Scabies

I have dealt with them in many different settings. In a residential setting of at risk individuals, if more then one resident has acquired them without being outside, then it is a major/primary indicator of abuse and investigation of possible sexual assault should occur.

All non-partner outbreaks with three or more individuals with limited outdoor exposure that I have investigated have had included at least one individual who was the victim of an assault. This has include the following outbreak locations: day care, elementary, high school, and college (especially hazing and parties where Rhopy was present), disaster rescue and relief shelters, disabled residential facilities including half way house and LTC.

If you see more then one case in a residential facility then the ill residents should be screened for all STD’s including Hep A, B, C, and HIV. My last hospitalized pediatric patient was a 5-year-old admitted for an appendectomy in the middle of winter. She did have appendicitis. During the Emergency Department exam they did not fully undress here and missed the scabies rash on her buttocks. I requested further testing and was allowed to do a throat culture and add blood work to her pre-op orders. SANE was initially refused. Her throat culture came back positive for gonorrhea and her VDRL was positive. Once the throat culture came back positive a full evaluation was ordered and the police were brought in.

What needs to be considered when presented with a case of scabies?
Is this an isolated case?
Could the patient have acquired them on their own?
Was it a warm day and were they in prolong contact with the grass?

If all questions are “YES” then assault investigation is not indicated. If there are any are: "NO's”, further investigation is indicted

I've seen pt's with scabies. In LTC is one or two residents end up with Scabies then usually there are some employees that get it then more pts get it.... Usually have to Kwell the whole facility. I hate that because we all know it's just pioson, but what can you do? You have to wash all linens and pt's clothes even the ones in their closets, because someone may have hung an infected sweater back in the closet. You also need to wash all the w/c's and mattresses. I worked at a facility that had an outbreak of scabies once and they ended up sending most of the linen out to be cleaned.

Are you having an outbreak of scabies?

I took care of a pt this weekend in acute care that I would bet money has scabies. Dr told one of the other "You nurse worry too much about scabies."

Noney

Sorry I don't know how they sent them out. It was years ago. I just remember clothes being bagged up and sent out. You're lucky(and smart) you caught it so soon and took care of things before it got out of hand.

Noney

So how did the employee come down with it since close intimate contact, (i.e. sexual contact, sharing of clothing and sleeping in the same bed) is required for transmission? Remember this is not lice and does not spread even as easily as lice.

Umm of all of 100’s of cases I have dealt with none ever spread to another patient or employee through such casual contact. I have had iaotrogenic outbreaks of conjunctivitis and respiratory transmissible conditions like Chicken Pox, but never a parasite in the US (inculding at residential schools for the disabled).

When you reported the outbreak to the Health Department how did they take it? If other employees contracted the scabies, how did the States Worker’s Compensation Commission react? Did it spread to other family members of employees so opening your risk for additional worker compensation claims by the family members? How many months/years will you be doing follow up liver function studies if Kwell was used? Has your facility had retraining on infection control practices yet?

Since Elimite is a permethrin insecticide (for human use) and can trigger asthma attacks I have not used it much. In mild case I have just waited it out and used good universal protection.

If any employees contracted scabies while at work then yes it is a reportable illness. Reportables are both injury and illness. If an employee were to file on their own and the commission or OSHA where to discover the company or facility did not file timely there could be consequences. Workers compensation commissions and OSHA expect the employers to know they have to file and hold them to higher standard then the individual employee.

As I mention before I have never seen casual contact spread scabies. Lice I have seen spread casually and I have seen lice confused with scabies. And I have seen many cases of chicken pox and shingles mistaken for scabies, especially if the outbreak is in the groin or under the arms.

The only group I know of who got scabies and initially appeared casual, was a high school and college group of Deaf/deaf students. The outbreak investigation actually tracked it back to an outdoor study group on a lawn. They had all manage to sit on a nest of scabies. We did not medically treat this group because of the high incidence of undetected renal problems in deaf individuals. We used housing isolation and daily cleansing of bedding and clothing. Once the student appeared to no longer have active scabies they were moved to a clean dorm room. And the old was treated.