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Unformatted text preview: NOTICE: T's": i’t‘ii'fi’il may he protected “by COpyrighi aw (Title 17, Dwain, ) sac/reg 178 ‘ MMWFI March 25, 1m 1. Epidemiologic Notes and Reparts in Health-Care Facilities — Iowa ‘Scabies continues to occur among residents and staff of Iowa nursing homes and hospitalsiFor the 8-year period July 1979—June 1987,‘the Iowa Department of Public Health confirmed scabies in 25 nursing homes, 1 hospital, 1 state institution, and 1 county residential care facility. Reports of scabies ware received from 11 other facil- ities. A report of the investigation of this problem in three nursing homes follows. Facility 1. In September 1985, scabies mites were found on three of seven nursing home patients with lesions suggestive of the disease.\Skin scrapings from one of . these patients yielded mites and eggsFi-le was successfully treated with an appropri-. ate regimen of lindane lotion. The three visiting physical therapists who had treated the patient were also evaluated. Two had pruritic lesions compatible with scabies. A live mite was recovered in skin scrapings from one therapist, who was referred to her personal physician for treatment. Additional scabies cases were confirmed in this facility in December 1985 ll of 3 positive) and November 1986 (5 of 19 positive}. Facility 2. In September 1985. skin scrapings from a 90-year-old nursing home patient with a persistent skin rash yielded 23 mites. The patient had been hospitalized briefly 3 weeks prior to this assessment, and evidence of transmission to hospital personnel was reported. The condition persisted, and the patient received monthly maintenance treatments until she died during a subsequent hospitalization. Facility 3. In April 1987, an investigation revealed seven residents and three staff members with confirmed or probable scabies. All but two residents were confined to _ a ward of patients with Alzheimer's disease. The index patient. who had a rash of ' long duration, had transferred from another nursing home and probably had scabies upon arrival. Twice during 1986 the state health department had investigated the previous nursing home, which was the probable source of infestation, and had found rashes compatible with scabies but no positive scrapings. The index patient had been included in these investigatiOns. Reported by: RW Currier, DVM, C Christie, BSN, LA Winter-mayor. MO, State Epidemiologisr, Iowa Dept of Public Health. Div of Host Factors, Center for Infectious Diseases, CDC. Editorial Note:\Scabies becomes pandemic at approximately 30-year intervals (1,2 l. Evidence suggests that community scabies peaked in the mid-19705 but has persisted at high levels for the past 10 years'iUniversity of Minnesota, unpublished data). illScabiesis caused by infestation with the mite Sarcoptes scabiei and is a major problem in nursing homes! particularly among patients who are debilitated and require extensive hands-on care. Because treatment failure is common with approved scabicides'7(10%' crotamiton creamllotion. 1% Iindane creamllotion, and 10% sulfur in petrolatum}, lengthy, intensive retreatrnent may be necessary. \‘l’hesa reports from towa suggest that the scabies mite is introduced when infested patients are transferred between institutionshThe quantity of mites carried by these patients expedites transmission, which can occur directly, through contact between residents, or indirectly. through contact with staff] Thus, for such institutionat settings, it may be appropriate to screen new patients routineiy, preferably before admiSsion. if they have a pruritic rash. a Skin scraping is the only consistent means of detecting mites, assessing the degree of transmissibility, and evaiuating treatment when skin lesions persist or "cam—grm-uwm.r...w+mw..m..._.._...s.—..s... m n ,.. Vol. 37 I Scabies Feappea are not will oftt extensh with an, follower treatme special Mas: shouid examin. Success period I protecti serve 3: tion oft patient: scabicit mediatt‘ Nurs abdomr from th mites. aspecia problem persists scraping Raferenr 1. Orkin 2. Orkin 1978: ' 3. Juran ads.( 4. Larch scabiu contn Coop Centr 6. Currir Contr 5" 179 33' Vol. 31 i No. 11 mmwn Scabies - Continued ny red, raised, pruritic ski Iy due to other causes are susp will often yield Demodex foiliculorum mites. extensive pruritis, in addition to S. scabieii'l‘re crusted rashes. should be aggressiv n lesions {especially on the upper back} that act and shOuld be scrapedIScraping which may produce lesions without atment of residents, especially those a (e.g., Iindane lotion for 1 day, reappear (5 l. A are not obvious 3"? with atypical. ‘bhc i followed by 10% crotamiton lotion for 5 days, followed by a second Iindane "5.1 ' treatmentl.\Treatment should include the entire body from the neck down, with 3°"' . . special attention to the underside of well-trimmed fingernails! . Vf‘» i Mass prophylaxis will not totally eliminate scabies, and the decision to use it smfl should be based on the prevalence of scabies infestation in the facility. Follow-up to of examinations are recommended to assess overall control. Patients who cannot be DP'i' successfully treated should receive monthly maintenance treatments for an extended :ated period (e.g.. applications of 10% crotamiton lotion for 2 days each month). Use of 35- A protective clothing and gloves by the nursing staff and isolation of patients would not 9 her serve any useful purpose since treatment failures usually reflect inadequate applica- i this tion of the scabicide to all appropriate body surfaces and not reinfestation from other 9- patients or staff. Treatment failures occasionally result from resistance of mites to mine scabicides; failure for elderly, in5titutionalized persons may reflect concurrent call- ililed mediated immunodeficiency l3}. Spital \Nursing personnel frequently acquire scabies. especially on the upper arms and mm"! _ abdomen, but rarely on the hands and wrists (4.5 l! Recovaring mites in scrapings from these parsons‘is difficult because they usually carry a small number of adult 3 613“ mites. Occasionally, personnel experience psychogenic scabies or acarophobia,_ 719le _. especially after recent treatment. Standard treatment will usuallyeliminate the 35h 0f problem and should be given to the staff's family members. Health-care workers with CBbif-‘S persistent complaints are best managed by emotional support and repeated skin 3d the scrapings to demonstrate the absence of mites (6 i. found References 1. Orkin M. Resurgence of scabies. JAMA 1971;217:5933). his scabies pandemic. N Engl J Med :1 been 2. Orltin M, Maiback HI. Current concepts in parasitology: t i 1978;293:496-8. ' ns. in: Orkin M, Maiback HI, er RW. Millikan LE. Scabies control in institutio 1985:139-56. iologist. 3. Juranek DD, Curri eds. Cutaneous infestations and insect bites. New York: Deltlter. “1'25. - 4. Lerche NW. Currier RW, Juranek DD. Beer W. Dubay NJ. Atypical crustd 'Norwegian" ,rsisted scabies: report of nosocomial transmission in a community hospital and an approach to ‘ control. Cutie 1983131 :637-42,668,684. itai- _ 5. Cooper CL, Jackson MM. Outbreak of scabies In a small community hospital. Am J Infect a major . Control 1936;14:173- . :ed and i 6. Currier HW. Scabies and pedicuiosis: hospitalized mites and lice. Asepsis-The Infection ,pmved Control Forum 1934;6113-21. sulfur in '; infested ‘ 3y these between itutional y before sing the arsist or ...
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scabies - NOTICE: T's": i’t‘ii'fi’il may he...

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