Scabies Outbreak in an Intensive Care Unit with 1,659 Exposed Individuals—Key Factors for Controlling the Outbreak

Abstract

OBJECTIVE. To investigate a large outbreak of scabies in an intensive care unit of a university hospital and an affiliated rehabilitation center, and to establish effective control measures to prevent further transmission. DESIGN. Outbreak investigation.SETTING. The intensive care unit of a 750-bed university hospital and an affiliated 92-bed rehabilitation center.METHODS. All exposed individuals were screened by a senior staff dermatologist. Scabies was diagnosed on the basis of (1) identification of mites by skin scraping, (2) identification of mites by dermoscopy, or (3) clinical examination of patients without history of prior treatment for typical burrows. During a follow-up period of 6 months, the attack rate was calculated as the number of symptomatic individuals divided by the total number of exposed individuals.INTERVENTIONS. All exposed healthcare workers (HCWs) and their household members underwent preemptive treatment. Initially, the most effective registered drug in Switzerland (ie, topical lindane) was prescribed, but this prescribption was switched to topical permethrin or systemic ivermectin as a result of the progression of the outbreak. Individuals with any signs or symptoms of scabies underwent dermatological examination.RESULTS. Within 7 months, 19 cases of scabies were diagnosed, 6 in children with a mean age of 3.1 years after exposure to the index patient with HIV and crusted scabies. A total of 1,640 exposed individuals underwent preemptive treatment. The highest attack rate of 26%-32% was observed among HCWs involved in the care of the index patient. A too-restricted definition of individuals at risk, noncompliance with treatment, and the limited effectiveness of lindane likely led to treatment failure, relapse, and reinfestation within families.CONCLUSIONS. Crusted scabies resulted in high attack rates among HCWs and household contacts. Timely institution of hygienic precautions with close monitoring and widespread, simultaneous scabicide treatment of all exposed individuals are essential for control of an outbreak.

Development of Conventional and Real-Time Quantitative PCR Assays for Diagnosis and Monitoring of Scabies

“…The disease is generally considered to be the most prevalent in resource-poor communities and is associated with overcrowding and poverty. However, high-income countries are not immune to scabies, and outbreaks in institutions and health care facilities are not infrequent (5)(6)(7)(8)(9)(10)25). Nosocomial outbreaks can sometimes be extremely protracted, with huge numbers of secondary cases being found in patients and health care workers and tertiary cases being found in family members of affected health care workers (26,27).…”

“…Nosocomial outbreaks can sometimes be extremely protracted, with huge numbers of secondary cases being found in patients and health care workers and tertiary cases being found in family members of affected health care workers (26,27). One of the most important risk factors for nosocomial outbreaks is failure to recognize, isolate, and treat scabietic patients, especially those with crusted scabies (5,28). Misdiagnosis of scabies is not uncommon, owing partly to the multifarious manifestations of scabies but also the lack of clinical awareness by attending clinicians (19,29,30).…”

“…While microscopic examination of skin scrapings has a 100% positive predictive value and a short turnaround time, it has a low sensitivity, which further varies according to the quality and quantity of the skin scrapings received (19,20). These difficulties result in delayed treatment and, more importantly, hinder the early initiation of infection control interventions to minimize the transmission of mites, resulting in outbreaks causing service interruptions with substantial cost implications (5,8). Nucleic acid amplification tests (NAATs) have gained wider utility in diagnostic parasitology in recent years, offering higher sensitivities than conventional microscopy, and allow quantitation of the parasite load when quantitative assays are used (21).…”

A scabies outbreak in a diabetic and collagen disease ward: Management and prevention

“…Scabies outbreaks can be a serious health problem even in industrialized countries, particularly in schools, prisons, hospitals and in other health care facilities (7). Although a definitive diagnosis is made by dermatoscopy or microscopy, early diagnosis is sometimes made using clinical signs and symptoms (12).…”

“…In the present study, it was thought that the spread of infection could be minimized by quick action. There are a number of reports of limited damage and practices that can be followed to control scabies outbreaks in health facilities, and the studies suggest that countermeasures should start immediately in such cases (12,16). In the current study, the authors asked to be involved with the infection control committee in order to gain increased knowledge about the outbreak.…”