The Hillcrest Health Care facility in Ownesboro, Kentucky was closed for a few days last week as administration and staff attempted to get a scabies outbreak under control. Residents and staff were all treated and the nursing home has since reopened. At this point, it’s not clear how the scabies was brought into the facility. 

Unfortunately, scabies outbreaks are not unusual in nursing homes. Scabies is a contagious skin condition caused by microscopic insects that burrow under the skin. Scabies results in intense itching, which is often especially intense at night. Because it’s contagious, scabies spreads easily, especially in a closed environment like a nursing home. While children are most likely to get the disease, the elderly, especially those living in nursing homes, are a close second. 

Scabies in the elderly often presents in unusual ways and may be difficult to diagnose. This is partly the result of the changes in skin as we age, and partly due to some conditions that are more common among the elderly – Dementia, chronic illness and compromised immune systems. In addition, scabies are most likely to spread when people have close bodily encounters with others, circumstances that often arise when patients are paralyzed and/or bedridden, as many nursing home residents are.

Scabies are sometimes misidentified as other skin conditions, such as eczema. If scabies aren’t properly identified, isolated and treated immediately, they are apt to spread to other residents, leading to an infestation. At this point, nursing homes need to adopt stringent measures to eliminate the scabies. Residents and staff should be treated with anti-scabies medications – usually creams or oral medications. Frequent visitors and relatives should also be treated, even if they are not showing symptoms. Extensive cleaning treatments should be applied to the facility itself, cleaning and disinfecting all beds, floors and furnishing. Floors should also be vacuumed. Bedding should be laundered and set aside for three days, because research shows that scabies’ mites can only live without a host for 1-3 days. In extreme situations, nursing homes should purchase new bedding. 

While it is often difficult to determine the cause of an outbreak, scabies may often be introduced to a nursing home by a new arrival, or someone who has been transferred in from another facility. Visiting medical personnel are also sometimes a factor, as they may spread scabies to many different facilities. 

While scabies generally isn’t harmful, it can be extremely uncomfortable. And scabies that isn’t properly treated can sometimes lead to serious consequences, like staph infections or streptococcal infections. In rare cases, it can lead to fatal pericarditis. 

It is important for nursing homes to ensure that their facilities are kept clean and that residents are free of scabies. Administrators should put a plan in place to ensure that all residents – especially new residents – are examined for scabies and that scabies is identified and treated as soon as possible. 

More Information:
Nursing Home Gets Back to Normal After Scabies Outbreak
Scabies
Persistent scabies in nursing home patients