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An Outbreak of Scabies in a Teaching Hospital Lessons Learned

Published online by Cambridge University Press:  02 January 2015

Olugbenga O. Obasanjo ,
Peggy Wu ,
Martha Conlon ,
Lynne V. Karanfil ,
Patty Pryor ,
Geraldine Moler ,
Grant Anhalt ,
Richard E. Chaisson  and
Trish M. Perl
Olugbenga O. Obasanjo
Affiliation:
Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health
Peggy Wu
Affiliation:
Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health
Martha Conlon
Affiliation:
Johns Hopkins Hospital
Lynne V. Karanfil
Affiliation:
Johns Hopkins Hospital
Patty Pryor
Affiliation:
Johns Hopkins Hospital
Geraldine Moler
Affiliation:
Johns Hopkins Hospital
Grant Anhalt
Affiliation:
Department of Dermatology, the Johns Hopkins University Johns Hopkins Hospital
Richard E. Chaisson
Affiliation:
Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health Department of Medicine, Division of Infectious Diseases Johns Hopkins Hospital
Trish M. Perl*
Affiliation:
Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health Department of Medicine, Division of Infectious Diseases Johns Hopkins Hospital
*
Department of Hospital Epidemiology and Infection Control, 425 Osler, 600 North Wolfe St, Johns Hopkins Hospital, Baltimore, MD 21287-5425
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Abstract

Objective:

To investigate an outbreak of scabies in an inner-city teaching hospital, identify pathways of transmission, institute effective control measures to end the outbreak, and prevent future occurrences.

Design:

Outbreak investigation, case-control study, and chart review.

Setting:

Large tertiary acute-care hospital.

Results:

A patient with unrecognized Norwegian (crusted) scabies was admitted to the acquired immunodeficiency syndrome (AIDS) service of a 940-bed acute-care hospital. Over 4 months, 773 healthcare workers (HCWs) and 204 patients were exposed to scabies. Of the exposed HCWs, 147 (19%) worked on the AIDS service. Risk factors for being infested with scabies among HCWs included working on the AIDS service (odds ratio [OR], 5.3; 95% confidence interval [CI95], 2.17-13.15) and being a nurse, physical therapist, or HCW with extensive physical contact with infected patients (OR, 4.5; CI95, 1.26-17.45). Aggressive infection control precautions beyond Centers for Disease Control and Prevention barrier and isolation recommendations were instituted, including the following: (1) early identification of infected patients; (2) prophylactic treatment with topical applications for all exposed HCWs; (3) use of two treatments 1 week apart for all cases of Norwegian scabies; (4) maintaining isolation for 8 days and barrier precautions for 24 hours after completing second treatment for a diagnosis of Norwegian scabies; and (5) oral ivermectin for treatment of patients who failed conventional therapy.

Conclusions:

HCWs with the most patient contact are at highest risk of acquiring scabies. Because HCWs who used traditionally accepted barriers while caring for patients with Norwegian scabies continued to develop scabies, we found additional measures were required in the acute-care hospital. HCWs with skin exposure to patients with scabies should receive prophylactic treatment. We recommend (1) using heightened barrier precautions for care of patients with scabies and (2) extending the isolation period for 8 days or 24 hours after the second treatment with a scabicide for those patients with Norwegian scabies. Oral ivermectin was well tolerated for treating patients and HCWs who failed conventional treatment. Finally, we developed a surveillance system that provides a “barometric measure” of the infection rate in the community. If scabies increases in the community, a tiered triage system is activated to protect against transmission among HCWs or hospital patients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 1 , January 2001 , pp. 13 - 18
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

