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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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