Effective Strategies for Preventing and Managing Scabies Infestations

Introduction:

A human itch mite-Sarcoptes scabiei var. hominis, is the cause of the skin infestation - scabies. These itch mites are microscopic and burrow into the upper layer of a person's skin. The mites live in the skin and lay eggs. They commonly cause symptoms such as skin rashes (pimple-like rashes) and extensive itching. These itch mites spread through prolonged direct (skin-to-skin) contact with the person with scabies. The scabies mites spread in crowded areas where close body or skin contact frequently occurs, such as prisons, hospitals, childcare, and extended-care facilities. Scabies affects all races and social classes and is found worldwide.

What Are Norwegian or Crusted Scabies?

Crusted or Norwegian scabies occurs in immunocompromised individuals, the elderly, debilitated, or disabled with a weak immune system. It is a severe form of scabies in which thick crusts are seen on the skin containing large quantities of scabies mites and eggs. Individuals with crusted scabies are extremely contagious. In addition to direct skin-to-skin contact, contact with clothing, furniture, or bedding used by a person with crusted scabies can spread the infestation. Thus, this type of severe scabies requires aggressive and prompt medical treatment to prevent scabies outbreaks.

Can Scabies Spread by Using a Public Swimming Pool?

It is very unlikely that scabies may spread through water in the public swimming pool. The most common modes of transmission include:

• Direct skin contact.

• Contact with clothing, towels, and bedding used by the person with scabies (rare).

Do Animals Spread Human Scabies?

Pets and other animals do not spread human scabies. However, pets get infested with animal mites which can result in itching and skin irritation for their owners. The pets must be treated to get rid of the animal mites to relieve symptoms for the pets and their owners.

What Is the Key to Preventing the Spread of Scabies Within a Household?

Immediate and prompt treatment is required to prevent scabies from spreading. If a person is diagnosed with scabies, anyone who has had prolonged direct (skin-to-skin) contact with the infected individual, including all the household members, sexual partners, and other contacts, must be treated for scabies. All those in contact with the infested person must be treated at the same time to prevent re-infestation of scabies. If the scabies symptoms continue, or a new itch or rash occurs, retreatment is required to prevent the spread of scabies.

How to Prevent Scabies Mites Infestation on Household Items and Clothes?

Household items such as carpets, furniture, bedding, towels, and clothing may get contaminated with scabies mites. The mites that cause scabies do not survive for more than two to three days away from human skin. Thus decontamination can be done by dry cleaning or washing (using a machine) in hot water and drying (using a hot cycle). If the item cannot be dry cleaned or washed, it should be removed from the common area to avoid contact with skin (human body contact) for at least three days.

How to Prevent Scabies?

The symptoms of scabies take four to eight weeks to develop after infestation with the mite. However, a person infested with scabies can transmit scabies to others during this asymptomatic period also. In addition, contact with personal items such as clothing, towels, and bedding and sharing common furniture and carpets can lead to the spread of scabies to other people in contact with the person with scabies. The following steps can be taken to prevent scabies:

• Avoid direct skin-to-skin contact with the person with scabies.

• Avoid sharing towels, clothes, and bedding with the person with scabies.

• Members of the same household and others who were in contact with the infested person must get treated for scabies at the same time as the person with scabies to prevent reinfection.

• One must ensure that bedding, clothing, and other fomites used by the infested person (up to three days before treatment initiation) are decontaminated before using them again. Hot water washing, hot dryer cycles, and dry cleaning are the most effective ways to decontaminate contaminated items.

• Items that cannot be washed should not be used for a week and must be stored in closed plastic bags during the period. Scabies mites do not survive away from the skin for more than three days. Thus, care should be taken that the items do not come in contact with the skin of anybody for several days to a week's time, as it may enhance the chance of re-infestation.

• Adults and children must not return to work, school, or childcare (or any crowded places) before the treatment is complete.

