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

2. 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

3. 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 hours
Development from egg to adult takes about 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

4. 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 days

5. 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

6. 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).

7. 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.

8. 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)

9. Scabies Egg

10. 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

11. Classical Scabies

12. 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

13. Crusted Scabies

14. 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

15. 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

16. 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)

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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)

23. 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

24. 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 –