Page Page 1 of 9 Policy Objective To provide Heath Care Workers (HCWs) with details of all the clinical conditions, infections and organisms for which infection control measures, in addition to Standard Precautions, need to be taken. This policy applies to all staff employed by NHS Greater Glasgow & Clyde and locum staff on fixed term contracts and volunteer staff. KEY CHANGES FROM THE PREVIOUS VERSION OF THIS POLICY No significant changes. Document Control Summary Approved by and Board Infection Control Committee 14 September 2009 Date of Publication 15 September 2009 Developed by Infection Control Policy Sub-Group - 0141 211 2677 Related Documents Distribution / Availability Implications of Race Equality and other diversity duties for this document Equality & Diversity Impact Assessment Completed Lead Responsible Director / Manager NHSGGC Standard Precautions Policy NHSGGC Personal Protective Equipment Policy NHSGGC Hand Hygiene Policy http://www.nhsggc.org.uk/content/default.asp?page=s708_3 NHSGGC Infection Prevention and Control Policy Manual and the Internet This policy must be implemented fairly and without prejudice whether on the grounds of race, gender, sexual orientation or religion. September 2009 Lead Nurse Partnerships Board Infection Control Manager The most up-to- version of this policy can be viewed at the following website:
Page Page 2 of 9 Contents 1. Responsibilities 2. General Information on Scabies 3. Transmission Based Precautions for Scabies 4. Audit 5. Evidence Base 6. Useful Links 7. Glossary The most up-to- version of this policy can be viewed at the following website:
Page Page 3 of 9 1. Responsibilities HCWs must: Follow this policy. Inform a member of the ICT if this policy cannot be followed. Managers (In primary care settings this includes CH(C)P managers and AHP leaders) must: Support HCWs and ICTs in following this policy. ICTs must: Keep this policy up to-. Audit compliance with this policy. Provide education opportunities on this guideline. 2. General Information on Scabies Communicable Disease / Alert Organism / Clinical Condition Mode of Spread Incubation period Notifiable disease Period of communicability High-risk environment Sarcoptes scabei Parasitic disease of the skin. Prolonged (5-10 minutes) direct skin-to-skin contact with infested person. Minimal skin-to-skin contact or contact with bedding or clothing for crusted (Norwegian) scabies. 2-6 weeks before onset of itching in people without previous exposure. People who have previously been infested develop symptoms 1-4 days after re-exposure. NB itching may persist for several weeks after completion of treatment and is not an indication of continuing infection. No. Until mites and eggs are destroyed by the treatment; usually 2 courses of treatment, one week apart. Susceptibility is universal. Crusted (Norwegian) scabies is a severe form of scabies that can affect the elderly, immunocompromised or persons who have conditions that prevent them from scratching The most up-to- version of this policy can be viewed at the following website:
Page Page 4 of 9 3. Transmission Based Precautions for Scabies Accommodation (Patient Placement) Care plan available Clinical Waste Contacts Crockery / Cutlery Decolonisation / treatment application Domestic Advice Equipment Adult patients do not require isolation unless crusted (Norwegian) scabies is diagnosed. Mobile paediatric patients are isolated for practical reasons until completion of treatment. No. Clinical waste should not be allowed to accumulate inside room. Dispose waste into orange bag when ¾ full as per Clinical Waste Policy. All patients and HCWs who have been in direct contact with a case should be examined for signs of a rash / itch. Patients should be referred to medical staff for further examination if signs or symptoms are present. HCWs with signs or symptoms should be referred to the Occupational Health Department. As the incubation period is up to 6 weeks, HCWs should remain vigilant to the possibility of new cases in staff or patients. No special requirements. Treatment must be prescribed (the current NHSGGC Antimicrobial Guideline suggests the use of Permethrin cream 5%). Gloves and apron should be worn when applying treatments. Cream should be applied to the whole body including scalp, neck, face and ears, paying particular attention to between fingers / toes, soles of feet and under finger nails (this may contradict manufacturer s guidance on application). The cream should remain on the skin as per manufacturer s instructions. If in doubt further guidance should be sought from pharmacy. Any areas washed within the treatment period, e.g. hands or following incontinence should have treatment re-applied. A second treatment should be applied 7 days after initial treatment. No special requirements unless the patient is isolated. If isolated the SOP - Twice Daily Clean of Isolation Rooms should be followed. http://library.nhsggc.org.uk/mediaassets/infection%20control/mi crosoft%20word%20- %20SOP%20Daily%20Clean%20of%20Isolation%20Rooms.doc. pdf Decontaminate as per Decontamination of Equipment and the Environment Policy. http://library.nhsggc.org.uk/mediaassets/infection%20control/mi crosoft%20word%20- %20Decontamination%20final%20jan%2009.doc.pdf The most up-to- version of this policy can be viewed at the following website:
