Scabies: A Common Occurrence in Extended-Care Facilities

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As we age, our skin becomes thinner, loses elasticity and heals at a considerably slower rate. These changes make older individuals especially prone to a number of different skin conditions that normally would not be a serious issue. One of these conditions is scabies, and it is relatively common in long-term care facilities.

What is scabies?

Scabies is caused by an infestation of the upper layer of the skin by microscopic scabies mites. Female mites burrow into the skin where they deposit eggs, and this can cause a characteristic rash composed of crooked, raised lines and pimple-like bumps or blisters.

The most common sites for this rash are the webbing between the fingers, wrists, elbows, armpits, knees, back, external genitals or buttocks. The rash is also accompanied by intense itching, especially at night. This can be particularly dangerous for older individuals, as excessive scratching can cause open wounds that increase their risk of developing a bacterial infection.

How do you get scabies?

These mites are most commonly spread by prolonged skin-to-skin contact with an infested person, such as sexual contact or frequent interaction with close members of a household. Although less common, one can also get scabies from contaminated items such as bedding, clothing, furniture and carpet. For this reason, scabies is often spread in institutional settings such as nursing homes and long-term care facilities. It is important to note that human scabies cannot be transmitted by pets or other animals and is different from the kind of parasite that causes mange.

If a person has never had scabies before, it may take a few weeks for symptoms to appear, but reinfection typically becomes symptomatic in a few days. Even if an individual does not have symptoms, he or she is still able to transmit the parasites to others.

Scabies can be diagnosed by its unique rash or with a simple skin scraping. The scraping is examined under a microscope to confirm the presence of mites, eggs, or mite fecal matter. Even if these components are not found in the sample, treatment may still be recommended.

Can scabies be treated?

Treatment for scabies is relatively simple compared to many other parasitic infestations. Scabicides can be prescribed for treating those who have been diagnosed with this condition or who have been in close contact with an infested individual. This treatment typically comes in a lotion or cream form and is applied to the entire body from the neck down in order to ensure that the mites have little to no untreated skin available to infest. The medicated ointment should be applied to clean skin and worn for an extended period of time before it can be washed off to ensure maximum effectiveness in killing the adult mites and eggs.

A follow-up application may be necessary in community settings where more aggressive treatment is needed to eradicate the problem or prevent it from becoming more widespread. Itching may persist for a few weeks following treatment, even if it is successful.

To help soothe the intense itchiness that accompanies a scabies infestation, take an over-the-counter antihistamine medication. Oatmeal baths, anti-itch creams, compresses and cooling moisturizers containing menthol may provide some relief as well. It is important to refrain from scratching as much as possible.

Should I treat my house or personal belongings?

Scabies mites cannot survive away from the human body for longer than 48 to 72 hours. They are also sensitive to high heat and will die if exposed to temperatures over 122 degrees Fahrenheit for 10 minutes. It is recommended to wash clothes, bedding and other personal items in very hot water and dry them with high heat. Removing human contact with non-washable items (such as carpets and furniture) for at least 72 hours will typically kill any mites in or on these surfaces.

Crusted or Norwegian scabies

According to the Centers for Disease Control (CDC), a person infested with scabies only plays host to about 10 or 15 mites. However, a more severe case of scabies known as crusted or Norwegian scabies can involve hundreds or thousands of mites. This extreme infestation usually occurs in individuals who have a weakened immune system, or are elderly, disabled or ill.

Symptoms of crusted scabies are often different from less serious cases. Instead of the distinctive rash, the affected areas become covered in thick gray crusts. These crusts are full of scabies mites and eggs and cause the infested person (and their shed crusts) to be highly contagious to others.

Treatment for crusted scabies is similar, but much more aggressive due to the severity of the infestation. In addition to frequent treatment with a scabicide cream, an oral dose of ivermectin may be necessary to get rid of the parasites. It is also important to be consistent and proactive about disinfecting the person’s belongings and surroundings via thorough washing and vacuuming. This includes all carpets and furniture.

Facility guidelines

Since scabies can be more contagious to individuals in long-term care environments, health care facilities should be vigilant when it comes to identifying, treating, and educating patients, employees and caregivers. If an outbreak occurs, the facility should immediately notify the local health department for assistance in resolving the matter.

An individual in a facility who is diagnosed with scabies—especially the crusted variety—should be isolated from other patients and employees until 24 hours after treatment. Facilities will typically designate one group of employees who are responsible for providing care to infested patients in order to reduce the risk of spreading the parasites to others.

It is best for family members and caregivers to avoid direct contact with the affected person as well, or use gloves when providing care. If you think you or a loved one may have scabies, consult with a primary care physician, dermatologist or, if applicable, employees at their care facility in order to receive timely treatment and further information.

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