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References

1.Sterling, GB, Janniger, CK, Kihiczak, G, Schwartz, RA, Fox, MD. Scabies. Am Fam Physician 1992;46:1237–1241.Google Scholar
2.Schlesinger, I, Oelrish, DM, Tyring, SK. Crusted (Norwegian) scabies in patients with AIDS: the range of clinical presentations. South Med J 1994;97:352–356.CrossRefGoogle Scholar
3.Hopper, AH, Salisbury, J, Jegadeva, AN, Scott, B, Bennet, GCJ. Epidemic Norwegian scabies in a geriatric unit. Age Ageing 1990;19:125–127.Google Scholar
4.Orkin, M. Scabies in AIDS. Semin Dermatol 1993;12:9–14.Google Scholar
5.Kolar, AK, Rapini, RP. Crusted (Norwegian) scabies. Am Fam Physician 1991;44:1317–1321.Google ScholarPubMed
6.Cabrera, R, Agar, A, Dahl, MV. The immunology of scabies. Semin Dermatol 1993;12:15–21.Google ScholarPubMed
7.Lerche, NW, Currier, RW, Juranek, DD, Baer, W, Dubay, N. Atypical crusted “Norwegian” scabies: report of nosocomial transmission in a community hospital and an approach to control. Cutis 1983;31:637–684.Google Scholar
8.Corbett, EL, Crossley, I, Holton, J, Levell, N, Miller, RF, De Cock, KM. Crusted (“Norwegian”) scabies in a specialist HIV unit: successful use of ivermectin and failure to prevent nosocomial transmission. Genitourin Med 1996;72:115–117.Google Scholar
9.Pasternak, J, Richtmann, R, Ganme, APP, Rodriguez, EAC, Silva, FBM, Hirata, M, et al. Scabies epidemic: price and prejudice. Infect Control Hosp Epidemiol 1994;15:540–542.Google Scholar
10.Hubler, WR, Clabaugh, W. Epidemic Norwegian scabies. Arch Dermatol 1976;112:179–181.Google Scholar
11.Burns, DA. An outbreak of scabies in a residential home. Br J Dermatol 1987;117:359–361.Google Scholar
12.Sirera, G, Rius, F, Romeu, J, Llibre, J, Ribera, M, Sonarion, Y, et al. Hospital outbreaks of scabies stemming from two AIDS patients with Norwegian scabies. Lancet 1990;35:1227.CrossRefGoogle Scholar
13.Boix, V, Sanchez-Paya, J, Portilla, J, Merino, E. Nosocomial outbreak of scabies clinically resistant to lindane. Infect Control Hosp Epidemiol 1998;18:677.CrossRefGoogle Scholar
14.Clark, J, Friesen, DL, Williams, WL. Management of an outbreak of Norwegian scabies. Am J Infect Control 1992;20:217–2.Google Scholar
15.DelGiudice, P, Carles, M, Couppie, P, Bernard, E, Lacour, JP, Marty, P, et al. Successful treatment of crusted (Norwegian) scabies with ivermectin in two patients with human immune-deficiency virus infection. Br J Dermatol 1996;135:494–495.Google Scholar
16.Cordoliani, F, Vasseur, E, Baccard, M, Fournier, S, Feuilhade de Chauvin, M, Tancrede, E, et al. Ivermectin-responsive crusted scabies in HTLV1 carrier. Dermatology 1996;192:351–352.CrossRefGoogle ScholarPubMed
17.Youssef, MY, Sadaka, HA, Eissa, MM, El-Ariny, AF. Topical application of ivermectin for human ecto-parasites. Am J Trop Med Hyg 1995;53:652–653.Google Scholar
18.Currie, BJ, Maguire, GP, Wood, YK. Ivermectin and crusted (Norwegian) scabies. Med J Aust 1995;163:559–560.CrossRefGoogle ScholarPubMed
19.Meinking, TL, Taplin, D, Hermida, JL, Pardo, R, Kerdel, FA. The treatment of scabies with ivermectin. N Engl J Med 1995;333:26–30.Google Scholar
20.Aubin, F, Humbert, P. Ivermectin for crusted (Norwegian) scabies. N Engl J Med 1995;332:612.Google Scholar
21.Marty, P, Gari-Toussaint, M, LeFichoux, Y, Gaxotte, P. Efficacy of ivermectin in the treatment of an epidemic of sarcoptic scabies. Ann Trop Med Parasitol 1994;88:453.CrossRefGoogle ScholarPubMed
22.Currie, BJ, Connors, CM, Krause, VL. Scabies programs in aboriginal communities. Med J Aust 1994;161:636–637.Google Scholar
23.Lawrence, GW, Sheridan, JW, Speare, R. We can get rid of scabies: new treatment available soon. Med J Aust 1994;161:232.Google Scholar
24.Glaziou, P, Cartel, JL, Alzieu, P, Briot, C, Moulia-Pelat, JP, Martin, PM. Comparison of ivermectin and benzyl benzoate for treatment of scabies. Trop Med Parasitol 1993;44:331–332.Google Scholar
25.Dunne, CL, Malone, CJ, Whitworth, JA. A field study of the effects of ivermectin on ecto-parasites of man. Trans R Soc Trop Med Hyg 1991;85:550–551.Google Scholar
26.Orkin, M, Maibach, HI, eds. Cutaneous Infections and Insect Bites. New York, NY: Marcel Dekker, Inc; 1995.Google Scholar
27.Bolyard, EA, Tablan, OC, Williams, WW, Pearson, ML, Shapiro, CN, Deitchman, SC, et al. Guideline for infection control in healthcare personnel, 1998. Infect Control Hosp Epidemiol 1998;19:407–463.Google Scholar