Page Page 5 of 9 Exposures Furniture Hand hygiene Last Offices Laundry Moving between wards, hospitals and departments (including theatres) Notice for Door Outbreak Patient Clothing Avoid direct skin-to-skin contact by wearing gloves and disposable plastic apron until effective treatment is completed. No special requirements. In rooms used by patient with crusted (Norwegian) scabies soft furnishings should be suction cleaned (hepa filter) to remove mites. Wash hands before and after any patient contact. Hand hygiene should be carried out regardless of glove use. http://library.nhsggc.org.uk/mediaassets/infection%20control/mi crosoft%20word%20-%20hand%20hygiene%202008.doc.pdf No special requirements. Linen should be considered to be infested, and should therefore be placed in a red water soluble bag, a secondary clear polythene bag then a laundry bag before being sent to the laundry, until completion of the first treatment. The patient s bedding should be changed on completion of the first treatment. For patients with Norwegian Scabies linen should be considered to be infected until all treatment is completed. Unless detrimental to patient care, transfer to any other area should be restricted until completion of the first treatment. Any movement prior to completion of the first treatment should be discussed with a member of the ICT, and the receiving ward or department informed prior to transfer. Not required unless in isolation. Contact the ICT if an outbreak is suspected. The ICT will inform Occupational Health and advise appropriate treatment. Treatments will be given at the same time. Clothing (including undergarments) should be removed and fresh clothing worn on completion of the first treatment. Clothing worn anytime in the three days before treatment should be considered infested and should be placed in a patient water soluble bag laundry bag and then into a general patient clothing bag prior to being sent home for laundering. Clothing should be washed separately at the highest temperature recommended by the manufacturer and tumble dried or ironed. http://library.nhsggc.org.uk/mediaassets/infection%20control/20 09-07%20Patient%20Laundry%20Leaflet%20v2%20July%202009.p df The most up-to- version of this policy can be viewed at the following website:
Page Page 6 of 9 Patient information Provide information on scabies to the patient / parent / guardian / next-of-kin as appropriate. Personal Protective Equipment (PPE) Precautions Required Until Procedure Restrictions Risk assessment required Screening on Admission / Re-admission Screening HCWs Specimens required Specimens Mark as Danger of Infection Terminal Cleaning of Room Visitors Disposable nitrile gloves and plastic aprons should be worn when applying treatment and when direct skin-to-skin contact is anticipated. Hands should be washed on their removal. 24hrs after completion of first treatment application. If the patient is diagnosed with Norwegian Scabies they should only be removed from isolation on the advice of the ICT or dermatologist. None Yes, in conjunction with the ICT. As per admission assessment form. HCWs should contact Occupational Health for advice. If HCW has had no direct skin-to-skin contact with known / suspected case no action is required. Identification of scabies is almost entirely dependant on a clinical diagnosis. In the case of Norwegian Scabies skin scrapings from a suspected burrow can be obtained by a competent person, usually a dermatologist or occupational health staff (in some areas this might be the microbiology staff). Not required. Not required unless in isolation. Visitors should be advised of the risks associated with skin-to-skin contact with the patient until effective treatment is completed. Visitors should be advised to see their own GP / pharmacist if a rash / itch is present or develops or if they have any other concerns. The most up-to- version of this policy can be viewed at the following website:
Page Page 7 of 9 4. Audit Criteria Guide Score 1. HCWs know who to inform if a case is suspected. Ask HCW 2. HCWs know how to apply treatment to patient s skin Ask HCW how to apply treatment 3. HCWs know how to dispose of infested linen / clothing until completion of treatment Ask HCW how linen / clothing has been disposed of 4. HCWs now how scabies is spread. Ask HCW 5. HCWs know to wash hands after contact with patient Ask HCW how hands are decontaminated Audit undertaken by: Action plan: Results fed back to: Date: The most up-to- version of this policy can be viewed at the following website:
Page Page 8 of 9 5. Evidence Base Bellisimo-Rodrigues, Fernando, et al., (2008). Alcohol-Based Hand Rub and Nosocomial Scabies. Infection Control and Hospital Epidemiology. 29(8), pp782-783. BNF. Permethrin. Parasiticidal preparations. http://www.bnf.org/bnf/bnf/57/6205.htm (20/07/2009). CDC. Scabies. Parasites and Health. http://www.dpd.cdc.gov/dpdx/html/scabies.htm. (02/07/2009). HEYMANN, D.L., (2004). Control of Communicable Diseases Manual. 18 th Ed. Washington:American Public Health Association. NHS GGC Antimicrobial Management Team. Scabies Infection Management in Adults: Guidance for Primary Care. http://staffnet/nr/rdonlyres/1a28d653-7f9a-4d95-86dc- 9DA192B09486/55073/056_primarycare090720091.pdf (9/07/2009). 6. Useful Links NHS Greater Glasgow & Clyde Prevention & Control of Infection Manual. http:// NHS Greater Glasgow & Clyde Patient Information Leaflet: Taking Laundry Home Information for Carers http://library.nhsggc.org.uk/mediaassets/infection%20control/2009-07%20patient%20laundry%20leaflet%20v2%20july%202009.pdf NHS Greater Glasgow & Clyde Taking Laundry Home Information for HCWs http://library.nhsggc.org.uk/mediaassets/infection%20control/patients%20clothing%20bag%2 0-%20info%20sheet%20for%20nurses.pdf The most up-to- version of this policy can be viewed at the following website:
Page Page 9 of 9 7. Glossary AHP CH(C)P HH ICT PPE SOP Allied Health Professionals Community Health (and Care) Partnerships Hand Hygiene Infection Control Team Personal Protective Equipment Standard Operating Procedure The most up-to- version of this policy can be viewed at the following website: