Scabies outbreak in an acute care setting involving 1,075 individuals
Abstract number: P805
Buehlmann M., Beltraminelli H., Strub C., Jordan X., Itin P., Widmer A.
Objectives: Sarcoptes scabiei is an ectoparasite that causes either sporadical or in institutional outbreaks. We report a large outbreak in an University Hospital and a Rehabilitation Facility, that was controlled only after several months by strict infection control measures (IC).
Methods:Setting: University Hospital: primary and tertiary care centre with 750 beds, 39 intensive care unit (ICU) beds and 27,000 admissions per year. Rehabilitation Facility: primary and tertiary care centre with 92 beds (8 ICU beds) for patients with complex disabilities, spinal cord and brain injuries.
Epidemiological investigation: Scabies case definition: 1) positive skin scrape or 2) dermatoscopy or 3) typical burrows without history of prior scabicide treatment. Attack rate: The attack rate was defined as the number of symptomatic healthcare workers (HCW) in relation to all HCW exposed to scabies, and was evaluated by a standardised questionnaire.
Interventions: Individuals with scabies: treatment, contact precautions until 24 hours after initiation of treatment. HCW in contact with index case: preemptive treatment, including all household members (HM). Patients in contact with the index case or infected HCW: dermatological examination, later preemptive treatment for all patients.
Results: In June 2007, a HIV patient was diagnosed with Norwegian scabies (crusted scabies) after a 6 week hospitalisation in the ICU of an University Hospital and consecutive transfer to a Rehabilitation Facility.
University Hospital: 4 HCW and 3 HM and no patients were diagnosed with scabies within 9 weeks from June to August 2007. The attack rate was 18% in HCW overall, 27% for HCW with direct contact to the index case and 10% for HM. The outbreak was finished in August after initiation of strict IC.
Rehabilitation Facility: No diagnosis of scabies was made at the beginning of the outbreak. Two HCW, 2 HM and 2 patients were diagnosed with scabies from July to September 2007 due to difficult implementation of IC. The attack rate of HCW was 3.9%, and 12.9% for HCW with direct contact to the index case. The outbreak stopped after simultaneous preemptive treatment of all HCW and patients in the Rehabilitation Facility.
Overall, 1075 individuals underwent preemptive treatment.
Conclusions: Case finding during scabies outbreaks is impaired by uncertain diagnostic tests in the early stage of disease. Therefore, in a hospital setting, early broad preemptive treatment and strict IC are essential for control.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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