Scabies

Please click the frequently asked questions below for further information and IPC precautions required:

• What is Scabies?

  The Scabies mite burrows and lays eggs under the outer layer of skin (epidermis). The faeces deposited in the burrow cause an allergic reaction, leading to a rash around the site of the burrow. Each burrow contains a fecund female which lays eggs; after three or four days the baby mites (larvae) hatch and move to the surface of the skin where they mature into adults.

  Scabies thrive in warm places, such as skin folds, between the fingers, under the fingernails or around the buttocks. They can also be found under jewellery such as rings and wrist watches. The incubation period for scabies is up to eight weeks i.e. the length of time it can take for the symptoms of scabies to appear after initial infection. A simple skin scrape and examination under low power microscopy will reveal the adult and eggs.

  Crusted scabies (Norwegian scabies) is a rare form of the disease which affects people with impaired immune systems or the elderly, disabled or debilitated. It is a hyper-infestation, with thousands or millions of mites present in scales of exfoliated skin; people with crusted scabies may not show the usual signs and symptoms such as rash or itching. Individuals with crusted scabies are more contagious and can spread the infestation easily both, by direct skin to skin contact or by contamination of items such as their clothing, bedding and furniture.

• Why is this information important?

  If NIAS staff are aware that the patient has a suspected or confirmed case this should be communicated to the Control Room (Emergency or Non-emergency as appropriate) and the staff in the receiving unit when transferring the patient to ensure effective patient care and management.

• How is it spread?
  • Scabies is usually spread through prolonged periods of skin to skin contact with an infected person
  • Transmission by casual contact such as a handshake or a hug is unlikely
  • Scabies can also spread through sexual contact
  • Crusted scabies is highly contagious and in addition to transmission by direct contact, is easily transmissible via bedding, towels, clothes and upholstery
  • Transmission can occur before the patient is symptomatic
  • Diagnosis is difficult and may require consultation with a dermatologist
• IPC Precautions
  • Contact Precautions should be used.
  • Hand Hygiene should be completed as per the 5 moments in line with usual practice.
  • Eye protection should always be risk assessed and used with any patient where there is a risk of splashes including spitting and productive coughing.
  • Gloves and Aprons should be worn.
  • If prolonged full contact with the patient such as with personal care – risk assess the use of long sleeved gowns.
  • The patient should ideally be transported via ambulance (eg. PCS) with no other patients present where possible. Individual cases can be discussed with the IPC team and a risk assessment can be made.
  • Laundry should be treated as contaminated, placed into an alginate bag and placed into a red laundry bag. Ensure PPE is worn when handling linen and do not hold up against uniform.
  • Precautions should be maintained for 24 hours after the completion of appropriate treatment and the rash is crusted.
• What cleaning is required?

  All equipment and the ambulance should have an in-between patient clean paying particular attention to touch points.

• Do staff need any prophylaxis or follow up?

  Staff do not need to be followed up after caring for a patient with Scabies.