Scabies treatment

[Sarah Whiteley]

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

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

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[Anonymous]

Hi Sarah

We have had similar problems at one of our homes and have also recently managed a crusted scabies outbreak (Not Fun!)

We have followed all the guidelines but a few additional things I have found.

1. Weekly skin assessment for 3 months after outbreaks helps track any suspicious rashes and get them promptly treated. Without doing this is a structured manner it can be a bit hit and miss. (Ive attached a skin check document that is useful)

2. Use of a low toxicity fly spray for difficult objects such as slippers and shoes. I have found these can often be the source of the mites post treatment as they cannot always be washed and often skipped in the bagging as the residents want to wear something. I have placed these in direct sunlight out doors with a spray of insecticide for 6 hours and found no further reinfections in the wing (versus not doing this and having multipole reinfections )

3. In bagging clothes, I have found it easier to bag up clothes not frequently worn such as jackets, soft toys, soft furnishings and given the bag a spray of low toxicity fly spray and kept these bagged for the 1 week period between treatment programs. This has been with resident/family consent and found a better result and less time consuming than having to rebag items for round 2 of treatment. For each person we kept 1 weeks supply of clothes out of bags and ensured these were washed on the day of treatments.

4. Furniture in communal areas that are hard to clean (e.g. fabric material, deep crevices or seams,) treat with a spray of low toxicity fly spray. We have had much better outcome than in homes were we did not do this.

Scabies: Management in Residential Care Facilities Queensland Government January 2010
3.4 Concurrent disinfestation

As described for Stage 1, with the following additions:

Vacuum all carpets, rugs, fabric-covered chairs etc. For items unable to be laundered egg. fabric-covered chairs, rugs etc., place them in a plastic bag for 48 hours or leave them isolated in a closed room for 48 hours or spray with an insecticide.

Thoroughly wipe over non-fabric-covered surfaces such as vinyl chairs and plastic mattress covers with a standard cleaning solution.

Vacuum seams with a high suction (i.e. small diameter) nozzle. Seams should then be treated with insecticide because a vacuum cleaner may not pick up all mites.

The vacuum cleaner should be lightly sprayed with insecticide after use to destroy mites that may have accumulated on its surface during cleaning.

Areas such as toilet seats and commode chair seats need to be thoroughly wiped after each use with a cleaning solution.

Smooth floors need to be thoroughly mopped using a standard cleaning solution. Carpeted floors should be vacuumed and, if skin contact is possible, treated with an insecticide

Kind regards,

Helen Finlay
National Manager Infection Control
t 0427 110 668 | 03 8518 7356
e hfinlay@regis.com.au | w http://www.regis.com.au

Level 2, 615 Dandenong Road, Armadale VIC 3143

[cid:image004.jpg@01D70513.A70948C0]

From: ACIPC Infexion Connexion [mailto:ACIPCLIST@ACIPC.ORG.AU] On Behalf Of Sarah Gaines Hill
Sent: Wednesday, 3 March 2021 6:07 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: [ACIPC_Infexion_Connexion] Scabies treatment

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]

Disclaimer

This email message and any attachments are confidential and may contain privileged information. You should not read, copy, use or disclose it without authorisation. If received in error, please contact us at once by return email and then delete all emails and attachments. You should check this email for viruses or defects. Our liability is limited to resupplying any affected message or attachments. Any personal information in this email must be handled in accordance with the Privacy Act 1988 (Cth).
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

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[Anonymous]

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

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

Disclaimer

This email message and any attachments are confidential and may contain privileged information. You should not read, copy, use or disclose it without authorisation. If received in error, please contact us at once by return email and then delete all emails and attachments. You should check this email for viruses or defects. Our liability is limited to resupplying any affected message or attachments. Any personal information in this email must be handled in accordance with the Privacy Act 1988 (Cth).

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to acipclist@acipc.org.au

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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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[Michael Wishart]

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]

Disclaimer

This email message and any attachments are confidential and may contain privileged information. You should not read, copy, use or disclose it without authorisation. If received in error, please contact us at once by return email and then delete all emails and attachments. You should check this email for viruses or defects. Our liability is limited to resupplying any affected message or attachments. Any personal information in this email must be handled in accordance with the Privacy Act 1988 (Cth).

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to acipclist@acipc.org.au

To send a message to the list administrator send an email to admin@acipc.org.au

You can unsubscribe manually from this list by sending ‘signoff acipclist’ (without the quotes) to listserv@aicalist.org.au

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to acipclist@acipc.org.au

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