[caffine addict]

It's funny that you mentioned Chicken pox and shingles. I've been questioning that!

We had another resident on the same unit with shingles a few weeks prior to the out break. He lived a few doors down and only came out to meals and returned back to his bed. How would this be transmitted to and only affect the 3 women room mates with the rash?

I didn't realize that you could pick up scabies outdoors and was just asking where they come from. I mean they just couldn't live from person to person continuously.

Im going to have to look into our workers comp. rules and ask some questions. No one ever taught me that step in all the years that I've been in management. Boy that makes me wonder what else I've missed. I was never mentored. I'm one of those people who was just thrown in to sink or swim and I'm still waiting for someone to throw me the life jacket.

[Sharon]

Zoster transmission is a much more likely culprit in an institution then scabies. Since both, Varicella Zoster and Herpes Zoster are fomites transmissible and therefore can be spread on clothing. I have seen outbreaks in which the subsequent patient developed symptoms as far away as separate buildings on. It s not uncommon in adults to skip units and floors. Who gets it and how it manifests itself depends on prior exposure history and current immune status. If any vesicle formation occurs, you should evaluate for zoster. To complicate matters people with lowered mental status have a tendency to scratch and change the rash pattern due to trauma before initial assessment and diagnosis.

When you think scabies think more of ticks then lice. It is much more common to pick up ticks from outdoors and close intimate (sexual contact) then from casual contact. Since I always have problems with identifying rashes, I use the DERM IS website (http://www.dermis.net/index_e.htm) to compare rashes when trying to identify them. This website is available in English, German,, French, Spanish and Portuguese. A portion of the DermIS website description for scabies:

“Contagious disorder caused by the mite Sarcoptes scabiei, which attacks infants and children as well as adults. Scabies is transmitted in the course of close physical contact, e.g. during sexual intercourse, as well as in camps and between children under unsanitary living conditions. Transmission by means of underwear or linen is rare . . .”


Most states have workers compensation web pages and links to the actual regulations. I hope yours does. If you do have trouble finding it out, you are welcome to PM me confidentially your location and I will try some resources I have through my professional memberships.

[caffine addict]

Thanks Sharon!!!!!


Great web site


I looked at images of all 3 types of rashes, the resident in the room down the hall definitly had shingles and the ladies looked much like scabies. There were no vesiciles and the areas were spread put like scabies not as close together as chicken pox and not localized like shingles.

[Audreyfay]

Scabies CAN be transmitted very easily. According to "Instructions for Pediatric Patients - 2nd Ed" - Barton D. Schmitt, "Scabies is highly contagious. The symptoms take 30 days to develop after exposure. Close contacts of the infectied child, such as a friend who spent the night or a babysitter, should also be treated." I learned the hard way how contagious it was. I was working agency nursing in Hawaii. I took care of a patient who had a severe dermatitis and was septic. I had to apply an ointment on the areas, as well as wrap the patient with plastic so the ointment would not come off. They had no gowns, only gloves. (Supplies were very scarce in HI). Thirty days later I had an itchy rash, which my hubby got also. I never even knew the patient had scabies until I was working at the hospital again, and the patient was STILL there. He was then in isolation and still sick. I guess the initial problem was....scabies!

[Sharon]

I started to respond and stopped. Since I am in DC today with epidemiologist, pathologists, infectious disease, occupational and environmental health, public health MD’s and pathologists (derm and parasitology) I went and asked them to confirm my understanding about scabies. These are the same people who would be called into investigate an outbreak in an institution.

1. Scabies are not easily transmissible between humans and takes multiple encounters of close intimate sexual contact to occur.
2.Scabies incubation period is only hours to days but the health care worker may not recognize it for quite awhile.
3. It is impossible for scabies to get through one layer of clothing and transmit to another person.
4. If a rash is scabies, it is impossible to be spread to an employee through routine patient care even if isolation clothing is not used.
5. All occupational transmissions between patients and employees have been legally mandated to be reported on the Occupational Safety and Health log for decades.
6. Occupational transmission does meet the minimum threshold criteria for reporting suspected abuse of at risk persons.
7. None of these field-investigating physicians have ever seen a true scabies outbreak even in institutional setting.
8. They gave me a list of much more likely culprits if it is truly a rash type outbreak that looks like scabies and parasites were way down the list.

Again I refer you to the DERM IS site from my previous post which is one of the most current worldwide databases for rashes in my previous.

The other reminder is that the diagnosis is not confirmed until the lab has visualized the parasite.

