An outbreak of scabies in a teaching hospital: Lessons learned

Olugbenga O. Obasanjo, Peggy Wu, Martha Conlon, Lynne V. Karanfil, Patty Pryor, Geraldine Moler, Grant Anhalt, Richard E. Chaisson, Trish M. Perl

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

OBJECTIVE: To investigate an outbreak of scabies in an inner-city teaching hospital, identify pathways of transmission, institute effective control measures to end the outbreak, and prevent future occurrences. DESIGN: Outbreak investigation, case-control study, and chart review. SETTING: Large tertiary acute-care hospital. RESULTS: A patient with unrecognized Norwegian (crusted) scabies was admitted to the acquired immunodeficiency syndrome (AIDS) service of a 940-bed acute-care hospital. Over 4 months, 773 healthcare workers (HCWs) and 204 patients were exposed to scabies. Of the exposed HCWs, 147 (19%) worked on the AIDS service. Risk factors for being infested with scabies among HCWs included working on the AIDS service (odds ratio [OR], 5.3; 95% confidence interval [CI95], 2.17-13.15) and being a nurse, physical therapist, or HCW with extensive physical contact with infected patients (OR, 4.5; CI95, 1.26-17.45). Aggressive infection control precautions beyond Centers for Disease Control and Prevention barrier and isolation recommendations were instituted, including the following: (1) early identification of infected patients; (2) prophylactic treatment with topical applications for all exposed HCWs; (3) use of two treatments 1 week apart for all cases of Norwegian scabies; (4) maintaining isolation for 8 days and barrier precautions for 24 hours after completing second treatment for a diagnosis of Norwegian scabies; and (5) oral ivermectin for treatment of patients who failed conventional therapy. CONCLUSIONS: HCWs with the most patient contact are at highest risk of acquiring scabies. Because HCWs who used traditionally accepted barriers while caring for patients with Norwegian scabies continued to develop scabies, we found additional measures were required in the acute-care hospital. HCWs with skin exposure to patients with scabies should receive prophylactic treatment. We recommend (1) using heightened barrier precautions for care of patients with scabies and (2) extending the isolation period for 8 days or 24 hours after the second treatment with a scabicide for those patients With Norwegian scabies. Oral ivermectin was well tolerated for treating patients and HCWs who failed conventional treatment. Finally, we developed a surveillance system that provides a “barometric measure” of the infection rate in the community. If scabies increases in the community, a tiered triage system is activated to protect against transmission among HCWs or hospital patients.

Original languageEnglish (US)
Pages (from-to)13-18
Number of pages6
JournalInfection Control and Hospital Epidemiology
Volume22
Issue number1
DOIs
StatePublished - Jan 1 2001

Fingerprint

Scabies
Teaching Hospitals
Disease Outbreaks
Delivery of Health Care
Ivermectin
Acquired Immunodeficiency Syndrome
Therapeutics
Odds Ratio
Triage
Physical Therapists
Urban Hospitals
Tertiary Healthcare
Centers for Disease Control and Prevention (U.S.)
Infection Control
Case-Control Studies

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

Cite this

An outbreak of scabies in a teaching hospital : Lessons learned. / Obasanjo, Olugbenga O.; Wu, Peggy; Conlon, Martha; Karanfil, Lynne V.; Pryor, Patty; Moler, Geraldine; Anhalt, Grant; Chaisson, Richard E.; Perl, Trish M.

In: Infection Control and Hospital Epidemiology, Vol. 22, No. 1, 01.01.2001, p. 13-18.

