PublicHealth(1990), 104, 189-190
© The Societyof Public Health, 1990
Scabies in a Nursing H o m e K. M. Myint Hull Health Authority
Cases of scabies crop up from time to time in Nursing Homes and similar closed communities. It is of prime importance that such instances should be dealt with appropriately and control measures undertaken to effect a speedy therapy and prevention of further spread.
Case Finding and Diagnosis An elderly resident of a local private Nursing Home was diagnosed as having scabies, following her admission into Hull Royal Infirmary. The Nursing Home was visited and enquiry was made as to whether or not there were any other residents with itchy or other rashes. No member of the staff" had an itch or a rash, but among the residents three elderly persons were reported to be suffering from an itchy rash. O f the three, two were already on treatment with steroid topical creams prescribed by the family doctors following being diagnosed as having senile pruritus. The other case had an itch of recent onset and was yet to be seen by the GP; on examination, this resident had an itchy rash consistent with scabies. Arrangements were therefore made to have him seen and treated by his family practitioner. To avert diagnostic confrontation with the GP's concerned, it was decided to obtain laboratory confirmation in the other two cases, by demonstration of Sarcoptes sca[~ mite and/or its eggs microscopically. Sometimes, burrows could be opened up and the mite and its products scraped for microscopy. In difficult cases, the area of skin suspected of harbouring the mite can be painted with ink and then wiped clean with an alcohol swab, having the burrow delineated by ink remaining in the burrow track. In the present cases, however, mere scraping of the superficial skin was carried out and the scrapings collected separately in clean empty petri dishes. They were sent for microscopy to the local Public Health Laboratory where the presence of Sarcoptes scab~ eggs were reported in scrapings of one resident.
Control Measures With a multiple o f cases of scabies thus diagnosed, the scabicide treatment o f all residents and members o f the staff" was called for. H u m a n scabies can be classified into two categories, the simple scabies and the crusted scabies (the so-called Norwegian scabies, named after its first discovery in Norwegian lepers). ~Simple scabies is spread essentially by direct skfn-to-skin contact between persons, and fomites play an unimportant part in its transmission. On the other hand, Norwegian scabies is a fulminating infestation which spreads via the mite-laden skin crusts falling from the patient and being deposited on the bedspreads, chair seats and other fomites. Correspondence: Dr K. M. Myint, Senior Clinical Medical Officer,Department of Public Health, Hull Health Authority, Hull, HU2 8TD.
190
K. M. Myint
In the control of an outbreak involving the Norwegian crusted type, it is essential to carry out scabicide fumigation o f the furnitures and rooms, under the supervision o f the Environmental Health Department. In the described cases however, in the scenario of simple scabies, the involvement of the Environmental Health Officer was considered unwarranted. An attempt was made to identify the index case from where the infestation was transmitted, and an informal enquiry o f regular visitors of the cases involved was undertaken through the Matron of the Nursing Home, under the guidance o f the Infectious Diseases Nurse. However, no further cases came to light following this procedure. The entire population of the Nursing Home, consisting of 31 elderly residents and 26 members of staff were treated. Fewer side-effects with elderly cases, inexpensiveness, and lastly the requirement of only a single application all being considered, the treatment of choice was 0.5% Malathion in aqueous emulsion (Derbac Liquid). It was applied by means o f a 3" paintbrush to the whole body, from the neck down, including the soles o f the feet. 2 Reapplication to the hands after every handwashing is necessary and therefore the initial application was done last thing in the evening when the need to wash hands thereafter was at the least. No prior bathing was allowed before the application, but bathing was advised the following morning. Due to the unimportance of fomites in the transmission of simple scabies, no special precaution was taken with regard to the clothing and bed sheets except for the usual laundering on hygiene grounds. Post-treatment itchiness was experienced in two cases and this was controlled by Piriton tablets, which were however discontinued after 2 weeks when a re-examination o f all the cases were undertaken to check any evidence o f scabies persisting. No evidence was found. Thus an instance of scabies cropping up in a Nursing Home was controlled and it was shown that Malathion could be used effectively in such cases. References 1. Robinson, R. (1985). Fight the mite and ditch the itch. Parisitology Today, I, 140-142. 2. Burgess, I., Robinson, R. J. F., Robinson, J. & Maunder, J. W. (1986). Aqueous malathion 0.5% as a scabicide: clinical trial. British Medical Journal, 292, 1172.
© The Societyof Public Health, 1990
Scabies in a Nursing H o m e K. M. Myint Hull Health Authority
Cases of scabies crop up from time to time in Nursing Homes and similar closed communities. It is of prime importance that such instances should be dealt with appropriately and control measures undertaken to effect a speedy therapy and prevention of further spread.
Case Finding and Diagnosis An elderly resident of a local private Nursing Home was diagnosed as having scabies, following her admission into Hull Royal Infirmary. The Nursing Home was visited and enquiry was made as to whether or not there were any other residents with itchy or other rashes. No member of the staff" had an itch or a rash, but among the residents three elderly persons were reported to be suffering from an itchy rash. O f the three, two were already on treatment with steroid topical creams prescribed by the family doctors following being diagnosed as having senile pruritus. The other case had an itch of recent onset and was yet to be seen by the GP; on examination, this resident had an itchy rash consistent with scabies. Arrangements were therefore made to have him seen and treated by his family practitioner. To avert diagnostic confrontation with the GP's concerned, it was decided to obtain laboratory confirmation in the other two cases, by demonstration of Sarcoptes sca[~ mite and/or its eggs microscopically. Sometimes, burrows could be opened up and the mite and its products scraped for microscopy. In difficult cases, the area of skin suspected of harbouring the mite can be painted with ink and then wiped clean with an alcohol swab, having the burrow delineated by ink remaining in the burrow track. In the present cases, however, mere scraping of the superficial skin was carried out and the scrapings collected separately in clean empty petri dishes. They were sent for microscopy to the local Public Health Laboratory where the presence of Sarcoptes scab~ eggs were reported in scrapings of one resident.
Control Measures With a multiple o f cases of scabies thus diagnosed, the scabicide treatment o f all residents and members o f the staff" was called for. H u m a n scabies can be classified into two categories, the simple scabies and the crusted scabies (the so-called Norwegian scabies, named after its first discovery in Norwegian lepers). ~Simple scabies is spread essentially by direct skfn-to-skin contact between persons, and fomites play an unimportant part in its transmission. On the other hand, Norwegian scabies is a fulminating infestation which spreads via the mite-laden skin crusts falling from the patient and being deposited on the bedspreads, chair seats and other fomites. Correspondence: Dr K. M. Myint, Senior Clinical Medical Officer,Department of Public Health, Hull Health Authority, Hull, HU2 8TD.
190
K. M. Myint
In the control of an outbreak involving the Norwegian crusted type, it is essential to carry out scabicide fumigation o f the furnitures and rooms, under the supervision o f the Environmental Health Department. In the described cases however, in the scenario of simple scabies, the involvement of the Environmental Health Officer was considered unwarranted. An attempt was made to identify the index case from where the infestation was transmitted, and an informal enquiry o f regular visitors of the cases involved was undertaken through the Matron of the Nursing Home, under the guidance o f the Infectious Diseases Nurse. However, no further cases came to light following this procedure. The entire population of the Nursing Home, consisting of 31 elderly residents and 26 members of staff were treated. Fewer side-effects with elderly cases, inexpensiveness, and lastly the requirement of only a single application all being considered, the treatment of choice was 0.5% Malathion in aqueous emulsion (Derbac Liquid). It was applied by means o f a 3" paintbrush to the whole body, from the neck down, including the soles o f the feet. 2 Reapplication to the hands after every handwashing is necessary and therefore the initial application was done last thing in the evening when the need to wash hands thereafter was at the least. No prior bathing was allowed before the application, but bathing was advised the following morning. Due to the unimportance of fomites in the transmission of simple scabies, no special precaution was taken with regard to the clothing and bed sheets except for the usual laundering on hygiene grounds. Post-treatment itchiness was experienced in two cases and this was controlled by Piriton tablets, which were however discontinued after 2 weeks when a re-examination o f all the cases were undertaken to check any evidence o f scabies persisting. No evidence was found. Thus an instance of scabies cropping up in a Nursing Home was controlled and it was shown that Malathion could be used effectively in such cases. References 1. Robinson, R. (1985). Fight the mite and ditch the itch. Parisitology Today, I, 140-142. 2. Burgess, I., Robinson, R. J. F., Robinson, J. & Maunder, J. W. (1986). Aqueous malathion 0.5% as a scabicide: clinical trial. British Medical Journal, 292, 1172.
