A nosocomial scabies outbreak originating from immunocompromised transplant patients in Turkey: Upholstery as a possible cause

Abstract

Background Inpatients with crusted scabies represent an important source of nosocomial transmission with consequent outbreaks among patients and healthcare workers. This study aimed to report the course of an institutional scabies outbreak, which progressed with infestation of immunosuppressed transplant patients, health care workers, and caregivers. Methods Patients diagnosed with scabies in a nosocomial outbreak in a 200‐bed, tertiary hospital were included. Following a diagnosis of scabies in the index patient, strict contact isolation measures were implemented. During the outbreak, a root cause analysis (RCA) was carried out by an infection prevention and control team. Results Forty‐two individuals were affected (7 patients, 25 health care workers, and 10 family members of the patients) during the outbreak consisting of three attacks. Index case was a multiple myeloma patient who received hematopoietic stem cell transplantation and presented with crusted scabies. A RCA suggested that upholstery could serve as a means of reservoir. All upholstery of the sofa and armchairs in patient rooms as well as in lounge areas were replaced by wipeable leather material. After the 19‐week course of the outbreak, no additional cases of scabies have been observed until now. Conclusion A high index of suspicion should be maintained, particularly in immunocompromised patients, in order to achieve rapid diagnosis of scabies and to implement institutional infection control measures. It should also be borne in mind that the transmission may occur through direct contact as well as fomites, such as upholstery.

Crusted scabies at a tertiary care center: Case series and cautionary tale

“… 3 , 4 Scabies outbreaks in health care facilities can lead to significant morbidity for other patients and staff, in addition to administrative burden. 11 In all 3 cases, the patients arrived at the hospital without a diagnosis of scabies and did not have contact precautions, leading to numerous exposures for frontline health care workers. Once scabies was suspected, patients were placed on contact precautions and hospital epidemiology was notified.…”

“…Ultimately, scabies should be kept on the differential diagnosis list for pruritic rashes in patients who exemplify well-known risk factors, and contact precautions should be instituted while diagnostic workup is pursued. 11 …”

Bullous Scabies in an Immunocompromised Host

“…Controlling the spread of transmission presents a public health challenge, particularly in poor socioeconomic conditions and in regions with limited health infrastructure [ 15 , 16 ]. Past reports have demonstrated the effective control of crusted scabies outbreaks in hospital and community settings utilizing contact tracing, treatment for clinically positive cases, and prophylaxis for direct contacts [ 17 , 18 ]. Despite diagnostic delay and multiple healthcare workers being exposed to the patient in this case, no healthcare workers developed suspicious or confirmed scabies lesions.…”

“…Multiple nursing outreach visits to the patient's remote village identified additional cases which were treated with topical permethrin. Prophylactic treatment for direct contacts was not utilized as described in prior studies [ 17 , 18 ]. In the absence of appropriate public health intervention, our patient likely would have reacquired the infection after returning home.…”

Infection Control among Healthcare Workers and Management of a Scabies Outbreak in a Large Italian University Hospital

“…Scabies outbreaks can be more frequent in healthcare settings, due to the clinical peculiarities of patients (e.g., physical or mental disability, advanced age, immunodeficiency), the duration of hospitalizations, and the direct physical contact necessary for assistance. Most of the outbreaks in healthcare settings are caused by unrecognized Norwegian scabies in hospitalized patients [10][11][12][13][14]. Moreover, the diagnostic delay may underestimate the prevalence of scabies in these contexts [15].…”