detailed information on the following:

• precautions to minimise the risk of scabies spreading
• procedures for treating potentially infested bedding, clothing, furnishings, flooring and other surfaces
• surveillance programs and what they need to include
• management of case contacts
• communication with staff and residents to ensure they are properly informed
• treatment that is based on the severity of the infestation, including engaging in a dermatologist or an infectious disease physician to determine a treatment regime.

Outbreaks

In an outbreak scenario, patients should be treated presumptively if diagnosed though contact with known cases and the presentation of characteristic symptoms. However; reassessment by a medical practitioner may be necessary if treatment appears to have failed.