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Policy for the Management of Scabies in Hospital

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					                                                 Royal United Hospital Bath NHS Trust
                                                       Management of Scabies Policy




                Policy for the Management of Scabies in Hospital


 Reference Number:                   607/2007


 Author / Manager Responsible:       Denise Meyers Infection Control Nurse
                                     Tracey Halladay Senior Infection Control Nurse



 Deadline for ratification:
 (Policy must be ratified within 6 January 2010
 months of review date)


  Review Date:                       July 2009


 Ratified by:                        Clinical Governance Committee


 Date Ratified:                      January 2007




 Related Policies                    Universal precautions
                                     Linen and handling
                                     Hand Decontamination




Author : Denise Meyers                                         Date: 27/02/07
Job title: Infection Control Nurse                                   Version:2
Page 1 of 13                                            Review date: July 2009
                                                 Royal United Hospital Bath NHS Trust
                                                       Management of Scabies Policy


INDEX

Section                                                              Page

Consultation and ratification schedule       -   -     -         -       3

 1.0 Policy Objectives               -   -   -   -     -         -       4

 2.0 Managers Responsibilities -             -   -     -         -       4

 3.0 Clinical Presentation -             -   -   -     -         -       4

 4.0 Classical Scabies               -   -   -   -     -         -       5

 5.0 Crusted/Norwegian Scabies               -   -     -         -       6

References -             -           -   -   -   -     -         -       8

Appendix A Crusted Scabies Patient Contact tracing form          -       9

Appendix B Crusted Scabies Staff Contact tracing form            -       10

Flowchart for the Management of Scabies in the Acute
Hospital Setting    -    -      -     -       -     -            -       11

Consultation Checklist               -   -   -   -     -         -       13




Author : Denise Meyers                                            Date: 27/02/07
Job title: Infection Control Nurse                                      Version:2
Page 2 of 13                                               Review date: July 2009
                                                Royal United Hospital Bath NHS Trust
                                                      Management of Scabies Policy



CONSULTATION AND RATIFICATION SCHEDULE


 Name and Title of Individual                     Date Consulted
 Tracey Halladay:- Senior infection Control       June 2006
 Nurse
 Dr Kim Jacobson:- Infection Control Doctor       June 2006
 Kay Dawkes:- Specialist Nurse Dermatology        June 2006
 Susan Smith:- Infection Control Nurse            June 2006
 Dr Sarah Meisner:-Consultanat Microbiologist     June 2006
 Dr Sue Murray:- Clinical Microbiologist          June 2006
 Dr Phillips:- Consultant Dermatologist           June 2006
 Dr. Lovell:- Consultant Dermatologist            June 2006
 Dr Aplin:- Consultant Dermatologist              June 2006
 Dr Darby:- Consultant Dermatologist              June 2006
 Dr Regina Brophy:- Head of Pharmacy              June 2006
 Jo Rowntree:-Occupational Health                 June 2006

 Name of Committee                                Date of Committee
 RUH Infection Control Committee                  Oct 06
 Medical Division                                 Dec 06
 Surgical Division                                Dec 06
 Specialty Board                                  Dec 06
 Clinical Practice Committee
 Clinical Risk Committee
 Clinical Governance Committee                    Jan 07




Author : Denise Meyers                                        Date: 27/02/07
Job title: Infection Control Nurse                                  Version:2
Page 3 of 13                                           Review date: July 2009
                                                             Royal United Hospital Bath NHS Trust
                                                                   Management of Scabies Policy



1.0 POLICY OBJECTIVES

    •   To establish infection control procedures for suspected and
         confirmed cases of scabies.
    •   To ensure Healthcare Workers are aware of the actions and
        precautions required to minimise the risk of transmission between
        patients, staff and visitors.

2.0 MANAGERS’ RESPONSIBILITIES

Managers must ensure that:

    •   Staff are aware of, have access to and comply with this policy.
    •   Staff are adequately trained in all aspects of this policy.
    •   Staff inform a member of the Infection Control Team if this policy
        cannot be followed

3.0 Clinical Presentation

Scabies (Sarcoptes scabiei) is primarily an allergic reaction to the mites
which live on the skin. Classical sites of infestation include between the
fingers, the wrists, axilliary areas; female breasts peri-umbilical area, scrotum
and buttocks causing an irregular pale, persistent rash and vesicular lesions
which are often symmetrical in shape (Burgess 2003) Burrows may be
visible as lines up to 10mm in length.

Positive diagnosis is made by finding and identifying the mite or its eggs.
(This can be done by skin scraping between the papular lesions.)

If mites are present they can be identified under a microscope.

Refer to dermatology for a formal diagnosis (Telephone 5658)

Once away from the human body, mites do not survive more than 48-72
hours.




               Scabies mite, viewed under a microscope.
               In real life, it is smaller than a pin head




Two types of scabies exist and the diagnosis between Classical (typical,
simple) or Norwegian (crusted) scabies must be made.
Author : Denise Meyers                                                     Date: 27/02/07
Job title: Infection Control Nurse                                               Version:2
Page 4 of 13                                                        Review date: July 2009
                                                 Royal United Hospital Bath NHS Trust
                                                       Management of Scabies Policy


4.0 CLASSICAL SCABIES.

Symptoms

The main symptom of scabies in otherwise healthy individuals is itching,
particularly at night. It may take up to six weeks to develop following initial
exposure, but appears within a few days of re-infection. This is because
scabetic itch is related to an allergic response to the mite or its products and
as in all sensitisation reactions, symptoms occur more quickly on re-
exposure.

Route of transmission.

Transmission of classical scabies is by skin to skin contact, most likely to
occur when immature mites crawl from one person to another. Symptoms
often take 2-6 weeks to develop after initial exposure.

Infection control precautions for Classical Scabies

Classical Scabies has low infectivity therefore patients do not generally
require isolation. However patients presenting with dry, flaking skin should be
isolated until a positive diagnosis is established.

Universal infection control precautions, including gloves and aprons must be
worn for close contact with the patient, and for handling of clothing and bed
linen. This must be placed in alginate bags and outer red bag. (Refer to Linen
Policy).

Routine cleaning of the patients room/bed space is sufficient.

Treatment

A suitable parasitical preparation must be prescribed by the physician.
Treatment must be applied following manufacturer’s guidance and
instructions. It is important that compliance with the treatment is thorough,
including the importance of re-applying the treatment to areas that are
washed during the treatment period e.g. if the patient is incontinent or
following hand washing. Secondary bacterial infection may occur if left
untreated or from constant scratching.

Close contacts will require treatment if symptomatic.

Staff to refer to Occupational Health for advice and guidance, if required,
Telephone ext.4064

Pregnant women and parents of young children should discuss treatment
options with their doctor or pharmacist.
Author : Denise Meyers                                          Date: 27/02/07
Job title: Infection Control Nurse                                    Version:2
Page 5 of 13                                             Review date: July 2009
                                                 Royal United Hospital Bath NHS Trust
                                                       Management of Scabies Policy
Patients should be warned that the itching persists for some time after the
treatment because it takes several days for the allergic response to subside
even though the mites have been killed.


5.0 NORWEGIAN SCABIES (CRUSTED)

Norwegian scabies is caused by the same mite that causes classical scabies,
but usually occurs when the infested person is immunologically or
neurologically compromised. Sometimes the presentation may be atypical,
with no crusted lesions or itching.

 In the absence of the normal immune response, the mites multiply but no
itching develops. The mites multiply rapidly, causing many thousand of mites
to spread all over the body, sometimes including the head (Wilson 2001).

Patients develop widespread grey/brown scales or crusted areas. Skin scales
and crusts are heavily contaminated with mites and in this form the infestation
is highly contagious.

Infection control precautions for Crusted/ Norwegian Scabies

Immediate isolation and early identification of cases with urgent referral to
dermatology is essential to control spread and ensure prompt, effective
treatment of the affected patient and their contacts. Both the infection control
and occupational health departments must be notified. (Contact ext 4064).

The contact list of both patients and staff must be completed. This will include
all those who have been in contact with the affected patient e.g. patients in
the same bay and staff who have been nursing the patient (Appendix A &B)

Isolation precautions are recommended until treatment has been completed.
This includes the use of personal protective clothing including the use of long
sleeved gowns and gloves in severely affected patient (Available from sterile
services). Linen must be handled very carefully and treated as infectious
linen (Refer to linen policy).

Daily cleaning of the isolation room is required. After treatment of the patient,
the floor and upholstery must be vacuumed and all bedding and clothes
changed.

Treatment

    Treatment is as for classical scabies however in the case of patients with
    crusted scabies it may be necessary to increase the number and
    frequency of applications of treatments in order to eliminate all the mites.
    Infection control precautions must continue until the treatment period has
    been completed.
Author : Denise Meyers                                          Date: 27/02/07
Job title: Infection Control Nurse                                    Version:2
Page 6 of 13                                             Review date: July 2009
                                                Royal United Hospital Bath NHS Trust
                                                      Management of Scabies Policy


    If the patient has been transferred from another institution they must be
    informed of the diagnosis so that they may liaise with the Health
    Protection Agency who will instigate appropriate treatment of residents
    and carers as required.

    •   If a diagnosis is made in more than one person the infection control
        and the Occupational health teams need to be informed.

    •   Treatment must be agreed with the dermatologist and all close
        contacts including patients and staff advised to have treatment.

    •   All close contacts must be informed. Treatment will be coordinated by
        the Occupational health department for staff and infection control
        department for patients (refer to staff health policy).

    •   Everyone identified as a close contact should receive treatment at the
        same time to prevent re infestation.

