ENRICHEnabling Research in Care Homes
New Research – manage scabies in care homes
Scabies is a contagious skin condition caused by tiny mites that burrow into the skin. The main symptom of scabies is intense itching that’s worse at night. It also causes a skin rash on areas where the mites have burrowed. A particularly unpleasant condition, which can further discomfort and cause agitation for those with dementia.
A team of researchers from Sussex and London (KA Hewitt, A Nalabanda, JA Cassell), supported by the Infectious Diseases Research Network based at the UCL Farr Institute and using guidance provided by ENRICH toolkit have been investigating how scabies is diagnosed and how out breaks are managed amongst care home residents.
Their research shows that delayed diagnosis contributes to outbreaks, which may be prolonged and difficult to control. They investigated factors influencing outbreak recognition, diagnosis and treatment, and staff experiences of outbreak control, identifying areas for intervention. This was done through 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.
The study demonstrates the need for improved support for care homes in detecting and managing these outbreaks. Something which the research team are hoping to help achieve through further research in developing tools and new guidance in their next study.
Scabies mites are called Sarcoptes scabiei. They feed using their mouths and front legs to burrow into the outer layer of skin (epidermis), where they lay eggs.
After three to four days, the baby mites (larvae) hatch and move to the surface of the skin, where they mature into adults.
Scabies like warm places, such as skin folds, between the fingers, under fingernails, or around the buttock or breast creases. They can also hide under watch straps, bracelets or rings.
How scabies is spread
Scabies is usually spread through prolonged periods of skin-to-skin contact with an infected person, or through sexual contact.
It’s also possible – but rare – for scabies to be passed on by sharing clothing, towels and bedding with someone who’s infected.
It can take up to eight weeks for the symptoms of scabies to appear after the initial infection. This is known as the incubation period.
Read more about the causes of scabies.
People sometimes think scabies is caused by unhealthy living conditions and poor personal hygiene. However, there’s no evidence to support this.
Anyone can get scabies, but certain groups are more at risk through being in close contact with lots of other people. High-risk groups include:
- children – outbreaks of scabies can occur in schools and nurseries
- parents – from being in close contact with infected children
- elderly people – who live in nursing homes
- sexually active people
Care Home Managers wanting further advice on how to manage a scabies outbreak and care for people affected should review the National Institute for Care and Excellence (NICE) guidance published here.