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Scabies Control. Massachusetts Department of Public Health Presented by: Elizabeth Land, MS November 2006. Presentation Objectives. Provide an overview of scabies Description Transmission Symptoms Diagnosis and treatment Control measures

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scabies control

Scabies Control

Massachusetts Department of Public Health

Presented by: Elizabeth Land, MS

November 2006

presentation objectives
Presentation Objectives
  • Provide an overview of scabies
    • Description
    • Transmission
    • Symptoms
    • Diagnosis and treatment
    • Control measures
  • Examine the Department of Mental Retardation (DMR) protocols for scabies prevention and control
scabies description
Scabies Description
  • Contagious infestation of the skin
  • Caused by human mites (Sarcoptes scabiei subsp. hominis)
  • Distributed worldwide
  • Reported incidence increasing in US since 1970’s
  • Humans are the reservoir
slide4

Scabies Infestation:

Mites burrow under skin to feed and lay eggs

Can burrow beneath skin in 2.5 minutes

Adult female mite

.3 - .4 mm long

scabies transmission
Scabies Transmission
  • Direct, prolonged, skin–to-skin contact
  • Sexual contact
  • Household contact
  • Indirect transfer from clothing, towels and bedding, only if contaminated immediately before contact
  • Communicable
    • while infested and untreated
    • during incubation period
scabies symptoms
Scabies Symptoms
  • Symptoms caused by reaction to mites
  • Pimple-like rash or burrows between fingers, on wrist, elbows, armpits, belt line, navel, abdomen, and/or buttocks
  • Intense itching over most of the body, especially at night
  • Sores on the body caused by scratching
  • Incubation period:
    • 2-6 weeks without previous exposure
    • 1-4 days after re-infestation (usually milder)
scabies diagnosis
Scabies Diagnosis
  • Confirmed by skin scrapings of papules or intact burrows
  • Burrows and mites may be few in number (only 10-12) and difficult to find
scabies treatment
Scabies Treatment
  • Applicaton of scabicide over entire body below head:
    • 5% permethrin cream (wash after 8-14 hrs)
    • 1% lindane cream (wash after 8-12 hrs)
  • Ivermectin, single dose, orally
  • Itching may continue for several weeks despite successful treatment
  • In ~5% of cases, 2nd treatment may be necessary after 7-10 days.
applying prescription creams
Applying Prescription Creams
  • Follow package insert
  • Apply thin layer over whole body from neck down, paying particular attention to folds in skin
  • Trim fingernails and toenails, apply under nails
  • Reapply after handwashing
  • Leave on for at least 8 hours, but not longer than maximum time recommended for product
  • Wash off with warm, soapy water and dry skin
scabies control11
Scabies Control
  • Prompt diagnosis and treatment of patients
  • Simultaneous, prophylactic therapy:
    • household members,
    • sexual contacts, and
    • caregivers with prolonged skin-to skin contact
  • Launder all clothing worn within 48-72 hrs. of treatment in hot water and dry in hot dryer
  • Thorough vacuuming of carpets and upholstered furniture
dmr protocols for scabies
DMR Protocols for Scabies
  • Who should be treated?
  • Who should be prophylaxed?
  • Who should be notified?
  • Who should be isolated and for how long?
  • Who should be monitored and for how long?
  • What environmental treatment is needed?
  • Who is responsible for follow-up?
dmr protocol for suspect scabies case
DMR Protocol forSuspect Scabies Case
  • Staff reports suspect scabies case to their supervisor
  • Primary care physician or dermatologist is contacted for appointment
  • Case remains at home to minimize exposure to others until medical clearance is obtained
  • Physician completes the Scabies MD Treatment Form
dmr notification protocol for confirmed scabies case
DMR Notification Protocol for Confirmed Scabies Case
  • Day and residential program directors, as applicable
  • Area office nurse
  • Day program and/or residential program nurse
  • Primary care physician for all others living in household of confirmed case
  • Family/guardian
  • Residential staff, if applicable
  • Transportation staff, if applicable
dmr treatment protocol
DMR Treatment Protocol
  • Confirmed case
  • All people living in the household of a confirmed case
  • All residential staff
  • Exposed day program individuals and staff do not need to be treated, but will be monitored for rash for 6 weeks
dmr follow up protocol
DMR Follow-up Protocol
  • Isolation of treated, confirmed cases at home is determined by physician
  • For confirmed or suspect cases – signed doctor’s note is required to return to any day program
  • For exposed individuals - family members and residential staff may sign note that treatment has been completed or is not indicated
  • Exposed individuals are monitored for 6 weeks
  • Area office nurse tracks additional cases
dmr environmental protocol
DMR Environmental Protocol
  • Wash all bedding and towels used by case during last 4 days in hot water and dry on hot cycle
  • Wear gloves to launder and discard after
  • Store items that cannot be washed in plastic bag for 14 days
  • Clean all washable surfaces
  • Vacuum rugs, furniture, and mattresses
  • Clean and vacuum all vehicles
dmr scabies control
DMR Scabies Control
  • Educate clients about personal hygiene, including handwashing
  • Increase awareness and surveillance for scabies with program staff
  • Report any suspect cases promptly to program nurse or area office nurse
  • Seek medical visit as soon as possible, if indicated
  • Conduct contact investigation as soon as possible, if indicated
prevention and handwashing
Prevention and Handwashing
  • Germs are everywhere:
    • People carry millions of germs on their hands.
    • Germs are on also on objects that we touch every day (doorknobs, handrails)
  • “30 second solution”
  • Least expensive way to stay healthy
  • Forming good habits early in life keeps us healthy
  • Biggest factor in preventing spread of infectious diseases!
how to wash your hands
How to Wash Your Hands
  • Use warm running water
  • Lather with soap (liquid preferred)
  • Scrub, including between fingers, for 20 seconds
  • Rinse with water
  • Dry thoroughly with a clean dry towel or paper towel
  • Turn off faucet with towel
references
References
  • American Academy of Pediatrics. Summaries of Infectious Diseases. In:Pickering LK, ed. Red Book: 2006 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003:584-587.
  • Heymann, DL, Control of Communicable Diseases Manual. Washington DC: American Public Health Association; 2004:473-476. 
  • Isada, C. et al. Infectious Diseases Handbook. 6th ed. Hudson, Ohio: Lexi-Comp, Inc.; 2006:293-294.
  • http://www.cdc.gov/ncidod/dpd/parasites/scabies/default.htm