Practice No.
445
Reference: 10/06
Version 1
Page 1 of 4
New
April 2009
HCC AS 31/00
Care Homes
HCC AS 20/06
Regulations 2001
HCC AS 10/06 126
HCC AS 10/06 128
HCC AS 10/06 445
Appendices A,B,C
&D
Control of Scabies Infestation
in Residential and Community Care
This summarises the nature, cause, and effect of Scabies infestation and the management of
incidences which may occur in residential and community care.
1.
2.
WHAT IS SCABIES AND IS IT IMPORTANT IN THE COMMUNITY?
1.1
Scabies is an inflammatory disease of the skin caused by the Scabies mite, Sarcoptes
scabei, of the variety hominis. The mites vary, according to gender, from 0.2 – 0.4 mm in
length and can therefore be seen on careful inspection. They are cream-white in colour
and have a life cycle of 4-6 weeks. The female lays 40-50 eggs during her life span, not all of
which will hatch, and hatching takes 3-4 days with 10-15 days to maturity.
1.2
Female scabies mites cause inflammatory disease by burrowing under the skin to lay their
eggs, and are particularly attracted to skin folds. They may burrow up to 5 mm (approx.
1/5th of an inch) and deposit 2-3 eggs at a time. The hatched larvae will migrate to hair
follicles and perpetuate the life cycle. They feed on cells and tissue fluid. A typical infestation
will only involve an average of 12 mites.
1.3
Inflammation is created by an allergic reaction to both the eggs and the mite’s faeces. This
may take 2-4 weeks to develop, which is important for the identification of the source of the
infestation. Where there is a re-infestation, the previous sensitization will cause the allergy to
develop earlier.
1.4
Scabies is of particular importance where there is a high population level of elderly people, of
people with poor immunity and in underprivileged communities. This is because lowered
immunity allows a stronger infestation, possibly of thousands of mites. A stronger infestation
may develop into a more virulent form of the allergy, known as ‘Crusted’ Or ‘Norwegian’
scabies. In this form, the mites will form crusts on the skin but there may not be the
characteristic itching. The number of mites involved in this particular form of Scabies
makes it highly contagious.
HOW DO YOU GET SCABIES ?
Being in brief contact with someone who has Scabies will not necessarily cause infection.
Prolonged skin to skin contact, such as hand holding or intercourse, is more likely to allow the
mites to migrate from person to person.
In general, Scabies is not transmitted on clothing or bedding as the mite is unable to live away
from the skin. However, where a bed or clothing is shared, infestation is probable.
Mites transmitted from animals with Mange or Scab will only create a temporary problem as they
are a different variety and unable to multiple on humans. They will die out with their natural life
cycle.
3.
4.
IDENTIFICATION OF INFESTATION

The presence of severe itching, particularly at night or after a hot bath, although not all
people will have symptomatic itching. The itching typically starts on the hands, the most
common point of first contact, but spreads to other areas

A symmetrical rash, which may appear anywhere on the body, but particularly where
there are folds of skin such as between fingers, armpits, the inside of the thighs and on
the abdomen. This is blotchy red and lumpy

Mite tunnels may be seen on the skin. These are dark or silvery lines about 2-10 mm
long. They may be anywhere on the skin, but commonly on the hands

Scratching, resulting from the severe itching, may cause skin damage and secondary
infection, in which case the skin will be red, hot and tender.

Once the body is sensitised to the Scabies mite, the allergic reaction will be quicker

A clear warning sign of Scabies infection can be seen where the above symptoms
occur in a number of associated people.
CARE OF A SERVICE USER WITH SCABIES
4.1
All work bases should have a designated member of staff to deal with infection control matters
and to ensure that the manager’s responsibilities to provide adequate arrangements for
prevention of infections in the home, under the Care Homes Regulations 2001, are fulfilled.
4.2
Residents and Service User, particularly the elderly, will need to be cared for with considerable
tact and sensitivity. Scabies, like Head Lice, is traditionally considered to be a shameful
disease associated with poverty and poor hygiene. Whilst this might once have, and may still
be, a secondary consideration for some disadvantaged communities with poor facilities for
hygiene, this is no longer the case in general. Anyone can get Scabies.
4.3
Where scabies has been identified, all staff in physical contact with residents or service users
who are diagnosed as infested, or potentially infested, should wear disposable oversleeves as
part of their personal protective equipment, when providing personal care.
4.4
Diagnosis:
For both residents and day service users, a diagnosis can be deduced by any member of staff,
but where treatment is going to be delivered under the auspices of Hampshire County Council,
this must be under the direction of a qualified prescriber e.g. GP or prescribing nurse.
Consequently, the GP should be consulted and must be consulted for residents.
4.5. Treatment:
4.5.1
Resident or Service User:

Before any treatment is given an appropriate risk assessment must be undertaken and
recorded and confidentiality must be assured.

