Rasmus Leistner1, Dirk Buchwald2, Marc Beyer3, Sandra Philipp3. 1. Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany. 2. Department of Hospital Hygiene, Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany. 3. Department of Dermatology, Venerology and Allergology, Chariteplatz 1, Berlin, Germany.
Abstract
BACKGROUND: This article reports on a scabies outbreak among healthcare workers (HCW) in an acute care hospital. The outbreak was associated with a patient suffering from a chronic skin disease that was later diagnosed as crusted scabies. OBJECTIVE: The objective was to determine the outbreak drivers and define a prevention strategy against future outbreaks. METHODS: All staff that had contact with the patient were treated with 5% permethrin ointment. An interdisciplinary outbreak investigation team was established. The team conducted a questionnaire-based case-control study. FINDINGS: After the permethrin treatment, no further case was found. Twenty-seven HCWs who had contact with the index patient answered the questionnaire (response rate 73%). The outbreak questionnaire revealed 13 cases of secondary scabies among HCWs. In the multivariable analysis, a lack of glove use (odds ratio [OR], 9.8; P value = 0.036) and frequent close physical contact (OR, 8.151; P value = 0.038) were associated with increased risk of scabies acquisition. DISCUSSION: The scabies outbreak was most likely driven by three factors: an index patient with crusted scabies; a delayed diagnosis of this patient; and close physical contact without gloves during his hospital stay. The use of disposable gloves for patients with unclear dermatological diagnosis have the potential to limit future scabies outbreaks.
BACKGROUND: This article reports on a scabies outbreak among healthcare workers (HCW) in an acute care hospital. The outbreak was associated with a patient suffering from a chronic skin disease that was later diagnosed as crusted scabies. OBJECTIVE: The objective was to determine the outbreak drivers and define a prevention strategy against future outbreaks. METHODS: All staff that had contact with the patient were treated with 5% permethrin ointment. An interdisciplinary outbreak investigation team was established. The team conducted a questionnaire-based case-control study. FINDINGS: After the permethrin treatment, no further case was found. Twenty-seven HCWs who had contact with the index patient answered the questionnaire (response rate 73%). The outbreak questionnaire revealed 13 cases of secondary scabies among HCWs. In the multivariable analysis, a lack of glove use (odds ratio [OR], 9.8; P value = 0.036) and frequent close physical contact (OR, 8.151; P value = 0.038) were associated with increased risk of scabies acquisition. DISCUSSION: The scabies outbreak was most likely driven by three factors: an index patient with crusted scabies; a delayed diagnosis of this patient; and close physical contact without gloves during his hospital stay. The use of disposable gloves for patients with unclear dermatological diagnosis have the potential to limit future scabies outbreaks.
Authors: Fernando Bellissimo-Rodrigues; Magda Fabbri Isaac Silva; Regina Puti de Souza; Paulo de Tarso de Oliveira e Castro Journal: Infect Control Hosp Epidemiol Date: 2008-08 Impact factor: 3.254