1. health and fitness
2. disease

Policy for the Management of Scabies in Hospital
Reference Number:
Author & Title:
607
Katie White, Infection Control Nurse
Julia Bloomfield, Infection Control Nurse
Responsible Directorate:
Corporate
Review Date:
April 2014
Ratified by (committee):
Operational Governance Committee
Date Ratified:
April 2011
Version:
4
Related Procedural Documents
•
•
•
Universal Precautions Policy
Linen Policy
Hand Decontamination Policy
Index:
1.
Introduction _________________________________________________________ 3
2.
Purpose of this policy _________________________________________________ 3
3.
Aims and Objectives of this policy_______________________________________ 3
4.
Duties / Responsibilities _______________________________________________ 3
5.
Diagnosis ___________________________________________________________ 4
6.
Treatment and Management of Classical Scabies __________________________ 5
7.
Norwegian Scabies (Crusted) ___________________________________________ 7
8.
Monitoring Compliance ________________________________________________ 8
9.
References___________________________________________________________ 9
Appendix 1:
Consultation Schedule______________________________________ 10
Appendix 2:
Crusted Scabies Patient Contact Tracing RUH __________________ 11
Appendix 3:
Crusted Scabies Staff Contact Tracing ________________________ 12
Appendix 4:
Flow Chart for the Management of Scabies in the Acute Setting ___ 13
Equality Impact Assessment Tool __________________________________________ 14
Consultation Checklist ______________________________ Error! Bookmark not defined.
Ratification Check List ______________________________ Error! Bookmark not defined.
Document name: Policy for the Management of Scabies in Hospital
Issue date: April 2011
Page 2 of 15
Ref.: 607
Status: Final
1.
Introduction
Scabies is an inflammatory disease of the skin caused by the Sarcoptes scabiei. It is
associated with poor personal hygiene and overcrowding. It is more prevalent in
children, young adults, in urban areas and in winter. Outbreaks have occurred in
hospitals, nursing and residential homes where both patients and staff have been
affected (Hawker 2005).
2.
Purpose of this policy
The purpose of this policy is to provide guidance for staff within the Royal United
Hospital, Bath NHS Trust about the requirements and processes for the
management of Scabies.
3.
Aims and Objectives of this policy
•
To outline the signs and symptoms of a patient with Scabies
•
To highlight the risks of cross infection from Scabies and identify appropriate
preventative measures to reduce the risk
•
Provide staff with information on who to contact for advice when caring for patients
with Scabies or staff that may have Scabies.
4.
Duties / Responsibilities
4.1
Chief Executive
The Chief Executive has ultimate responsibility to ensure that the control of hospital
infection is addressed according to department of health directives. This
responsibility is delegated to the Director of Infection Prevention and Control.
4.2
The Director of Infection Prevention and Control
The Director of Infection Prevention and Control is responsible for the organisational
adoption of the policy for the control and management of scabies infection.
4.3
Infection Control Team and Occupational Health Team
The Infection Control Team is responsible for giving expert advice and training
related to all infection control practice concerning scabies management. The
Infection Control Team will commence contact tracing in the event of a scabies
outbreak for patients and the Occupational Health Team will commence contact
tracing for staff management issues.
4.4
Ward Managers and Head of Departments
Ward Managers and Heads of Department are responsible for ensuring that all staff
are familiar with the policy and that the management of patients or members of staff
Document name: Policy for the Management of Scabies in Hospital
Issue date: April 2011
Page 3 of 15
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Status: Final
diagnosed with scabies is carried out in their areas in accordance with this trust
policy.
4.5
Individual Responsibility
All staff both clinical and non clinical must ensure they have read and understood the
policy and incorporate the guidance on the care and management of patients with
scabies into their clinical practice. They must be aware of their role in the prevention
of healthcare associated infection in the working environment, including reporting
unusual rash and pruritic conditions.
Staff will inform Occupational Health if they suspect or develop symptoms of scabies.
5.
Diagnosis
Scabies (Sarcoptes scabiei) is a contagious skin infestation caused by a parasite.
The scabies mite can cause Classical (typical) or Norwegian (crusted) scabies. A
diagnosis must be made by a dermatologist, as patient management is
different for each condition.
Scabies is transmitted by skin to skin contact, most likely to occur when immature
mites crawl from one person to another. This typically occurs within families, sexual
partners and between patients and care givers. Symptoms often take 2-4 weeks to
develop after initial exposure when allergy develops to mite saliva and faeces and
an itchy symmetrical rash appears. The rash comprises of small red papules and
can be seen anywhere on the body. If the person has had scabies, before the rash
may appear within a few days after of re- exposure. The elderly,
immunocompromised patients, infants and young children at particularly at risk and
can develop the rash on the face neck, scalp and ears (Hawker 2005).
