Scabies Community Infection Control Nurses LNR PCT’s Health Protection Agency Nurses LNR Social Care Providers LNR

Aims To raise awareness of the diagnosis, treatment and control of scabies Objectives To enable staff to recognise signs and symptoms of scabies To identify the different types of scabies To give an overview of how scabies is transmitted and treated

What is Scabies ? Scabies is a condition caused by a mite. Mites burrow down into the deeper layers of the skin where the female lays eggs which hatch in 50-72 hours Development from egg to adult takes about 10-15 days and mites die after 4 to 6 weeks Mites are dependent on humans for their survival This presentation initially describes classical scabies. The presentation then moves on to talk about crusted scabies

The Scabies Mite Oval in shape and measures 0.2-0.4mm in length The body is covered with fine lines and long hairs Is blind Has eight legs when an adult Usually live 30-60 days

How is it transmitted ? Scabies is passed from one infected person to another via prolonged direct skin contact (10 minutes or more, often through hand holding) An infected person who has no itching can pass the mite onto other people Scabies is rarely transmitted via clothing and bedding

What is the Incubation Period? You have caught scabies as soon as the mite has burrowed beneath the skin. The length of time between contact with an affected person and developing signs of scabies (itching/rash) is between 2-6 weeks For re-infection symptoms can appear within 48 hours If a person becomes re-infected it may only take 48 hours for symptoms to appear When a person becomes infected with scabies they develop a very itchy rash. This rash is an allergic reaction by the body to the mite, its waste products (faeces) and its eggs).

How is Scabies diagnosed ? Ask a GP to diagnose Ascertain if any other residents/staff are affected with similar symptoms: A history of itching usually worse at night or following a warm bath/shower Pimple-like irritations, burrows or rash on the skin: Webbing between the fingers Skin folds on the wrist, elbow, knee or auxiliary areas The penis and scrotum The breast (particularly the nipples) Shoulder blades Occasionally skin scrapings for microscopic examination (looking for mite, eggs or faeces) The fertilised female scabies mite gnaws her way through the skin and creates a little passageway in the process. In these passageways they lay their eggs and die. Approximately three weeks later the eggs hatch and a new generation of mites are ready to reproduce.

Who should be contacted ? Infection Control Group/Health and Safety Team If in doubt contact the HPA or your local Infection Control Nurse (insert ICN number)

Scabies Egg

Types of Scabies Classical Is the form usually found in healthy people with a normal immune system Spread is usually confined to breasts, waist, genitalia, buttocks, knees and ankles Typically there are fewer than 10 mites on the entire body of an infested person Symptoms are caused by an allergic reaction to the mites saliva, faeces or egg hatching fluid

Classical Scabies

Types of Scabies Crusted Also known as Norwegian Scabies Occurs in people where the immune systems is impaired Eventually small areas of thickening and crusting of the skin appears (usually on the hands, feet and scalp) and may be itchy Average number of mites can be thousands Is a common cause of outbreaks Clothing and linen are risk factors due to skin scales Clients with learning disabilities are more prone to this type of scabies Learning disability and the elderly clients are more prone to crusted scabies for the following reasons: They don’t have the same impulse to itch They are more tactile Therefore they are not scratching. Sometimes the scratching can remove the mite

Crusted Scabies

What is the Treatment? Lyclear Dermal Cream Apply all over the whole body and wash off after 8-12 hours Derbac M Apply all over the body and wash off after 24 hours Pregnancy and Breastfeeding Derbac M is the treatment of choice during Young Children Lyclear Dermal Cream is the treatment of choice for children over 2 months but under 6 months

Treatment Application Don’t apply treatment after a hot bath. Treatment should be applied to cool, dry skin. Apply to the whole body Nails should be short and clean If the hands or any other part of the skin are washed (during the treatment period) re-apply the treatment. If using cream - rub it in lightly to the skin If using a lotion – pour it into a bowl for ease of application, then use a sponge for even coverage

Treatment Application Repeat the application a week later to complete the treatment After the first application or treatment has been completed you are no longer infectious Itching commonly persists for up to 3 weeks following successful treatment (although this will decrease in severity) In cases of Crusted Scabies that do not respond to above treatment, always seek advice from the Health Protection Agency (0116) 263 1400

Who Should be Treated ? All cases – check contacts and seek advice Contacts include: Those with prolonged skin to skin contact e.g. bed partners, grandchildren When the problem affects more than 25% of residents and staff in a communal healthcare environment, seek advice from the Health Protection Agency

Infection Control Precautions Staff should wear gloves and aprons when applying treatment Linen should be washed at the hottest temperature the garment allows Linen should be place directly into the washing machine when changed Linen should be placed in a plastic bag to prevent contamination of the environment if it is not possible to place directly into a washing machine

Infection Control Precautions Freshly laundered clothing should be worn once the lotion has been washed off Freshly laundered bed linen/night wear should be worn once the lotion has been washed off All fabric surfaces should be hovered at the time of treatment application All non-porous surfaces should be wiped with a disposable cloth soaked in warm water and detergent

Treatment Failure Treatment failure is likely if: treatment was not applied correctly or twice (one week apart) Itching persists (without signs of improvement) Not all contacts were treated at the same time Cleaning is not carried out effectively

Outbreaks (Nursing/Residential Homes) Where there are two or more cases, inform the Infection Control Nurse and/or the Health Protection Agency If treatment is to go ahead then the treatment should be planned carefully: Do not be in a hurry to treat, ensure the treatment is co-ordinated and planned well Decide on a 24-hour period for the treatment and inform staff Treat everyone at the same time to prevent re-infection

Outbreak Prevention (Nursing/Residential Homes) Promote good surveillance of new residents Observe for rashes on arrival at the home, then at 3 weeks and 6 week intervals Maintain a high level of suspicion if patients present with undiagnosed rashes Educate staff on presentation and transmission of scabies Encourage staff to report rashes (including on themselves and their family)

Outbreak Management (Nursing/Residential Homes) Confirm diagnosis Record and list: Number of residents in home Number of residents with suspect rash Number of staff employed Number of staff with rash Any staff families with rash Relatives and other visitors with a rash Number of staff working at other institutions/agencies

Outbreak Management (Nursing/Residential Homes) For each person detail: Name, date of birth and GP Date any rash appeared and its visual appearance Symptoms e.g. itching Areas affected Any scabicidal products already in use Number of times used and when Please inform: Infection Control Nurse : (insert own number) HPA – 0116 263 1400