Scabies: Everything you are itching to know

1. Causes and Transmission:

• Scabies is a contagious skin disease caused by the infestation of the skin by the Sarcoptes scabiei mite.

• Transmission occurs through prolonged skin-to-skin contact or, less commonly, through contact with contaminated bedding, clothing, or furniture.

• Crusted (Norwegian) scabies is a severe form that is highly contagious due to the large number of mites present.

2. Symptoms:

• Intense itching, particularly at night.

• Red, raised bumps or burrows, commonly found in the webbing of the fingers, wrists, elbows, and other folds of the skin.

• Crusted scabies involves thick crusts of skin containing mites, making it more infectious.

3. Risk Groups:

• Elderly individuals, immunocompromised patients, and those in crowded or institutional settings (e.g., hospitals, care facilities).

• Healthcare workers are at risk of exposure, especially during outbreaks.

4. Diagnosis:

• Clinical examination of characteristic burrows and rashes.

• Confirmation through skin scrapings viewed under a microscope to detect mites or eggs.

Best Practices for Cleaning Hospital Rooms After Scabies Patients

1. Isolation:

• Patients with confirmed scabies should be isolated until 24 hours after appropriate treatment begins.

• Use dedicated personal protective equipment (PPE) for healthcare workers.

2. Cleaning Procedures:

• Perform terminal cleaning after patient discharge, focusing on thorough disinfection of surfaces and objects that may harbor mites.

• Use disinfectants approved by the hospital for environmental cleaning (e.g., quaternary ammonium compounds or hydrogen peroxide-based solutions).

3. Bedding and Laundry:

• Wash all linens, blankets, and towels used by the patient in hot water (≥60°C) and dry on high heat.

• Items that cannot be washed should be sealed in plastic bags for at least 72 hours to ensure mite death.

4. Furniture and Upholstery:

• Vacuum upholstered furniture and mattresses thoroughly.

• Use steam cleaning where applicable.

• If contamination is suspected, isolate and treat furniture as necessary.

5. Equipment Decontamination:

• Clean and disinfect medical equipment and shared devices using hospital-approved agents.

• Avoid using porous or non-disinfectable materials in high-risk areas.

6. Waste Management:

• Dispose of waste (e.g., used gloves, dressings) in sealed biohazard bags.

• Ensure proper disposal protocols to prevent accidental contamination.

7. Staff and Visitor Protocols:

• Ensure all staff involved in patient care receive prophylactic treatment, if necessary.

• Restrict unnecessary visitation to prevent external transmission.

8. Monitoring and Reporting:

• Monitor for new cases among patients and staff for at least 6 weeks post-exposure.

• Report outbreaks to public health authorities if required.

9. Education and Awareness:

• Provide training for healthcare workers on recognizing and managing scabies.

• Emphasize proper hand hygiene and the use of PPE to minimize transmission risks.

Key Challenges

• Crusted Scabies Management: Requires intensive environmental cleaning and potentially mass treatment of contacts.

• Outbreak Control: Institutions like hospitals and nursing homes may face challenges due to the fast transmission rate and asymptomatic carriers.

Cleaning Agents for Environmental Control

Disinfectants

• Quaternary Ammonium Compounds (QACs):

• Effective against mites on hard surfaces.

• Commonly used for cleaning floors, walls, and furniture.

• Hydrogen Peroxide-Based Solutions:

• Broad-spectrum efficacy, including against microbes and mites.

• Ideal for high-touch areas like doorknobs, bed rails, and medical equipment.

• Steam Cleaning:

• Excellent for upholstered furniture, carpets, and mattresses where chemical cleaning is insufficient.

• Mites are killed at temperatures >60°C.

Vacuuming

• Use vacuums with HEPA filters to capture fine particles, including mites and eggs.

• Focus on areas like bed crevices, chairs, and carpets.

Sealing Contaminated Items

• Items that cannot be cleaned (e.g., books, non-washable fabric) should be sealed in plastic bags for 72 hours or longer.

Laundry

• Wash all textiles in hot water (≥60°C) and dry on high heat for at least 30 minutes.

• For items that cannot be washed, use a dryer at the highest heat setting.