Name of Responsible (Ratifying) Committee

SCABIES POLICY

Version / 2
Name of responsible (ratifying) committee / Infection Prevention Management Committee
Date ratified / 23 May 2017
Document Manager (job title) / Infection Prevention
Date issued / 18 July 2017
Review date / 17 July 2020
Electronic location / Infection Prevention and Control Policies
Related Procedural Documents / Trust Policies:
Linen policy
Hand Hygiene policy
Standard Precautions policy
Decontamination policy
Key Words (to aid with searching) / Scabies, transmission precautions, source isolation, protective isolation

Version Tracking

Version / Date Ratified / Brief Summary of Changes / Author
2 / 23/05/2017 / Minor revision (no change to process) / IPCT
1 / 21/08/2015 / New document / IPCT

CONTENTS

QUICK REFERENCE GUIDE 3

1. INTRODUCTION 4

2. PURPOSE 4

3. SCOPE 4

4. DEFINITIONS 4

5. DUTIES AND RESPONSIBILITIES 5

6. PROCESS 5

7. TRAINING REQUIREMENTS 8

8. REFERENCES AND ASSOCIATED DOCUMENTATION 8

9. EQUALITY IMPACT STATEMENT 8

10. MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS 9

EQUALITY IMPACT SCREENING TOOL 10

QUICK REFERENCE GUIDE

This policy must be followed in full when developing or reviewing and amending Trust procedural documents.

For quick reference the guide below is a summary of actions required. This does not negate the need for the document author and others involved in the process to be aware of and follow the detail of this policy.

1. Scabies is a communicable skin condition caused by a tiny parasite (mite). The female mite penetrates the outer layers of the skin within an hour and lays her eggs. Scabies can spread quite rapidly under crowded conditions such as hospitals and residential homes where there is frequent skin to skin contact between people.

2. Patients who are suspected to have scabies should be isolated at first suspicion. Where no suitable single room is available in the immediate clinical area, staff should escalate to the Infection Prevention Team

3. Staff caring for patients with scabies must wear long sleeved gowns when applying the lotion/cream and for direct contact during the initial stage. Gowns should be disposed of in a clinical waste bin prior to washing hands with soap and water.

4. All bed linen must be treated as infectious; all linen should be bagged at the bedside, placed in an orange alginate bag followed by a red bag.

5. The room must be cleaned at least once daily with dedicated cleaning equipment using a suitable agent (hypochlorite e.g., Actichlor Plus). Terminal clean is required when the patient has been moved/discharged from the cubicle.

1.  INTRODUCTION

Scabies is a communicable skin condition caused by a tiny parasite (Sarcoptes scabiei mite) which burrows into the skin. The female mite penetrates the outer layers of the skin within an hour and lays her eggs. The life span of the female mite can continue definitely without effective treatment. The immune system reacts to the mite’s saliva and droppings which produces the intense itching seen in scabies. There are two types of scabies; classical and Norwegian scabies. The main risk is scabies’ ability to cause outbreaks in crowded conditions.

·  In the case of Classical Scabies 10-12 mites may be present within the burrow.

·  In Norwegian or crusted scabies, which is highly contagious, thousands of mites will be present. This type of scabies affects the immuno-compromised and elderly people.

Symptoms: the main symptom of scabies is intense itching that is worse at night. It also causes a skin rash in areas where the mite has burrowed. Scabies like warm places such as skin folds around the wrist and web of the fingers in adults and under the finger nails, around the buttock and under the breasts. In children the head and neck areas, soles of the feet and palms may be affected.

TRANSMISSION:

Scabies is usually spread through prolonged periods of skin-to-skin contact with an infected person. It is unlikely that scabies mites will be transmitted through brief contact. Scabies mites can survive outside the human body for 24-36 hours, so it is possible to become infected through sharing towels, bedding and clothes, however, this is rare. Scabies mites cannot jump or fly.

A scabies infestation can spread quickly as people are unaware that they have the condition for 2-3 weeks. The incubation period is up to 8 weeks after contact with an affected person.

Scabies Mite

2.  PURPOSE

The purpose of this policy is to provide healthcare workers with appropriate information on the identification, management and prevention of transmission of scabies

3.  SCOPE

This policy applies to all PHT Healthcare Workers (HCW), including agency, bank, locum staff, and Carillion staff including porters, house keepers and visiting HCW’s from other organisations.

