Scabies: Everything you are itching to know
Scabies is a highly contagious skin condition caused by the human itch mite (Sarcoptes scabiei var. hominis). These microscopic mites burrow into the skin to live, lay eggs, and trigger an allergic reaction, leading to intense itching and a rash.
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.
