3210 - Not the Creepy Crawlies!: A Scabies Investigation

Session Description: This session will describe the identification and Infection Prevention response to a delayed diagnosis of a patient with scabies in an inpatient rehabilitation unit. We will provide the educational background on the lifecycle and epidemiology of scabies and provide our de-identified clinical case as the foundation for the presentation. The index patient was difficult to initially identify as he had an ongoing and widespread drug reaction rash which made the scabies rash nearly indistinguishable. The patient was confirmed positive with scabies via skin scraping after spending 26 days in the rehabilitation unit. Interventions to treat not only the patient but exposed healthcare workers were initiated by the Infection Prevention Physician and staff. The case definition, along with suspected case definition, will be elaborated during the session.

Healthcare workers exposed to the patient were interviewed, evaluated, and provided treatment if symptomatic. All healthcare workers on the unit were monitored daily by Infection Prevention during the 2–6-week scabies incubation period for any development of symptoms consistent with infection. By the end of the 6-week investigation - 2 healthcare workers received a diagnosis of scabies, 29 healthcare workers were symptomatic and treated, and 16 other healthcare workers were examined with no treatment indicated. All data was communicated back to the Health Department.

It is important to discuss infrequently seen diseases as they are challenging to evaluate and diagnose. The delay of identifying this disease in a difficult clinical case had significant consequences of furthering transmission to healthcare workers. This topic can provide further insight to not only Infection Preventionists, but all healthcare workers to help prevent similar transmission events.