4.  DEFINITIONS

Communicable Disease: infection which is capable of spreading from person to person.

Terminal Clean: is a full room clean performed Carillion Staff. This clean includes the walls and ceiling as well as a change of curtains or cleaning of blinds. All clinical equipment cleaned with Chlorine or Difficil-S by nursing staff, as per guidelines.

Isolation: patient is nursed in a single cubicle with all precautions in place, in order to reduce the spread of Scabies.

5.  DUTIES AND RESPONSIBILITIES

Infection Prevention Team:

·  Give additional advice regarding the management of patients requiring isolation and management where required

·  Promote good practice and challenge poor practice

·  Review and update Scabies policy

Microbiologists:

·  Alert Infection Prevention Team and clinical teams of patients requiring isolation following a suspected case of scabies.

Patient Flow / Duty Hospital Managers:

·  Facilitate placement of patients with potential or known scabies into appropriate isolation rooms as soon as possible.

·  Escalate difficulties in isolation to the Infection Prevention Team

·  Report breaches of isolation to Infection Prevention Team and by incident reporting

Matrons / Ward Managers:

·  Must be aware of the signs and symptoms of Scabies and be familiar with the policy

·  Promote good practice and challenge poor practice

Medical Staff:

·  Ensure compliance with scabies policies

·  Follow advice from the Infection Prevention Team relating to isolation of patients

·  Review the need for isolation on a daily basis

All Healthcare Staff:

·  Must adhere to scabies policy to reduce the risk of cross infection to patients and staff

·  Promote good practice and challenge poor practice

·  Refer to the Infection Prevention Team if unable to follow the policy guidelines

·  Keep patient informed of their infection status and provide information as necessary

·  Must ensure that patients who are isolated with scabies are kept informed about their condition.

6.  PROCESS

6.1 Identification, Diagnosis and Treatment of Scabies

·  Identification of scabies can occur between 2-6 weeks after the infestation of scabies. The most common symptom generally is an intense itching over the body, especially at night. This leads to scratching and excoriation of the skin which may lead to secondary infection.

·  Symptoms: An itching rash may appear as red bumps, mainly between the fingers, wrists and skin folds.

·  Diagnosis: A diagnosis is usually made upon clinical manifestation. This may be difficult in some elderly patients where the skin is dry with pre-existing dermatological conditions.

Scrapings from lesions for Microscopic examination may be necessary to establish a diagnosis.

·  Treatment of Adults with Scabies: There are 2 main treatments for scabies:

o  1st Line treatment – Permethrin 5% (7 days apart)

o  2nd Line treatment – Malathion 0.5% aqueous liquid

Treatments should not be applied immediately after a hot bath.

·  Application: apply in a thin layer from the scalp, neck, behind the ears downwards to the toes, excluding around the eyes, nose and mouth. The cream/lotion should be washed off after 8-12 hours.

Two or more applications, a week apart, may be necessary to eliminate all the mites and eggs, especially with Norwegian scabies. It may be necessary to treat household members who are symptomatic of scabies at the same time as inpatients infested with scabies.

If first line treatment is not effective, especially in the case of Norwegian Scabies, second line or oral medication (Ivermectin) may be necessary.

Pregnant women and children under 2 years old: only use Permethrin under medical supervision

6.2 Infection Control precautions for Norwegian and Classical Scabies

Isolation: Although Norwegian scabies is more infections than classical scabies, for the purpose of Infection Control within the care setting, precautions will remain the same. Early and prompt diagnosis is the key in the control of scabies. Patients with Norwegian or classical scabies must be isolated in a cubicle until effective treatment has been completed.

1. Patients who are suspected to have scabies should be isolated at first suspicion
2. Where no suitable single room is available in the immediate clinical area, staff should escalate to: Patient Flow Coordinator/Duty Hospital Manager.

Hand hygiene: Refer to the Hand Hygiene policy. Hands must be washed with soap and water after removal of PPE to reduce the risk of transmission of the scabies mite.

Personal Protective Equipment: Staff caring for patients with scabies must wear long sleeved gowns when applying the lotion/cream and for direct contact during the initial stage. The gowns should be disposed of in a clinical waste bin prior to washing hands with soap and water.

