Role of prolonged surveillance in the eradication of nosocomial scabies in an extended care Veterans Affairs medical center.

Although general guidelines for control of institutional outbreaks of scabies have been published, little information is available on the long-term efficacy of these measures in extended care facilities. An epidemic of scabies occurred in a comprehensive care Veterans Affairs facility as a result of an unrecognized case of crusted scabies, with a total of 112 persons affected during a 12-month period. The initial outbreak occurred in the acute care units, with highest attack rates among roommates of the index patient (11/14, 78%) and nursing staff (27/55, 49%). Despite sustained infection control measures, secondary outbreaks continued to occur in the extended care units. Factors contributing to the persistence of the epidemic were transfer of patients with unrecognized infestation within the facility, prolonged latency period and atypical manifestations in elderly patients, and failure of scabicide treatment. In addition, a role may be played by carriage of scabies mites by infested staff members before they have symptoms. Control of the epidemic was only achieved with the following: increased awareness and better scabies recognition, restriction of staff rotation in the facility, and improved communication among primary providers and infection control personnel. Prolonged surveillance may be required for eradication of nosocomial scabies in extended care settings.