The Scabies mites burrow into the epidermis, where the females lay eggs that hatch
between 50 to 72 hours. The larvae mature and the females lay new eggs. Once
away from the human body, mites do not survive more than 48-72 hours.
The main symptom of scabies in healthy individuals is itching, particularly at night.
Burrows may be visible as a line about 5cm in length. They can occur anywhere on
the body but are often more easily identified on the wrists and hands, particularly
within the finger webs.
Positive diagnosis is made by finding and identifying the mite or its eggs. This can
be done by skin scraping between the papular lesions. Refer to the Dermatology
Department for a formal diagnosis (Telephone 5658).
Document name: Policy for the Management of Scabies in Hospital
Issue date: April 2011
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Status: Final
If mites are present they can be identified under a microscope.
Scabies mite (viewed under a microscope). Their actual size
0.3mm long.
6.
Treatment and Management of Classical Scabies
6.1
Infection Control precautions for Classical Scabies
Prevention of scabies is dependent on early diagnosis and prompt effective
treatment. (See appendix 3)
•
Isolation
A patient with classical scabies may or may not need isolation, please discuss with
the Infection Control Team. However, patients presenting with dry, flaking skin
should be isolated until a positive diagnosis is established.
•
Personal Protective Equipment (PPE)
Gloves and aprons must be worn for close contact with the patient and placed in
clinical waste after use.
•
Linen
Patients own clothing and hospital bed linen must be placed in red alginate bags
and outer red bag. (Refer to Linen Policy)
•
Hand Hygiene
Hands must be washed with soap and water once PPE is removed. Staff paying
strict attention to hand hygiene after contact with an individual will reduce the risk of
transmission. (Refer to Hand decontamination Policy)
•
Housekeeping
Routine daily cleaning of the patients room/bed space is sufficient. Vacuuming of
fabric chairs and other soft furnishings will minimise environmental contamination.
6.2
Treatment
Document name: Policy for the Management of Scabies in Hospital
Issue date: April 2011
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Status: Final
A suitable parasitical preparation must be prescribed by the physician or
dermatologist. Treatment must be applied following manufacturer’s guidance and
instructions. It is important that compliance with the treatment is thorough.
Secondary bacterial infection may occur if left untreated or from constant scratching.
•
•
•
•
•
•
•
•
•
6.3
Ensure the patient’s skin is clean, dry and cool before application. Individuals
do not need to have a hot bath before treatment. All persons having treatment
should do so at the same time so as to not re-infect one another.
For adults and children under 2 years old; apply treatment to cover the whole
body from the neckline down including the genital area. Usually the best time
to do this is last thing at night before bed.
Children under 2 years old and the elderly should be treated with a thin film of
the treatment applied to the scalp, face and ears. Care must be taken to
avoid the vicinity of the mouth where it would be licked off, and the areas
close to the eyes.
Nails should be trimmed and medication applied with cotton wool buds to the
nails and nail bed. If hands are subsequently washed re-apply treatment to
hands
Remove medication by washing thoroughly with soap and water between 12
and 24 hours after application.
Repeat treatment may be considered after one week on patients with clinical
infection (not contacts) Bedding and all clothing worn should be changed an
laundered as normal at the end of treatment
Patients should be advised that itching will persist for a few weeks after
treatment. Moisturisers such as Cetraben cream may be applied to residual
itching areas. Calamine lotion or Aqueous cream is NOT advocated by The
Dermatology Department.
Family contacts of infested patients should consult their GP for treatment
even if they are asymptomatic; this also applies to patients from
nursing/residential homes, where the matron/charge nurse should be
informed immediately.
Pregnant women and parents of young children should discuss treatment
options with their doctor or pharmacist.
Occupational Health
Staff must liaise with Occupational Health on Telephone ex4064 for advice and
guidance if they develop symptoms or are concerned.
If there has been contact with staff prior to a patient’s diagnosis, consideration must
be given to treating staff. This would be under guidance from Occupational Health in
conjunction with the infection control team. (See appendix 2)
If a member of staff develops scabies, treatment is recommended for his or her
close household contacts and they may return to work once treatment has been
completed (Hawker 2005).
Document name: Policy for the Management of Scabies in Hospital
Issue date: April 2011
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Status: Final
7.
