Do we know how scabies outbreaks in residential and nursing care homes for the elderly should be managed? A systematic review of interventions using a novel approach to assess evidence quality

Abstract

Currently no national guidelines exist for the management of scabies outbreaks in residential or nursing care homes for the elderly in the United Kingdom. In this setting, diagnosis and treatment of scabies outbreaks is often delayed and optimal drug treatment, environmental control measures and even outcome measures are unclear. We undertook a systematic review to establish the efficacy of outbreak management interventions and determine evidence-based recommendations. Four electronic databases were searched for relevant studies, which were assessed using a quality assessment tool drawing on STROBE guidelines to describe the quality of observational data. Nineteen outbreak reports were identified, describing both drug treatment and environmental management measures. The quality of data was poor; none reported all outcome measures and only four described symptom relief measures. We were unable to make definitive evidence-based recommendations. We draw on the results to propose a framework for data collection in future observational studies of scabies outbreaks. While high-quality randomised controlled trials are needed to determine optimal drug treatment, evidence on environmental measures will need augmentation through other literature studies. The quality assessment tool designed is a useful resource for reporting of outcome measures including patient-reported measures in future outbreaks.

Sarcoptes Infestation. What Is Already Known, and What Is New about Scabies at the Beginning of the Third Decade of the 21st Century?

“…Many researchers emphasize that delayed or misdiagnosed Sarcoptes infection may lead to serious consequences, such as extensive outbreaks of the infestation, for example, in health institutions and among nursing home residents and personnel [ 16 , 69 , 70 , 71 , 72 ]. In high-income countries, scabies outbreaks also occur in homeless populations and groups living in crowded conditions such as schools, prisons, and child-care facilities [ 16 ].…”

Estimating the global burden of scabies: what else do we need?*

“…A specific focus on the education of allied healthcare practitioners and family members is imperative to ensure timely diagnosis and appropriate treatment 53. More high‐quality research exploring the diagnosis and management of scabies in special care facilities and in outbreak situations is needed 8,52…”

“…49,50 In turn, there may be unforeseen psychological and economic effects, especially if infected residents are transferred between care facilities prior to effective treatment. 51,52 Management of scabies in these settings is often challenging. A specific focus on the education of allied healthcare practitioners and family members is imperative to ensure timely diagnosis and appropriate treatment.…”

“…53 More high-quality research exploring the diagnosis and management of scabies in special care facilities and in outbreak situations is needed. 8,52 Integration of skin Neglected Tropical Disease programmes and their potential impact on the burden of scabies A shift from disease-specific programmes to integrated management strategies for all skin NTDs has dominated recent discussions between researchers, clinicians, funding bodies and policy stakeholders. [54][55][56][57][58] Strategic partnerships and an integrated approach for all skin NTDs could lead to significant financial savings and logistic improvements through common diagnostic pathways, shared approaches to mapping, compatible drug regimens and overlapping nonpharmacological management.…”

Prevalence of scabies in long-term care hospitals in South Korea

“…It was considered one of the most commonly neglected tropical diseases by the World Health Organization (WHO) in 2017, and the parasite can quickly spread from one individual to another, resulting in an outbreak [1][2][3]. Several scabies outbreaks have been reported in nursing care homes (also referred to as nursing care facilities, elderly care facilities, long-term care facilities, and long-term care hospitals [LTCHs]) [4][5][6]. A review of institutional scabies outbreaks on a global scale revealed that 48% of the outbreaks were reported in LTCHs [7,8].…”