Re: Scabies treatment

03/03/2021 at 10:42 pm #77763

Michael Wishart

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Author:
Michael Wishart

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State:
NSW

Hi all

I have a story for you. Many, many years ago when I was a fresh and young infection controller, I worked in a facility that had an attached nursing home. We had a prolonged scabies outbreak over many, many months, that appeared to be fully contained for a month or so then suddenly flared up again. This cycle repeated about five times, and was really frustrating for residents families and staff. We had concerted efforts to include everyone in prophylactic treatment, involved entomologists who taught us about scabies mite lifestyles and how they were transmitted (did you know you needed gravid female mites to transmit infestation?). We cleaned, crobbex, bagged, and cleaned nd scrubbed more.

Anyway, to bring my story to a close, the cycles stopped when one of our semi-regular respites died. His autopsy showed he had Norwegian (crusted) scabies, which had remained undiagnosed for a long time, due to other long term pre-existing skin conditions he also had. He just kept coming back in, shedding many gravid females onto staff and into the environment. He often had been discharged a while before the first cases started itching in each cycle.

Just thought this was a nice opportunity to share my story. I hope you enjoyed it. It was a pretty unpleasant experience at the time, for all concerned. Good luck managing your outbreak. Don’t forget those with skin conditions that can ‘hide’ Norwegian scabies.

Cheers
Michael

Michael Wishart, CICP-E
Infection Control Coordinator
St Vincent’s Private Hospital Northside

________________________________
From: ACIPC Infexion Connexion on behalf of Lisa Campbell
Sent: Wednesday, March 3, 2021 7:52:02 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Scabies treatment

Good evening,

There are a few questions I would ask.

Are residents sharing slings for lifting equipment or other equipment that may be in direct contact with their skin?
( Our residents each have their own and there are back ups for when those are being laundered).
Have any skin scrapings identified scabies on any of your residents?( Keeping in mind it may be difficult to get a conclusive result).
Is this in a memory support unit or a particular part of the facility?
Have any family members of residents been diagnosed with scabies?
Have any staff members been diagnosed with scabies?

Whilst I was working at Eastern Health in Victoria, our Infectious Disease Consultants would treat all Residents with Ivermectin instead of using Ivermectin.This way residents are treated systematically. This is dosed individually by weight.

The issue with Lyclear is often staff do not apply enough or apply it correctly. Some residents due to behaviour issues make it impossible to do so. Also, if they do not leave it on the prescribed amount of time before showering, it may not be effective.

If it is Norwegian crusted scabies, Lyclear may also be ineffective.

24 hours after treatment, we would do a terminal clean.

We bagged fomites for 7-10 days.

We laundered all clothes and linen in a hot wash cycled then dried.

This was repeated in 7-10 days.

We did not prophylactically treat staff. Lyclear can have toxic side effects and you can build resistance. You need to generally have prolonged skin to skin contact to be at risk of acquiring scabies.

Soft furnishings were vacuumed and steam cleaned.

We did not generally use insecticide. Though in large clusters it was considered.

Kind regards,
Lisa Campbell
Infection Prevention & Control Manager
Bolton Clarke

Sent from my iPhone

On 3 Mar 2021, at 6:50 pm, Sarah Gaines Hill wrote:

Good Afternoon Aged Care colleagues,

We have a very perplexing situation at one of our sites where we seem to get a regular visit from scabies mites. The occurrence is too far apart for it to be an ongoing infestation.

We have implemented multiple changes as follows:

1. Treat any undiagnosed rash as potentially infectious until proven otherwise using contact precautions and isolation
2. Treat suspected or confirmed cases with lyclear including all staff who have had prolonged skin-to-skin contact or with laundry and linen
3. Simultaneously treat environment remove and launder bed clothes, clothes, towels, vacuum carpet and mattress, steam clean same.
4. Bag up other fomites for 72 hours post treatment
5. Educate staff on scabies rash identification

Do any of you treat the environment with insecticides? I have never done this and what I have read is not indicated.

Any other ideas??? I am at a loss for how to eradicate this from this particular home.

Any pearls of wisdom would be greatly appreciated.

Thanks

Sarah

[BlueCross]
Sarah Gaines Hill
Infection Control Nurse Coordinator
P: +61 3 9828 1705 | M: +61 429 480 183
Level 1, 117 Camberwell Road, Hawthorn East, VIC 3123
[BlueCross]

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