• Those who have crusted scabies and their family members and close contacts must be treated aggressively and rapidly to prevent outbreaks.

• An aggressive, rapid, and sustained response is required for institutional outbreaks (as they are difficult to control)

• Rooms used by crusted scabies patients should be cleaned thoroughly and vacuumed after use.

• Using pesticide sprays, fumigation, and other environmental disinfestation methods is unnecessary.

How to Prevent Re infestations and the Symptoms That Persist After Scabies Treatment?

The symptoms of scabies, such as itching and rashes, can persist for some time (weeks to months), even after successful treatment. In order to relieve the symptoms, one can request their healthcare provider for medications that can provide relief. The various reasons why a person can continue to have symptoms even after treatment include:

• Misdiagnosis - Incorrect diagnosis of scabies in case of other medical conditions, such as reactions to drugs or allergies, can lead to the symptoms. A confirmative diagnosis of scabies through thorough investigation for scabies can prevent such scenarios.

• Re-infestation from a Family Member or Other Contacts - All members of the family and their contacts must be treated simultaneously to prevent re-infestation with scabies.

• Treatment Failure - Faulty use of topical medication, poor penetration of the medication, and resistance to the medication can lead to treatment failure and re-infestation. The topical scabicides should be applied as advised by the healthcare provider.

In case of re-infestation or treatment failure, repeated treatment with combination medications (oral and topical application) can prevent further infestation and can successfully kill all the eggs and mites. Re-infestation with items such as towels, clothing, and bedding can be prevented by thorough washing (hot water) or dry cleaning. Contaminated items that cannot be washed must not be used and kept away from direct skin contact for a minimum of three days to prevent re-infestation.

What Can Institutions Do to Prevent Scabies?

Scabies outbreaks occur among patients, staff, and visitors in institutions such as hospitals, nursing homes, childcare, and long-term care facilities. Delayed diagnosis and treatment of scabies, especially crusted scabies, in institutionalized, immunocompromised, debilitated, or elderly persons result in outbreaks. Such patients may not have the characteristic symptoms of scabies, such as rashes and itching, leading to misdiagnosis or inadequate treatment, leading to continued transmission. The guidelines for scabies prevention and control provided by the health departments must be followed meticulously to prevent scabies outbreaks. These include:

• Early detection and treatment of scabies.

• Implementation of appropriate isolation for scabies patients.

• Implementation of infection control practices to prevent scabies outbreaks.

• Maintaining a high index of suspicion that the patients with undiagnosed skin rashes or itching may have scabies (even in the absence of the characteristic signs).

• Screening and evaluating new employees and patients carefully for any skin conditions.

• Being vigilant for early warning signs of a scabies outbreak, such as staff with scabies (indicating asymptomatic patients with scabies).

• Employing experienced and trained professionals to examine the skin scrapings of suspected cases for identification of the scabies mites.

• Ensuring appropriate infection control practices (such as using gloves, masks, and gowns and avoiding direct skin-to-skin contact) and isolation protocols.

• Collecting the clinical and epidemiologic information about the suspected and confirmed scabies patients.

• Conducting a systematic review to identify and respond promptly to potential scabies outbreaks.

• Using an aggressive approach to control and prevent scabies, especially if crusted scabies is suspected or confirmed.

• Notifying the local health department and other neighboring institutions in case of any possible outbreak.

• Treating (prophylactic treatment) the staff, the household members, and other patients who were in contact with the person with scabies.

• Avoiding direct skin-to-skin contact with scabies patients for at least eight hours after treatment.

• Implementing institution-wide programs to spread awareness about scabies.

Conclusion:

Scabies is a mite infestation that can be prevented by using appropriate measures. If a person has symptoms of scabies, they should immediately seek treatment. Items used by a person with scabies must be decontaminated and disinfected. All the household members and others who were in contact with the person with scabies must be treated prophylactically for scabies to prevent scabies infection and reinfection. In addition, institutional-level preventive measures are necessary to prevent scabies outbreaks.