Linen: Refer to the Linen Handling and Laundry policy. All bed linen must be treated as infectious; all linen should be bagged at the bedside, placed in an orange alginate bag followed by a red bag. Bed linen and night clothes should be changed daily. Patient’s own linen must be placed in the appropriate soluble property bag and sent home for washing.

Daily cleaning: The room must be cleaned at least once daily with dedicated cleaning equipment using a suitable agent (hypochlorite e.g., Actichlor Plus, or chlorine dioxide e.g., Difficil-S)

·  Carillion are responsible for cleaning the clinical environment.

·  Clinical staff are responsible for cleaning clinical equipment.

·  Ensure that the room is kept clean and uncluttered, with flat surfaces clear of unnecessary items.

·  Only stock that is required should be taken into the room.

·  Clinical equipment inside the room must be dedicated to the patient, until the patient is discharged or no longer deemed to be infectious. The equipment must then be appropriately decontaminated before being used on other patients. If equipment cannot be restricted to a single patient, then equipment must receive a thorough clean with a dioxide agent before leaving the room, and enhanced cleaned until treatment has been completed.

·  Discard all unused disposable items prior to terminal cleaning.

·  Terminal clean is required when the patient has been moved/discharged from the cubicle.

·  Decontamination of the cubicle with H2O2 is not usually necessary

Escalation Strategy: Infection Prevention Team: ext 6261 (Bleep 0064) Monday-Friday 9am-5pm. Out-of-hours on-call service can be reached via Switchboard.

Common Principles of Isolation:

·  The need for isolation should be clearly communicated to the patient, family members (if appropriate) and clinical staff.

·  The need for isolation should be reviewed on a daily basis. Discuss specific cases with the Infection Prevention Team.

·  An isolation sign should be prominently displayed on the room door which provides sufficient information to instruct and protect contacts without breaching confidentiality.

·  Ensure that the door remains closed.

Transport of Patients with Scabies:

·  Movement of patients with scabies should be kept to a minimum. When it is necessary to transfer patients to other wards or departments, precautions to minimise the risk of transmission must continue.

·  If it is possible to delay an investigation without adversely affecting the patient’s management this should be considered. However, scabies should not compromise urgent clinical investigations.

·  The receiving area must be informed, prior to transfer, to ensure appropriate precautions are in place and that suitable segregation facilities are available.

·  When the patient is ready to be discharged home, it is safe to wait in the discharge lounge, preferably in a cubicle. The area will need to be decontaminated when the patient leaves the department.

Terminal Room Cleaning: the cubicle must be thoroughly cleaned with Actichlor Plus/Difficil-S when the patient is discharged or transferred.

·  Curtains must be removed and sent to the laundry as infected linen.

·  All disposable equipment should be discarded into orange clinical waste bags.

·  All clinical equipment, including bed frames should be thoroughly cleaned by clinical staff.

·  All areas of the cubicle should be cleaned using disposable clothes with particular attention paid to touch points and horizontal surfaces e.g., door handles, taps, dispensers, nurse call system, toilet areas, bed frame, tables, lockers, chairs

Staff Section: staff caring for patients with scabies must remain extra vigilant for signs and symptoms of scabies infestation and report to their Manager, Occupational Health and Infection Prevention and Control Team. It may be necessary to see their GP to establish a diagnosis. Once a course of treatment has been completed return to work may be appropriate. If unsure, contact the Infection Prevention and Control Team.

7.  TRAINING REQUIREMENTS

·  All staff (clinical and non-clinical) must be aware of the contents of this policy.

·  The Infection Prevention and Control Team (IPCT) will provide direct or indirect (electronic) training to increase education and compliance with Modern Matrons, Clinical Directors, Clinical Leads, Practice Development Teams and Infection Prevention Link Advisors.

·  All staff have a duty of care to their patients to ensure they deliver a high standard of care in line with current research and recommendations.

·  Modern Matrons have a duty to report any deficiencies in knowledge and ensure appropriate training is undertaken.

·  Modern Matrons must ensure that all staff attend annual mandatory infection control updates according to hospital policy.

·  Medical staff will receive Infection Prevention education on induction.

8.  REFERENCES AND ASSOCIATED DOCUMENTATION

1.  DPH Georgia Department of Public Health: SCABIES HANDBOOK

2.  CDC: http://www.cdc.gov/parasites/scabies/

3.  British Association of Dermatologist: http://www.bad.org.uk/ResourceListing.aspx?sitesectionid=159&itemid=377