Scabies is an intensely itchy skin condition by an immune reaction to the mite Sarcoptes scabiei and their saliva, eggs and faeces which can be passed on through close prolonged skin to skin contact with an affected person. Scabies is not usually a serious condition but must be treated quickly to stop it spreading.
There are two forms of scabies caused by the same mite:
- Classical (typical) scabies – low numbers of mites present (about 5–15 per host).
- Crusted (Norwegian) scabies – thousands or millions of mites present in exfoliating scales of skin. Developing as a result of insufficient immune response by the host.
Crusted scabies is primarily seen in people with:
- A history of immunosuppression
- Reduced ability to scratch.
- People with learning difficulties or neurological disorders (such as Down’s syndrome or dementia).
- Elderly people
Crusted scabies may need prolonged and repeated treatment, as some patients may have significant underlying conditions influencing prognosis.
Symptoms of Scabies
Symptoms of scabies include intense itching especially at night and a raised rash or spots and appearance of track like burrows in the skin. Click here for more information from the NHS. The rash often appears in the webs of the fingers and then spreads across the whole body. Elderly people may not display symptoms especially in those with underlying cognitive impairment, and so recognising it can be challenging. Symptoms can last for weeks, can be hard to spot and are often mistaken for other skin infections leading to avoidable spread in the setting.
What can you do to prevent the spread of scabies?
If you suspect an outbreak of scabies in your setting report the outbreak to UKHSA HPT. Email: EastOfEnglandHPT@UKHSA.gov.uk and remember to copy in HertsHPT.SPOC@hertfordshire.gov.uk.
You will be provided with advice and support on co- ordination of treatment for all cases and contacts and outbreak control measures. IMPORTANT: all cases and contacts must be treated simultaneously to break the cycle of transmission.
Click here for Scabies guidance for treatment of outbreaks (Jan 2023)
Click here for the UKHSA guidance on the management of scabies cases and outbreaks in long-term care facilities and other closed settings
Click here for the HCC Action card for management of a scabies outbreak in a care home setting
Key points:
- Staff should be vigilant to signs and symptoms of scabies and aware of potential for asymptomatic infection in the elderly.
- Staff and visitors should wear appropriate PPE – gloves and plastic apron when providing direct personal care to an affected person.
- Affected individuals should avoid close physical contact with others until after first 24 hr treatment completed.
- Affected staff can return to work after completing first 24 hr treatment.
- Cleaning of the environment to remove skin scales and dust. Increase frequency of vacuuming and deep clean after each treatment.
- Daily washing of staff uniform or clothing is important.
- Laundry should be managed as per guidance. Click here for the UKHSA guidance. Click here for the NHS England guidance.
- A risk assessment must be undertaken for any new admission to a setting experiencing a scabies outbreak.
- Warn and inform all visitors to the setting until whole mass treatment is complete.
Important! If a scabies case or contact requires transfer to a hospital or other care setting, the admitting setting should be informed of the outbreak prior to the admission to allow a risk assessment to be undertaken. It is recommended transfers of cases and contacts occur after the first 24- hour treatment is completed.
Click here for the UKHSA guidance on the management of scabies cases and outbreaks in long-term care facilities and other closed settings
Click here for the HCC Action card for management of a scabies outbreak in a care home setting
Below are some useful resources relating to scabies:
Click here for the PHE standard publication template – a useful document. The Action card for scabies in care homes is on page 15-16 and Appendix 3 has IPC precautions.
Click here for the Scabies Policy for care home settings
Click here for information from NICE regarding Scabies