Aged Care Community of Practice – webinar questions

[Carrie Spinks]

Hello everyone,

Great to see so many online yesterday for our monthly webinar – Scabies Management. Thank you to Yvonne Andrews for a wonderful presentation.

Thank you for all the great questions. Please find the remaining Q&A from the scabies management webinar yesterday.
1. What are common causes of treatment failure?
Scabies treatment failure is most caused by improper application of medication, failure to treat all (reinfestation), using single-dose ivermectin instead of two doses and not repeating the topical permethrin treatment after 7days. Other factors include failing to decontaminate bedding/clothing, , and potential drug resistance, particularly to topical permethrin

2. What are peoples responsibilities when there is persistent scabies due to poor processes especially when the cases have lasted over many months?
Correct diagnosis, correct identification of close contacts, correct treatment and application, correct isolation periods, thorough environmental cleaning, linen and furnishing cleaning, communications

3. Do you recommend any TGA approved disinfectants that specifically target scabies?
Neutral cleaner and hospital grade disinfectant, careful vacuuming of furniture and carpets in rooms used for suspected or confirmed scabies cases are recommended. It is the physical cleaning that removes the mite.

4. you mentioned that clothing and non washable items bagged for 72 hours. Would this time include long enough time for the hatching of mite eggs. I have recommended bagging these items for 8 days.
Scabies guidelines recommend three days – the mites die after three days without human skin – hatching generally occurs under the skin

5. Is mass treatment recommended where individual is diagnosed with suspected scabies but the scrapping is -ve.
Diagnosis is via GP observation and / or scraping. It is not guaranteed to get a mite from scrapings and hence these can be non-conclusive.

6. If there are two confirmed/suspected cases ‘mass’ treatment to close contacts is recommended. We have been observing an unexplained rash in residents intermittently, but it is difficult to confirm scabies when the GPs have not ordered any tests. The GPs have only noted it as a “query scabies” so far. How can we encourage the GP to order appropriate investigations or tests to help confirm scabies case?
Diagnosis can be via GP observation – scrapings can be non-conclusive if no mites are present where the scraping is taken. Treatment is required.

7. Do we need to have the skin scraping test to confirm the infection or gp’s findings and suspect would be enough?
Diagnosis can be via GP observation. Treatment is required for confirmed and suspected.

8. Could you confirm isolation period? Did you say 24hours after treatment?
Correct

9. what colour code linen bag we need? red disposable then yellow?
Infection is yellow – yellow soluble bag and yellow linen bag. However, all states/territories/facilities have their own processes

10. Is it true that once we have started the treatment we should be keeping all the linen and clothes in their room ties up in seperate linen bag and leave there for 7 days. Please advise.

No. Linen and clothes used for 3 days prior and on the day of treatment should be washed and managed as infectious linen.
Items that cannot be washed should be bagged for 3 days till the might dies.

11. What does deep cleaning entails for scabies? can you list some?
There is no true definition of deep clean – but the clean would not differ for scabies and any other infection in aged care.
2 step clean throughout, vacuum floors and upholstery – steam clean as required, bag items3 days that can not be washed, ventilation

12. At times GP treats with Oral and topical together is outcome different when treatment includes both?
If it is particularly a bad case or multiple cases or the way the GP prescribes – both may be prescribed. It’s a stronger treatment plan – which needs to be weighed up with tolerance risks. Certainly, Norwegian Scabies is oral.

The powerpoint and recording can be located at:https://www.acipc.org.au/acipc-aged-ipc-webinar-series/scabies-in-residential-care-identification-management-and-outbreak-control/

Look forward to seeing all next month for IPC Aged Care Governance.

[Author]

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