The written consent of the resident or their agreed representative should be obtained.
Where the individual refuses treatment the Registered Manager must consult the Service
Manager and the designated Care Manager for further direction.

An appropriate prescription should be obtained from the GP and dispensed by the
pharmacist in accordance with the Management of Medication procedure 06/09 and
Practice guidelines No. 126 and 128. This will need to be sufficient to apply full body
cover twice, therefore the size of the person to be treated must be considered, as some
people may require larger quantities to effect a full treatment. If in doubt, the dispensing
pharmacist should be consulted.

Whilst it would be appropriate to undertake the treatment in a bathroom, it should
not be done following a bath, as this increases absorption of the scabicide into the
skin and reduces the topical effect on the skin where is it required

The skin should be cool and dry before treating

Put on gloves, oversleeves and an apron as for routine personal care

Apply, or assist the individual to apply, the cream or lotion thinly over the entire body.
National guidelines at the date of writing, recommend that ALL skin is treated, although
this may vary with the scabicide being used. All skin includes the soles of the feet,
between the fingers and toes, around the genitalia and under the nails. Care must be
taken to avoid the mouth, eyes and nose during application of the scabicide

The scabicide must be left on for the recommended time and must be reapplied to any
area washed during that period. This is particularly important for hands. Some scabicides
will require 8 - 12 hours to work effectively and some up to 24 hours

When the prescribed period has elapsed, a shower or bath may be taken and it is
important to use freshly laundered clothing and bedding following treatment

Treatment is usually repeated in one week, according to the directions on the medication
packaging

All people in contact with the infested person should also be treated, including the families
of staff where appropriate. Any children who are involved in the treatment may need to be
kept away from school until the first treatment has been given

WARNING: Failure of treatment is usually a failure of correct application of the scabicide
or a failure to treat all contacts

For Day Service users, the individual should not attend the day service until the first
treatment has been completed

Treatment with a scabicide will not relieve any itching and the GP may also prescribe an
anti-inflammatory, steroid, or mild sedative medication, to be given until the itching ceases

Where a number of individuals in one unit require treatment, each person must have their
own dispensed prescription. It is also important, in the event of a large number of infected
people, that everyone is treated at the same time e.g. in one 24 hour period.
4.5.2 Staff
5.

Where staff require prophylactic treatment, they should follow the above procedure which
can be applied between shifts. Where Scabies mites are present staff should obtain
treatment without delay and not return to work until the first application of the treatment
has been completed.

Any staff who may be additionally unwell e.g recently returned form sickness absence,
should be advised to consult their GP.

Staff may also be reminded of the Employee Support Line service.
CLOTHING AND BEDDING
Clothing and bedding should be treated at the same time to ensure eradication of the mites.

It will be sufficient to launder clothing and bedding on a hot wash cycle

For items that cannot be treated in this way, they should be left for 7 days, preferably in a
sealed plastic bag, before reusing

Alternatively bedding and clothing may be treated by tumble drying at a high temperature
for 30 minutes, or by dry cleaning and ironing

Living areas should be thoroughly vacuum cleaned.
6.
CRUSTED SCABIES
In the event of a case of crusted or ‘Norwegian’ scabies, repeated treatment may be required. This
may involve different types of scabicide for each treatment. Care must be taken to ensure that the
different medications are applied correctly according to the Medication Management procedure and
practice No.128. Particular attention must be paid to treatment of the head and under the finger
nails.
7.
RECORDING AND REPORTING
7.1
Outbreaks of Scabies must be reported to the Health Protection Agency.
An outbreak is defined as :A rash of typical appearance and itching particularly at night. Often with other
similar cases reported amongst household and other close contacts. (HIoWLA
HPA 15/9/06)
A residential or day care unit may be described as a household.
7.2
An incident report must be completed as set out in Practice No. 306.
7.3
A Regulation 37 report must be made to CQC/CSCI.
7.4
A scabies outbreak record should be completed – see Appendix A.
7.5
The Registered Manager should maintain a Checklist of Action taken – see Appendix B.
7.6
A Scabies Monitoring Record should be kept – See Appendix C.
7.7
Each resident or service user must have their diagnosis, consent to treatment, treatment and
any other related actions, including risk assessments, recorded in their personnel file and
their care plan should be amended accordingly.
7.8
The Registered Manager will also decide if it is necessary to advise all visitors of the
outbreak, or only those who may be in close contact with infected individuals e.g. family. A
suggested format is set out in Appendix D.
References
Hampshire & Isle of Wight Heath Protection Unit – Scabies Policy Version 1 15th September 2006
National Prescribing Centre Management of Scabies in Primary Care V.18 No: 4 March 2008
Patient Uk http://www.patient.co.uk/showdoc/23068817/ online @ 1/4/2009
BUPA
http://hcd2.bupa.co.uk/fact_sheets/html/scabies.html
online @ 1/4/2009
Information leaflet http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1194947398079