    •   Treatment for staff families is not usually required (refer to
        occupational health)

    •   During the ensuing 6 weeks observe for any further presence of
        scabies so that any possible cases can be dealt with promptly.

Pregnant women and parents of young children should discuss treatment
options with their doctor or pharmacist.

Patients should be warned that the itching persists for some time after the
treatment because it takes several days for the allergic response to subside
even though the mites have been killed.




Author : Denise Meyers                                        Date: 27/02/07
Job title: Infection Control Nurse                                  Version:2
Page 7 of 13                                           Review date: July 2009
                                                   Royal United Hospital Bath NHS Trust
                                                         Management of Scabies Policy



REFERENCES

Burgess. I. (2003) Understanding scabies. Nursing Times Infection Control
Supplement Vol. 99 NO 7.

Wilson, J. (2001) Infection Control In Practice. (2nd edition). Baillier Tindall,
Edinburgh.UK.




Author : Denise Meyers                                             Date: 27/02/07
Job title: Infection Control Nurse                                       Version:2
Page 8 of 13                                                Review date: July 2009
                                               Royal United Hospital Bath NHS Trust
                                                     Management of Scabies Policy




APPENDIX A CRUSTED SCABIES PATIENT CONTACT TRACING RUH

Crusted Scabies Patient Contact Tracing RUH
Name of Index Case…………………………….
Date of confirmed diagnosis…………………………..
Ward………………………………………….
Please record names of patients that have been in contact with the index
case. E.g. in the same bay.

Name DOB                Hosp No      Date of   Date of   GP Name and
                                     admission discharge telephone number




Author : Denise Meyers                                       Date: 27/02/07
Job title: Infection Control Nurse                                 Version:2
Page 9 of 13                                          Review date: July 2009
                                                  Royal United Hospital Bath NHS Trust
                                                        Management of Scabies Policy




 APPENDIX B CRUSTED SCABIES STAFF CONTACT TRACING

 Crusted Scabies Staff Contact Tracing
 Name of Index Case…………………………….
 Date of confirmed diagnosis…………………………..
 Ward………………………………………….
 Please record names of staff that have been in contact with the index case

Name               Date of      Date of    Name          Date of       Date of
                   Birth        exposure                 Birth         exposure




 Author : Denise Meyers                                         Date: 27/02/07
 Job title: Infection Control Nurse                                   Version:2
 Page 10 of 13                                           Review date: July 2009
                                                         Royal United Hospital Bath NHS Trust
                                                               Management of Scabies Policy
Flow Chart for the Management of Scabies in the Acute Setting




                                     Suspected case of
                                         Scabies



                                  Confirm diagnosis
                               (Refer to dermatology if
                                 necessary Ext 658)




    Classical Scabies Isolation                     Norwegian /Crusted Scabies -
   only required if skin dry flaky                         Isolate patient.
  or patient has a skin condition                   Long sleeved gowns & gloves
                                                          until fully treated.
   Gloves and aprons required
    until treatment completed.



         Treat as prescribed.                        Treat patient as prescribed.
      Inform close contacts. If                         Treat close contacts as
      transferred from another                       discussed with Occupational
       institution inform them.                      health and infection control.
                                                     Close family contacts should
                                                           contact their GP.




       If further cases contact                      Observe closely for any further
            infection control                            signs or symptoms.




Author : Denise Meyers                                                 Date: 27/02/07
Job title: Infection Control Nurse                                           Version:2
Page 11 of 13                                                   Review date: July 2009
                                                                    Royal United Hospital Bath NHS Trust
                                                                          Management of Scabies Policy
CONSULTATION CHECKLIST

Author; please attach this to each copy of the policy being sent to a meeting for
comments.
Dear Chairman, please would you review this policy at your committee and return any
amendments / comments to ____________________________ by _____ / _____ / _____

Title of meeting                  ______________________________________

Date of meeting                    ______________________________________

Name of policy                     ______________________________________

Name of author                    ______________________________________

                                                                   Yes        No        N/A
Are there any elements of this policy which present operational
issues that require further discussion? If yes, please provide a
contact name for the author.
___________________________________

Is the policy referenced?
Does the policy include a training plan?
If you are the appropriate forum, have the necessary
resources been agreed to implement this policy?
Is there a plan for policy implementation?
Does your meeting recommend further consultation with
groups or staff other than listed at the front of the policy?
Other comments
from meeting.




Policy accepted without further comment. (Please circle)                    Yes / No
Policy needs further amendment. (Please circle)                             Yes / No

Name of Chair __________________________

Signature ______________________________                 Date _____ / _____ / _____

For Human Resources Policies only
Name of Staff Side ______________________
Signature ______________________________                 Date _____ / _____ / _____

         Author : Denise Meyers                                           Date: 27/02/07
         Job title: Infection Control Nurse                                     Version:2
         Page 13 of 13                                             Review date: July 2009

				
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Description: Policy for the Management of Scabies in Hospital