[michelle126]

Wow... about a year ago my then 3yo was dx with scabies... How I wondered..not in school or day care... didn't go to any play groups and was only in contact with 2 other children in the week prior. I still question if it really was scabies esp after reading all this info.. I just treated him once with premathin cream and did all the cleaning and washing stuff..Dont forget all the stuffed animals that LTC residents may have on their beds and carry with them all day long.

[cjr]

We had an outbreak in the LTC facility I work in. Affected approx 10 workers..but no patients. The patient that we think had it passed away the weekend before we were diagnosed. Because the only definitive dx is to do scrapings..and all of us were sent over the weekend to our occupational health person. There were no scrapings done. The doctor there said that in over 100 cases that he has diagnosed he never did scrapings. We were all tx with Elimite..then the facility told us it was not scabies because there was no definitive dx. We were told not to discuss it on the floor..They posted signs about "an unexplained irritation or rash" see DON if any questions. Anyone that had "the rash" was taken off the schedule until tx was fninshed. I was called to the admininstrators office along with the DON. He told me that he heard I was not happy with how the situation was handled..for example..we notified adm. on a tuesday about many staff members with unexplained "rash"..they did nothing about until Friday afternoon..when a nurse went to her own private MD.Anyways..he told me "your opinion is useless, I don't care what you think or what you feel. You are nothing but a liar. You lie on the floor, you lie to your co-workers. You are not to discuss this isssue anymore" I was so shocked..I just got up and left. I have been considered a valuable employee for 9 years. Have never had a problem with any previous adm. before this..He is new. Now the final kicker is..we are not getting paid for the time we were taken off the schedule because the consider it a workmans comp issue. Of course we were not told until we got our checks....and then they used our sick time to pay us for the time we were out. I did not think they could just use our sick time without asking us. We are all very uneasy at work right now. WE have all been spoken to and made to feel like we did something wrong. Any suggestions on where to turn. One more interesting fact..the patient who died...has a new rash on her arms. We were told that it would be unethical to speak with her about what we think it may be...........I am currently looking for a new job

[cjr]

Correction to the last part of my post...the wife of the patient who died...had the new rash

[Stillanurse]

Several yrs ago, when we used to keep hospitalized pts in for extended periods of time, we had an out break of scabies with our nurses aides. A pt had been in with an un-diagnosed rash (the Dr thought it was an allergic reaction to years of being on Lasix). It wasn't untill 3 or 4 of our dayshift aides (that gave the daily bath and linen change) started having a rash on their abdomens that itched so bad, that they couldn't sleep at night.
At that point, skin scrapings were done on the pt and the diagnosis was confirmed. Lesson learned; it is very easy to acquire scabies from carrying linens close to your body. ALL were given Kwell treatment and a very good lesson was learned by all of us!

[Sharon]

This information is specific to the U.S. and the species of scabies here. If you have a confirm outbreak of scabies between staff and patients this is a Major Indicator of probable assault and falls under most mandatory reporting laws requiring criminal investigation. It is easier to get gonorrhea through casual contact then it is scabies in the U.S.

Alleging a rash outbreak in any care facility can have major repercussions. Rashes should only be documented and referred to as “possible blank rash” until formally diagnosed. In order to be protected against charges of failing to report child or adult abuse, you must report the suspicions formally. You can not use an anonymous report as a defense if criminally charged with failing to report abuse. Many states have updated there reporting laws to include all at risk individuals as protected people and have expanded mandated reporters to anyone over the age of 18 years. The States that include all over the age of 18 years old do not care what your job is, i.e. student, truck driver, schoolteacher, retail sales staff, or health care professional.

CJR – Your administrators were right to shut down the speculation about scabies outbreak until proven through objective laboratory data. It sounds like your new admin is more current on the standards and science behind these allegations but needs more work on interpersonal aspects of his position. If you are still concerned are you really ready to go through a complete forensic body exam and investigation of your personal contacts regardless of who did it (Occ Doc, Police, Forensic Nurse Examiner, and/or Epidemiology Investigators)?

Sick benefits are not entitlements. It is the employer’s right to designate how they are to be used and which days off are charge from what benefit bank. There are no laws that say the employer has to pay you for being out sick unless it is work related. Anyone off sick could file a claim for worker’s compensation but as someone who has done infectious disease insurance claim investigation I will look for proof that employee filed all legally mandated reports as well as the worker’s compensation claim. Scope of information is broader then other worker’s compensation claims due to the potential of a criminal act having occurred and an outbreak.