Norwegian Scabies (Crusted)
Norwegian scabies is caused by the same mite that causes classical scabies, but
usually occurs when the infested person is immunologically or neurologically
compromised and in the elderly. In this form many more mites are present and the
skin presents as thickened with crusts, often mistaken for Psoriasis. Sometimes the
presentation may be atypical, with no crusted lesions or itching.
Patients develop widespread grey/brown scales or crusted areas. Skin scales and
crusts are heavily contaminated with mites and in this form the infestation is highly
contagious.
7.1
Infection Control precautions for Norwegian Scabies
Prevention of scabies is dependent on early diagnosis and prompt effective
treatment. (See appendix 3)
•
Isolation
A patient with Norwegian scabies must be isolated until treatment has been
completed as transmission can also occur via skin scales on bedding, clothes and
soft furnishings and is more infectious than classical scabies.
•
Personal Protective Equipment (PPE)
Long-sleeved aprons and gloves must be worn for patient contact and placed in
clinical waste after use.
•
Linen
Patients own clothing and hospital bed linen must be placed in red alginate bags
and outer red bag and treated as infectious linen. After treatment the patient’s bed
linen must be changed. (Refer to Linen Policy)
•
Hand Hygiene
Hands must be washed with soap and water once PPE is removed. Staff paying
strict attention to hand hygiene after contact with an individual will reduce the risk of
transmission. (Refer to Hand decontamination Policy)
•
Housekeeping
Routine daily cleaning of the patients room/bed space must be undertaken.
Vacuuming of fabric chairs and other soft furnishings will minimise environmental
contamination. The curtains in the side room must be changed, once treatment is
commenced.
Document name: Policy for the Management of Scabies in Hospital
Issue date: April 2011
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Status: Final
•
Contact Tracing
A contact list of both patients and staff must be completed. This will include all those
who have been in contact with the affected patient e.g. patients in the same bay and
staff who have been nursing the patient. This list must be given to Occupational
health and The Infection Control Team (Appendix 1 & 2).
In the event of an outbreak of scabies, the Infection Control Team will advise
on the planned co-ordinated management of the situation.
7.2
Treatment
Treatment is as for classical scabies; however in the case of patients with crusted
scabies it may be necessary to increase the number and frequency of applications of
treatments in order to eliminate all the mites. Infection control precautions must
continue until the treatment period has been completed.
If the patient has been transferred from another healthcare facility, they must be
informed of the diagnosis so that they may liaise with the Health Protection Agency
who will instigate appropriate treatment of residents and carers as required.
7.3
•
•
•
•
•
•
8.
Outbreak Management
If a diagnosis is made in more than one person the Infection Control Team
and the Occupational Health teams need to be informed.
Treatment must be agreed with the dermatologist and all close contacts
including patients and staff are advised to have treatment.
All close contacts must be informed. Treatment will be coordinated by the
Occupational Health Department for staff and Infection Control Department
for patients (refer to Staff Health Policy, See appendix 1 & 2).
Everyone identified as a close contact should receive treatment at the same
time to prevent re- infestation.
During the ensuing 6 weeks, observe for any further presence of scabies so
that any possible cases can be dealt with promptly.
The Infection Control Team will inform the Health Protection Agency of the
outbreak.
Monitoring Compliance
Evidence of non-compliance with this policy will be assessed by the Infection Control Team,
in order to identify immediate actions required to improve patient and staff safety.
Themes and trends related to the suboptimal management of Scabies patients will be
reviewed by the Saving Lives Implementation Committee, in order to identify actions
required to address identified areas of risk.
Document name: Policy for the Management of Scabies in Hospital
Issue date: April 2011
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Status: Final
9.
References
Burgess. I. (2003) Understanding scabies. Nursing Times Infection Control Supplement
Vol. 99 NO 7.
Hawker J et al (2005) Communicable Disease Control Handbook . (2nd Ed). Blackwell
publishing. Oxford.
Johnston G., Sladden M. (2005). Scabies: Diagnosis and Treatment British Medical Journal.
331,619-622
Wilson, J. (2001) Infection Control In Practice. (2nd Ed). Baillier Tindall, Edinburgh.UK.
Document name: Policy for the Management of Scabies in Hospital
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Status: Final
Appendix 1:
Consultation Schedule
Name and Title of Individual
Sarah Meisner – Infection Control Doctor
Infection Control Team
Jacqueline Strange – Dermatology Sister
Katie White – Infection Control Nurse
Date Consulted
November 2009
8th July 2010
12th March 2011
March 2011
Name of Committee
SLIC
Date of Committee
November 2009
Document name: Policy for the Management of Scabies in Hospital
Issue date: April 2011
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Status: Final
Appendix 2:
RUH
Crusted Scabies Patient Contact Tracing
Name of Index Case…………………………….
