Single Case

Local and/or state health departments may be able to provide guidelines for preventing and controlling scabies outbreaks.

Below are suggestions for developing guidelines for preventing, detecting, and responding to a single case of non-crusted scabies in an institution. (NOTE: For information specific to a single or multiple cases of crusted scabies, please see Crusted Scabies Cases.)

Surveillance

Establish surveillance.

• Have an active program for early detection of infested patients and staff.
• Maintain a high index of suspicion that scabies may be the cause of undiagnosed skin rash; suspected cases should be evaluated and confirmed by obtaining skin scrapings.
• Screen all new patients and staff for scabies.

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Diagnostic Services

Ensure that adequate diagnostic services are available.

• Consult with an experienced dermatologist for assistance in differentiating skin rashes and confirming the diagnosis of scabies.
• Ensure someone on-staff is trained and experienced in obtaining and examining a skin scraping to identify scabies mites.

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Control & Treatment

Establish appropriate procedures for infection control and treatment.

• Maintain records with patient name, age, sex, room number, roommate(s) name(s), skin scraping status and result(s), and name(s) of all staff who provided hands-on care to the patient before implementation of infection control measures: symptoms can take up to 2 months to appear in exposed persons and staff.
• Avoid direct skin-to-skin contact with any patient who has or is suspected to have scabies.
• Use gloves when giving hands-on care to any patient who is suspected or confirmed to have scabies; wash hands thoroughly after providing care to any patient.
• Avoid skin-to-skin contact with person with scabies for at least 8 hours after application of scabicide treatment
• Identify and treat all persons (e.g. staff, relatives, patients, etc.) having prolonged, direct skin-to-skin contact with an infested person before he/she was treated.
• Offer treatment to household members (e.g. spouses, children, etc.) of staff who are receiving scabies treatment.
• Staff generally can return to work the day after receiving a dose of treatment with permethrin or ivermectin; however, symptomatic staff who provide hands-on care to any patient may need to use disposable gloves for several days after treatment until sure they are no longer infested.
• Use procedures that minimize risk of transmission of secondary bacterial infections that may develop with scabies.

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Environmental Disinfection

Establish appropriate procedures for environmental disinfection.

• Machine wash and dry bedding and clothing of scabies patients using the hot water and hot dryer cycles.
• Environmental disinfestation is neither necessary nor warranted. Routine cleaning and vacuuming of the room should be done if and when a patient with non-crusted scabies leaves the facility or moves to a new room.

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Communication

• Establish procedures for identifying and notifying at-risk patients and staff who are no longer at the institution.
• Ensure a proactive employee health service approach to scabies including providing information about scabies to all staff and providing dermatologic consultation for employees and, when appropriate, their household members.
• Maintain an open and cooperative attitude between management and staff.

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