The very mention of the word incites the manifestation of a psychological phenomenon causing everyone and anyone who hears the name to immediately begin scratching, even there is no evidence tht they have developed a close relationship with the mite; and they usually. But health care workers often lose their perspective in the company of a patient currently diagnosed with that handy medical term.. “Cannot rule out.” Maybe this will help a little:

• The scabies mite does not hop, skip, jump or fly
•  Scabies is transmitted by close, personal, skin to skin contact.  So yes, a HCW giving close, physical care to a patient with scabies, runs the risk of transmission, but only if they don’t use precautions.

Diagnosis is often difficult; to obtain a more reliable diagnosis than “Cannot rule out” a positive skin scraping can be definitive; at the same time, a diagnosis could be missed if it just so happens the mite and its waste products were not collected in the specimen.

Traditionally, in order to cover the “Cannot rule out” diagnosis and the potential for an outbreak, Elimite (Permethrin) was ordered to treat the patient along with everyone and anyone. Treatment commenced for anyone and everyone at the same time and there were frequent 2^nd and even 3^rd rounds of treatment.

Recently, standardized treatment recommendations are based on the logical chain of events surrounding patients and those who have been in closest contact with them. For instance, someone who simply places a food tray on an overnight stand and leaves the room is not usually at risk for transmission of scabies.

We can help to quiet the jangled nerves of co-workers hit by a scabies scare by reminding them:

• The scabies mite is not transmitted through the air or droplets and they do not hop, skip, jump or fly.
• Scabies transmission may occur when there has been close, skin to skin contact.
• The chance of picking up the scabies mite from a patient’s laundry is very small. Conversely, if you are at home and you sleep in the same bed with a family member who has scabies, you could be at risk.   
• Be mindful. If you suspect scabies, wear gloves and a gown and report your suspicion.
• Most of all use Standard Precautions at all times, on all patients.  
• Follow your State Infection Control Guidelines for the Management of Scabies in Long-term Care, or  your own facility P & P or recommendations from the CDC.  

 You can stop itching now.

The term Standard Precautions speaks for itself. These are basic precautions taken to reduce the possibility of coming in contact with infectious body fluids including blood, secretions, excretions, non-intact skin and mucous membranes. In other words, anything that is warm and wet, except for sweat. Standard Precautions include hand washing, using alcohol hand sanitizers when there are no visible signs of soiling, and barriers such as gloves, gowns, masks and goggles, depending on the situation.

Transmission Based Precautions offer an added level of protection when the route of transmission is suspected or confirmed.  See the CDC 2007 Isolation Guidelines for more information on Droplet, Contact and Airborne Precautions;

CDC/HICPAC Isolation Precautions 2007

There you will also find Appendix A for type and duration of isolation precautions (pg. 94). These recommendations are the accepted standard for hospitals and long-term care facilities.

Next: ESBLs