Date of confirmed diagnosis…………………………..
Ward………………………………………….
Please record names of patients that have been in contact with the index case. e.g.
in the same bay.
Name DOB
Hosp No
Date of
Date of
admission discharge
Document name: Policy for the Management of Scabies in Hospital
Issue date: April 2011
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GP Name and
telephone number
Ref.: 607
Status: Final
Appendix 3:
Crusted Scabies Staff Contact Tracing
Name of Index Case…………………………….
Date of confirmed diagnosis…………………………..
Ward………………………………………….
Please record names of staff that have been in contact with the index case
Name
Date of
Birth
Date of
exposure
Name
Document name: Policy for the Management of Scabies in Hospital
Issue date: April 2011
Page 12 of 15
Date of
Birth
Date of
exposure
Ref.: 607
Status: Final
Appendix 4: Flow Chart for the Management of Scabies in
the Acute Setting
Suspected case of
Scabies
Confirm diagnosis
(Refer to dermatology)
Classical Scabies Isolation only
required if skin dry flaky or patient
has a skin condition
Norwegian /Crusted Scabies Isolate patient.
Long sleeved gowns & gloves until
fully treated.
Gloves and aprons required until
treatment completed.
Treat as prescribed. Inform close
contacts. If transferred from
another institution inform them.
If further cases contact Infection
Control
Treat patient as prescribed.
Treat close contacts as discussed
with Occupational Health and
Infection Control.
Close family contacts should
contact their GP.
Observe closely for any further
signs or symptoms.
Document name: Policy for the Management of Scabies in Hospital
Issue date: April 2011
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Status: Final
Equality Impact Assessment Tool
To be completed and attached to any procedural document when submitted to the
appropriate committee for consideration and approval
Initial Screening
Policy, service, strategy, procedure or function:
Policy
Lead (e.g. Director, Manager, Clinician):
Francesca Thompson
Person responsible for the assessment:
Name:
Julia Bloomfield
Job Title:
Infection Control Nurse
Is this a new or existing policy, service strategy, procedure or function?
Existing
Who is the policy/service strategy, procedure or function aimed at?
•
Patients
•
Carers
•
Staff
Are any of the following groups adversely affected by the policy?
If yes is this high, medium or low impact (see attached notes):
Group
Disabled people:
Race, ethnicity & nationality
Male/Female/transgender:
Age, young or older people:
Sexual orientation:
Religion, belief and faith:
Affected?
Impact
No
No
No
No
No
No
If the answer is yes to any of these proceed to full assessment.
This applies whether the impact assessment is high, medium or low.
If the answer is no to all categories, the assessment is now complete
1. Does the policy, service strategy, procedure or function
include measures which promote equality?
No
2. If yes, what are these measures?
Document name: Policy for the Management of Scabies in Hospital
Issue date: April 2011
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Status: Final
Ratification Check List
Author; attach this to each copy of the policy being sent to a Committee for final ratification.
Dear Chairman
Please would you review this document at your next meeting and agree final approval and
organisational ratification.
Title of meeting:
Operational Governance Commiittee
Date of meeting:
11 May 2011
Title and Reference of document: Policy for the management of Scabies in Hospital (607)
Name of author:
Julia Bloomfied
Are there any elements of this policy which present
operational issues that require further discussion? If yes,
please provide a contact name for the author.
Yes
No
N/A
Does the document include a training plan?
Yes
No
N/A
Is the policy referenced?
Yes
No
N/A
Are up to date National Guidelines included?
Yes
No
N/A
If you are the appropriate forum, have the necessary
resources been agreed to implement this document?
Yes
No
N/A
Is there a plan for policy implementation?
Yes
No
N/A
Does your meeting recommend further consultation with
groups or staff other than listed at the front of the policy?
Yes
No
N/A
What are the cost implications of implementing this policy?
Equipment
£
Yes
No
N/A
Staffing (additional)
£
Yes
No
N/A
Training
£
Yes
No
N/A
Other
£
Yes
No
N/A
Document endorsed without further comment?
Yes
No
Further amendments to document suggested?
Yes
No
Name of Chair:
Signature: ________________________________ Date: ________________________
Document name: Policy for the Management of Scabies in Hospital
Issue date: April 2011
Page 15 of 15
Ref.: 607
Status: Final