Scabies outbreaks in residential care homes: factors associated with late recognition, burden and impact. A mixed methods study in England

Abstract

Scabies outbreaks in residential care homes: factors associated with late recognition, burden and impact. A mixed methods study in EnglandArticle (Published Version) http://sro.sussex.ac.uk Hewitt, K A, Nalabanda, A and Cassell, J A (2014) Scabies outbreaks in residential care homes: factors associated with late recognition, burden and impact. A mixed methods study in England. Epidemiology and Infection. ISSN 0950-2688 This version is available from Sussex Research Online: http://sro.sussex.ac.uk/49876/ This document is made available in accordance with publisher policies and may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the URL above for details on accessing the published version. Copyright and reuse:Sussex Research Online is a digital repository of the research output of the University.Copyright and all moral rights to the version of the paper presented here belong to the individual author(s) and/or other copyright owners. To the extent reasonable and practicable, the material made available in SRO has been checked for eligibility before being made available.Copies of full text items generally can be reproduced, displayed or performed and given to third parties in any format or medium for personal research or study, educational, or not-for-profit purposes without prior permission or charge, provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way.Scabies outbreaks in residential care homes: factors associated with late recognition, burden and impact. A mixed methods study in England SUMMARYScabies is an important public health problem in residential care homes. Delayed diagnosis contributes to outbreaks, which may be prolonged and difficult to control. We investigated factors influencing outbreak recognition, diagnosis and treatment, and staff experiences of outbreak control, identifying areas for intervention. We carried out a semi-structured survey of managers, affected residents and staff of seven care homes reporting suspected scabies outbreaks in southern England over a 6-month period. Attack rates ranged from 2% to 50%, and most cases had dementia (37/39, 95%). Cases were diagnosed clinically by GPs (59%) or home staff (41%), none by dermatologists. Most outbreaks were attributable to avoidably late diagnosis of the index case. Participants reported considerable challenges in managing scabies outbreaks, including late diagnosis and recognition of outbreaks; logistically difficult mass treatment; distressing treatment processes and high costs. This study demonstrates the need for improved support for care homes in detecting and managing these outbreaks.

Epidemiology, Diagnosis, and Treatment of Scabies in a Dermatology Office

“…Although the literature studying scabies in developed countries describes outbreaks occurring at long-term care facilities and hospitals, [17][18][19][20] the vast majority of patients diagnosed with scabies in this study lived at home. The patients who did not live at home lived at long-term care facilities or in college dormitories.…”

“…1 In developed countries, scabies outbreaks have historically been described in long-term care facilities, hospitals, and areas of overcrowding. [17][18][19][20] Little is known of the current incidence of and treatment patterns for scabies in the United States. The purpose of this study is to examine demographic data, treatment types, success of treatments, and the misdiagnosis rate of scabies in an outpatient dermatology clinic in the Southeastern United States.…”

Indicators of health and safety among institutionalized older adults

“…Among them the most common are cellulite, pressure ulcers, scabies, mucocutaneous fungal infections, infections by the herpes virus and conjunctivitis (10) , which are the disorders most commonly seen in older adults. In this study, the incidence of scabies was as high as that of a study conducted in England in seven older adult institutions, in which the rate varied from 2% to 50%, of which 95% were older adults with dementia, 79.5% with incontinence, and 61.5% with impaired mobility (15) . Scabies is a contagious skin condition caused by a mite called Sarcoptes Scabiei, which affects humans by causing inflammatory and allergic reactions on the wrists, elbows, back, buttocks, external genital organs and fingers (14) .…”

“…Thus, there is an urgent need for support to allow for early recognition of outbreaks; and resources dedicated to training health teams to make diagnoses and management support protocols, including support from dermatology services, from directives that clearly establish the role and responsibility of each professional, and from the improvement of basic and primary care (15) . Pressure ulcers represent a great health and economic problem faced by long-term care institutions for older adults (17) .…”

Laboratory Diagnosis of Scabies Using a Simple Saline Mount: A Clinical Microbiologist's Report

“…There was also a recent report of an outbreak and spread of scabies in residential care centres, emphasizing the importance of knowledge and practice in the diagnosis and management of scabies [16]. …”