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Scabies

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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! ;)

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.

Sharon..you are completely right..we have found out that sick time is a benefit..not an entitlement. The major point here was that the lack of communication and the blame on the staff members created such anger. We understand as healthcare workers that these things can happen..as dedicated harworking professionals we did not deserve to be treated the way we were. We have certainly learned a lot from this experience..and that is what life is about!! Thanks for your input........

nyapa, RN

Specializes in Jack of all trades, and still learning.

"If you have a confirm outbreak of scabies between staff and patients this is a Major Indicator of probable assault..."

What species of scabies do you have in your location? We have Sarcoptes Scabiei

"Mites are transferred by direct contact with an infested person and can burrow beneath the skin in 2.5 minutes. Infestation from undergarments and bedclothes occurs only if these have been contaminated by the infested person immediately beforehand."

(Centre for Disease Control Northern Territory, 2003)

http://www.nt.gov.au/health/cdc/treatment_protocol/scabies.pdf

"Scabies infests all races and ages. After coming in contact with skin, the mite exudes a keratinase and sinks down one or two cell layers into the epidermis. There, it moves slowly forward, parallel to the epidermal level (at a centimeter a day), passing its life cycle of about a month. It takes about three to four weeks for an infested human to begin itching" (T Shwayder,, Dermatologist, 2003)

.http://www.medscape.com/viewarticle/459023_1

In our experience it is not always transmitted by close sexual contact. Many of our clients on our ward come in with multiple medical conditions and may have scabies as well. It is not uncommon for our staff to "catch" them. The hospital automatically gives us three days off with workers compensation if scabies has been diagnosed by a medical officer.

Dont forget, those who are immunocompromised are more likely to suffer from the severe form, crusted / Norwegian scabies. To protect ourselves we are required to wear the full gamut; theatre pants, longsleeved gowns, gloves, caps and booties. Then we spray our feet with insecticide when we leave the room. This must in itself indicate that close personal contact such as you describe is not the only way of transmitting this mite.

Jacqui

I am going to try to step out from this discussion. I am receiving way to many phone calls from physicians, law enforcement officers, and social workers about the misinformation of this issue among US Nurses.

Because of the change in the tone of some calls I have received from investigators, I am concerned about incomplete information posted about facilities on this thread triggering investigations.

NRSKarenRN, BSN, RN

Specializes in Vents, Telemetry, Home Care, Home infusion. Has 43 years experience.

A final word:

I think Sharon meant to state be careful of being too descriptive of facilities/scenerios when posting on the bulletin boards asking for information.

A definitive source of information is on the the US Centers for Disease Control website:

Fact sheet for public:

http://www.cdc.gov/ncidod/dpd/parasites/scabies/factsht_scabies.htm

Detailed professional clinical information:

http://www.dpd.cdc.gov/dpdx/HTML/Scabies.htm

NRSKarenRN