Scabies in Long-Term Care Facilities

The common parasitic infestation of scabies is an international microscopic terrorist, frequently occurring in long-term care facilities. Disruptive outbreaks have been reported in long-term care facilities throughout North America, Europe, and Israel. Once scabies is reported, the normal operations of a facility may be disrupted for several months at a time. Psychogenic scabies, threatened mass resignations of staff, and extensive local media coverage have been unwelcome sequelae of long-term care facility outbreaks. When confronted with an infestation, nursing staff and management are frequently left on their own to come up with a plan to eradicate the infestation. This may result in either inadequate treatment of infected individuals or excessive measures for the long-term care facility, such as closing admissions, banning visitors, and periodic mass “prophylaxis” treatment. Effective and efficient management of scabies outbreaks requires knowledge of the unique features of long-term care scabies and a systematic, yet practical, approach to treatment.