Research output: Contribution to journalArticle

Obasanjo, OO, Wu, P, Conlon, M, Karanfil, LV, Pryor, P, Moler, G, Anhalt, G, Chaisson, RE & Perl, TM 2001, 'An outbreak of scabies in a teaching hospital: Lessons learned', Infection Control and Hospital Epidemiology, vol. 22, no. 1, pp. 13-18. https://doi.org/10.1086/501818
Obasanjo OO, Wu P, Conlon M, Karanfil LV, Pryor P, Moler G et al. An outbreak of scabies in a teaching hospital: Lessons learned. Infection Control and Hospital Epidemiology. 2001 Jan 1;22(1):13-18. https://doi.org/10.1086/501818
Obasanjo, Olugbenga O. ; Wu, Peggy ; Conlon, Martha ; Karanfil, Lynne V. ; Pryor, Patty ; Moler, Geraldine ; Anhalt, Grant ; Chaisson, Richard E. ; Perl, Trish M. / An outbreak of scabies in a teaching hospital : Lessons learned. In: Infection Control and Hospital Epidemiology. 2001 ; Vol. 22, No. 1. pp. 13-18.
@article{337106a967164bac85131025946bff3a,
title = "An outbreak of scabies in a teaching hospital: Lessons learned",
abstract = "OBJECTIVE: To investigate an outbreak of scabies in an inner-city teaching hospital, identify pathways of transmission, institute effective control measures to end the outbreak, and prevent future occurrences. DESIGN: Outbreak investigation, case-control study, and chart review. SETTING: Large tertiary acute-care hospital. RESULTS: A patient with unrecognized Norwegian (crusted) scabies was admitted to the acquired immunodeficiency syndrome (AIDS) service of a 940-bed acute-care hospital. Over 4 months, 773 healthcare workers (HCWs) and 204 patients were exposed to scabies. Of the exposed HCWs, 147 (19{\%}) worked on the AIDS service. Risk factors for being infested with scabies among HCWs included working on the AIDS service (odds ratio [OR], 5.3; 95{\%} confidence interval [CI95], 2.17-13.15) and being a nurse, physical therapist, or HCW with extensive physical contact with infected patients (OR, 4.5; CI95, 1.26-17.45). Aggressive infection control precautions beyond Centers for Disease Control and Prevention barrier and isolation recommendations were instituted, including the following: (1) early identification of infected patients; (2) prophylactic treatment with topical applications for all exposed HCWs; (3) use of two treatments 1 week apart for all cases of Norwegian scabies; (4) maintaining isolation for 8 days and barrier precautions for 24 hours after completing second treatment for a diagnosis of Norwegian scabies; and (5) oral ivermectin for treatment of patients who failed conventional therapy. CONCLUSIONS: HCWs with the most patient contact are at highest risk of acquiring scabies. Because HCWs who used traditionally accepted barriers while caring for patients with Norwegian scabies continued to develop scabies, we found additional measures were required in the acute-care hospital. HCWs with skin exposure to patients with scabies should receive prophylactic treatment. We recommend (1) using heightened barrier precautions for care of patients with scabies and (2) extending the isolation period for 8 days or 24 hours after the second treatment with a scabicide for those patients With Norwegian scabies. Oral ivermectin was well tolerated for treating patients and HCWs who failed conventional treatment. Finally, we developed a surveillance system that provides a “barometric measure” of the infection rate in the community. If scabies increases in the community, a tiered triage system is activated to protect against transmission among HCWs or hospital patients.",
author = "Obasanjo, {Olugbenga O.} and Peggy Wu and Martha Conlon and Karanfil, {Lynne V.} and Patty Pryor and Geraldine Moler and Grant Anhalt and Chaisson, {Richard E.} and Perl, {Trish M.}",
year = "2001",
month = "1",
day = "1",
doi = "10.1086/501818",
language = "English (US)",
volume = "22",
pages = "13--18",
journal = "Infection Control and Hospital Epidemiology",
issn = "0899-823X",
publisher = "University of Chicago Press",
number = "1",

}

TY - JOUR

T1 - An outbreak of scabies in a teaching hospital

T2 - Lessons learned

AU - Obasanjo, Olugbenga O.

AU - Wu, Peggy

AU - Conlon, Martha

AU - Karanfil, Lynne V.

AU - Pryor, Patty

AU - Moler, Geraldine

AU - Anhalt, Grant

AU - Chaisson, Richard E.

AU - Perl, Trish M.

