Infection Control Guidelines for Scabies
in Long-Term Care Facilities
Scabies is a highly contagious, extodermal, parasitic disease caused by infestation of Sarcoptes scabiei—a white, oval flattened translucent mite.
Transmission occurs from person-to-person via skin-to-skin contact or by contact with clothing, bedding, or other personal items such as towels that have been recently used by the person with scabies infestation.
Predominant symptoms are rash and itching, caused by a hypersensitivity to the mites. Itching is frequently more intense at night. Sensitization must occur before pruritis begins. In persons newly infected for the first time, sensitization may take up to several weeks to develop. In persons with previous history of scabies, the time to develop symptoms after infestation may be as short as one to four days.
The rash is typically raised and red consisting of papules and linear burrows. The rash is characteristically distributed on the hands between the fingers, on the wrists and lower arms, elbows, axillary folds, on the abdomen around the belt line, under the breasts, and on the groin, buttocks and upper thighs. The head, neck, and back are usually spared in adults.
Excoriations from scratching are common. Occasionally 2-5 mm red-brown nodules are present, especially on covered parts of the body such as the genitilia, groin, and axilla. Secondary bacterial infection can occur.
Crusted or “Norwegian scabies” is an aggressive infestation that usually occurs in immunodeficient, debilitated or malnourished persons, is associated with greater transmissibility than uncomplicated scabies, and may demonstrate resistance to treatment.
Recommended treatment for adults, pregnant and nursing women, infants at least two months of age, and children is Permethrin Cream 5% (Acticin, Elimite). Alternative treatment for those severely allergic to permethrin, pyrethrins, or ragweed: Lindane 1% cream. Do not use lindane in pregnant or lactating women, children less than two years of age, and persons with extensive dermatitis. Do not apply lindane immediately following bath or shower. Do not repeat treatment with lindane.
In outbreak situations, consider treating all patients and staff (both symptomatic and asymptomatic) on the affected ward simultaneously. Staff should not be floated. Treat any symptomatic employee who works elsewhere and do surveillance for spread of skin lesions on that ward. Treatment should be recommended for families of patients and staff who have been diagnosed with scabies. Bedding and clothing worn next to the skin should be laundered in hot water (140 degrees F) and/or dried in a hot air dryer for 20 minutes. Scabies mites do not survive more than two to three days without contact with skin. Objects that cannot be washed can be placed in plastic bags for 14 days to kill eggs as well as mites. Affected patients and staff should be re-examined on days 14 and 28 post-treatment. Pruritis (itching) may persist for several weeks after treatment.
According to OAR 333-019-0010, persons who work at a health care facility shall not work at the facility whilst in a communicable stage of scabies. A person is considered no longer communicable 24 hours after treatment has been completed.