itchy residents

adrienurse, LPN · Nov 30, 2003

Atarax for geriatric patients is not a good idea, you're going to start having falls.

Is this a recent thing? Did your facility recently change soap products or laundry detergents? Could this be an allergy? You could recommend using a lotion like lac-hydrin or unimol which may reduce the itching. Where are the lesions located?

Nancy45 · Nov 30, 2003

thanks for your reply adrienurse. I just asked the laundry people, they have not changed anything this year. The lesions are all over, chest, back, lower legs on some people, scalp on one lady. This really is a mystery. I see a lot of people have seen my post but only one reply. I will talk again tomorrow with the DON about a dermatologist!

stressednurse · Nov 30, 2003

Did dietary make a change in vendors?

Did the docs order some new drug for these people? You probably already checked that one out.

Did the pharmacy make some kind of change?

I work in a 310 bed nursing home so 7 patients itching isn't a large number.

It is the start of winter with dry heat, this could just be dry skin. Are you using a new lotion on the dry skin?

Home Health Columnist / Guide · Nov 30, 2003

Was there a medication change, possibly brand drug now generic---have seen skin rashes from dyes too---need to rule out.

Found this skin lesions/rashes websites with pics for you to view.

Sounds like dermatologist consult is indicated .

http://www.healthcentral.com/mhc/top/003220.cfm

http://www.pennhealth.com/ency/article/003220.htm

http://health.discovery.com/diseasesandcond/encyclopedia/3241.html

http://www.aafp.org/afp/980915ap/rose.html

ktwlpn, LPN · Nov 30, 2003

Originally posted by Nancy45
The LTC facility I am working at has at least 7 residents who are itchy and actually have scabs from scratching! They have been treated with elimite, methylprednisolone, atarax & hydrocortisone. This is driving me crazy, not to mention the poor residents. I have called the Dr. repeatedly and talked to the ADON & DON. They don't seem very concerned. They haven't had anyone consult a dermatologist. Tomorrow, I am going to the DON again as I think this terrible and must be resolved somehow. All the scabies skin scrapes turned out negative. Anyone have further insights?

Scabies scrapings have a very HIGH rate of false negative-especially when performed by the nursing staff...The derm does several sites on one slide and never an actual burrow that has been scratched=he goes for the places that are known to harbor the little devils frequently like the webbing of the fingers and the wrists.....Sounds like your admin is in denial-they'll become VERY concerned when someone calls the board of health(it can be done anonymously) That will push them into acting.If you really feel that they are stonewalling then go in there tomorrow with as much info printed from good websites as you can find...And if you have to don't hesitate to make that anonymous report yourself....Treatment failure with topical meds is common-we had to resort to the po Ivermectin to stop our infestation.........

LucyGoosey · Dec 1, 2003

Huge issue for everyone -- not just residents. Scabies is often the first thing that comes to mind without ruling out other culprits or extensive troubleshooting.

As others have already warned -- going forward the elimite + atarax puts them at even greater risk. No room for guesswork.

Residents (as well as staffers that treat out of fear without warnings for their particular vulnerabilities such as ?pregnant

?asthma, s/p chemo? ) -- become prime candidates for adverse events when all this is followed with more heavy artillery. Say no to lindane or Ivermectin either of which is bad bad news.

Bacterial stuff might be picked up by doing some cultures from the skin.

Itching is one thing. Anybody complaining of biting or crawling? In addition to questions already posted....Any water leaks in the place? Sewage backup/problem? Mold? Monthy exteriminator services? Visiting pets? Window sills loaded with leaves or...bird nests?

Nancy45 · Dec 1, 2003

Ah. thank you very much for the info. I really need to get to the bottom of it because I can't just watch them itch. And it did cross my mind that if word got out , we would definitely lose residents. I can't decide if I should stay at this facility where they really need me or go somewhere where somebody has a clue. Ha ha. There are some really good people here, mostly on nights. Thanks again, I'm going to the websites now.

ktwlpn, LPN · Dec 1, 2003

Have an update for us,Nancy? I think that if you have ruled out everything but scabies then you have to get the facility to jump on that...Our dermatologist will now see any one with a suspicious rash within a day or so.....We had such a rough time and now they really take it seriously....

Speculating · Dec 1, 2003

Originally posted by stressednurse
It is the start of winter with dry heat, this could just be dry skin. Are you using a new lotion on the dry skin?

I think you hit the nail on the head, stressed, especially with there being no evidence so far of it being anything else. The question, Nancy, is are you using any lotion at all on the patients. It's cold. It's Michigan. The heaters are cranked. Sounds like a simple case of dry skin. I itch like a fein when the heaters start up this time of year. What I forgot I live in Florida ooops. Nancy rule out the simpliest of things first. Hope you find a cure soon.

ktwlpn, LPN · Dec 1, 2003

I think she said they have ruled out everything else----this thread reminds me of my admin...If it walks like a duck and quacks like a duck...hello! I am betting it's a duck! On a 44 bed unit we ended up with 17 positive scrapings and alot of complications from infection....Because it was the heat...the soap...etc,etc......If you have more then one resident with a problem and it is impacting their quality of life it is time to stop fooling around and get pro-active for their sakes....

deadend · Dec 1, 2003

had the same problem at my facility

the derm docs ruled out scabies in 8 0f the pts we sent

but lo and behold we sent one pt to a unknown dermatologist

and he came up with a positive scabies. Too late though the staff from laundry on up started itching.

Ever had Winter-Itch in your building? There is news out that bedbugs on on the rise which causes symptoms of scabies

FIND A NEW DERM DOC before you get a state visit and by all means isolate those 7 the state will frown upon you if you do not educate and protect the other residents and staff. This is the only thing that saved us when they came in. In my state it is a $65,000 fine and countless revisits. Have your ducks in a row because it is now not a matter of if they come in, it is when they come, because some staff person or family member will tip them off

Good Luck!!!!!!!!!!