PY - 2001/1/1

Y1 - 2001/1/1

N2 - OBJECTIVE: To investigate an outbreak of scabies in an inner-city teaching hospital, identify pathways of transmission, institute effective control measures to end the outbreak, and prevent future occurrences. DESIGN: Outbreak investigation, case-control study, and chart review. SETTING: Large tertiary acute-care hospital. RESULTS: A patient with unrecognized Norwegian (crusted) scabies was admitted to the acquired immunodeficiency syndrome (AIDS) service of a 940-bed acute-care hospital. Over 4 months, 773 healthcare workers (HCWs) and 204 patients were exposed to scabies. Of the exposed HCWs, 147 (19%) worked on the AIDS service. Risk factors for being infested with scabies among HCWs included working on the AIDS service (odds ratio [OR], 5.3; 95% confidence interval [CI95], 2.17-13.15) and being a nurse, physical therapist, or HCW with extensive physical contact with infected patients (OR, 4.5; CI95, 1.26-17.45). Aggressive infection control precautions beyond Centers for Disease Control and Prevention barrier and isolation recommendations were instituted, including the following: (1) early identification of infected patients; (2) prophylactic treatment with topical applications for all exposed HCWs; (3) use of two treatments 1 week apart for all cases of Norwegian scabies; (4) maintaining isolation for 8 days and barrier precautions for 24 hours after completing second treatment for a diagnosis of Norwegian scabies; and (5) oral ivermectin for treatment of patients who failed conventional therapy. CONCLUSIONS: HCWs with the most patient contact are at highest risk of acquiring scabies. Because HCWs who used traditionally accepted barriers while caring for patients with Norwegian scabies continued to develop scabies, we found additional measures were required in the acute-care hospital. HCWs with skin exposure to patients with scabies should receive prophylactic treatment. We recommend (1) using heightened barrier precautions for care of patients with scabies and (2) extending the isolation period for 8 days or 24 hours after the second treatment with a scabicide for those patients With Norwegian scabies. Oral ivermectin was well tolerated for treating patients and HCWs who failed conventional treatment. Finally, we developed a surveillance system that provides a “barometric measure” of the infection rate in the community. If scabies increases in the community, a tiered triage system is activated to protect against transmission among HCWs or hospital patients.

AB - OBJECTIVE: To investigate an outbreak of scabies in an inner-city teaching hospital, identify pathways of transmission, institute effective control measures to end the outbreak, and prevent future occurrences. DESIGN: Outbreak investigation, case-control study, and chart review. SETTING: Large tertiary acute-care hospital. RESULTS: A patient with unrecognized Norwegian (crusted) scabies was admitted to the acquired immunodeficiency syndrome (AIDS) service of a 940-bed acute-care hospital. Over 4 months, 773 healthcare workers (HCWs) and 204 patients were exposed to scabies. Of the exposed HCWs, 147 (19%) worked on the AIDS service. Risk factors for being infested with scabies among HCWs included working on the AIDS service (odds ratio [OR], 5.3; 95% confidence interval [CI95], 2.17-13.15) and being a nurse, physical therapist, or HCW with extensive physical contact with infected patients (OR, 4.5; CI95, 1.26-17.45). Aggressive infection control precautions beyond Centers for Disease Control and Prevention barrier and isolation recommendations were instituted, including the following: (1) early identification of infected patients; (2) prophylactic treatment with topical applications for all exposed HCWs; (3) use of two treatments 1 week apart for all cases of Norwegian scabies; (4) maintaining isolation for 8 days and barrier precautions for 24 hours after completing second treatment for a diagnosis of Norwegian scabies; and (5) oral ivermectin for treatment of patients who failed conventional therapy. CONCLUSIONS: HCWs with the most patient contact are at highest risk of acquiring scabies. Because HCWs who used traditionally accepted barriers while caring for patients with Norwegian scabies continued to develop scabies, we found additional measures were required in the acute-care hospital. HCWs with skin exposure to patients with scabies should receive prophylactic treatment. We recommend (1) using heightened barrier precautions for care of patients with scabies and (2) extending the isolation period for 8 days or 24 hours after the second treatment with a scabicide for those patients With Norwegian scabies. Oral ivermectin was well tolerated for treating patients and HCWs who failed conventional treatment. Finally, we developed a surveillance system that provides a “barometric measure” of the infection rate in the community. If scabies increases in the community, a tiered triage system is activated to protect against transmission among HCWs or hospital patients.

UR - http://www.scopus.com/inward/record.url?scp=0035153003&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035153003&partnerID=8YFLogxK

U2 - 10.1086/501818

DO - 10.1086/501818

M3 - Article

C2 - 11198016

AN - SCOPUS:0035153003

VL - 22

SP - 13

EP - 18

JO - Infection Control and Hospital Epidemiology

JF - Infection Control and Hospital Epidemiology

SN - 0899-823X

IS - 1

ER -