Scabies, Fleas and Lice - Management of Patients. Ref IPC v2.1. Status: Approved Document type: Procedure

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1 Scabies, Fleas and Lice - Management f Patients Ref IPC v2.1 Status: Apprved Dcument type: Prcedure

2 Cntents 1 Purpse Related dcuments Scabies (sarcptes scabiei) What are scabies? Hw d scabies affect peple? Lesins caused by scabies Tpical preparatin fr treating scabies Managing and treating scabies Individual treatment Grup treatment Treating crusted scabies Additinal infrmatin Fleas What d fleas lk like? Hw d fleas affect peple? Fleas f particular imprtance Husekeeping and cntrl measures fleas Lice What d lice lk like? Head lice Pubic lice Bdy lice Hw d lice affect peple? Head lice Pubic lice Bdy lice Husekeeping and cntrl measures - lice Head lice Pubic lice Bdy lice Dealing with clthing and linen Why deal with clthing and linen? Hw t deal with clthing fr bdy lice nly Hw t deal with bed linen Hair disinfectin Why carry ut hair disinfectin? Hair disinfectin equipment checklist Hw t carry ut hair disinfectin Definitins References and further reading Equality Analysis Screening Frm Dcument cntrl Examples f fleas and lice Ref IPC v2.1 Page 2 f 21 Apprved: 18 January 2019

3 1 Purpse This prcedure describes what t d when managing patients with human infestatin, frm scabies, lice and fleas. Please refer any patients with Scabies, fleas r lice t infectin preventin cntrl. 2 Related dcuments This prcedure describes what yu need t d t implement the Fleas, Lice and Scabies sectin f the Infectin Preventin and Cntrl Plicy The Standard (Universal) Precautins fr Infectin Preventin and Cntrl defines the universal standards fr IPC which yu must read, understand and be trained in befre carrying ut the prcedures described in this dcument. This prcedure als refers t:- Laundering and safe handling f linen and clthing Prtective clthing and equipment Dispsal f clinical Waste Plicy Hand Hygiene Ref IPC v2.1 Page 3 f 21 Apprved: 18 January 2019

4 3 Scabies (sarcptes scabiei) 3.1 What are scabies? The "itch" mite respnsible fr scabies is mm and nly just visible as a white spt with a chestnut-clured head. The female mite tunnels int the skin and depsits eggs. The tunnels may ccur anywhere but mst cmmnly affect arms, wrists, hands, particularly in the finger webs, underarms, nipples and genitals. The mite des nt fly r jump and it is blind. It will nt survive fr lng away frm the hst. Scabies is a cmmn public health prblem with an estimated glbal prevalence f 300 millin. The incidence f Scabies varies ver time. Epidemics ccur at apprximately 30 year intervals and persist fr abut 15 years. 3.2 Hw d scabies affect peple? Symptms Intense itching (especially at night) caused by an allergy t chemicals fund in the excrement f the scabies mite; Eczematus rash; Itching des nt start immediately but usually within 1-8 weeks after infectin ccurs. Transmissin Cntact thrugh care by nurses and ther carers (these staff may nt always shw classical signs); Skin t skin cntact e.g., sleeping tgether, hlding hands, sexual cntact. The mite des nt jump frm persn t persn. Identificatin 70% f mites are fund n the hands, usually between the fingers, the wrists, but may be fund n ther areas f the bdy; Smetimes in children under tw years, they can be fund n the sles f the feet; If there is difficulty in diagnsis, skin scrapings can help cnfirm the presence f mites. This shuld nly be carried ut by a trained, experienced dermatlgist r public health staff Lesins caused by scabies Type f lesin Identificatin Primary lesin These are the burrws fllwed by the Scabies rash which is a fllicular, papular rash n bdy areas such as upper arms, middle trunk, inner upper thigh and anterir aspect f the wrist. May als Ref IPC v2.1 Page 4 f 21 Apprved: 18 January 2019

5 be fund in ther less-cmmn areas. The rash can be very dense arund the axilla, abdmen and n penile areas blister like spts can frm. Intense itching may ccur particularly at night when warm in bed. This is due t the mite sensitising the skin f the persn. Diagnsis is cnfirmed by finding the mites r their eggs at the end f their threadlike tunnel r burrw. Secndary lesin Can take the frm f excriatin, eczematus areas and secndary infectins. Crusted scabies Can be seen in immunsuppressed clients, learning disability hmes and in the elderly ppulatin. Usually presents in the frm f crusted lesins fund mainly arund the wrist areas but can als affect ther parts f the bdy. An erythematus rash is usually fund cvering the bdy. Thusands f mites can be present, capable f disseminating int the immediate envirnment. Can live fr 1-2 days in warm cnditins. A cnfirmed diagnsis frm a Dermatlgist is essential t ensure that clients are nt being treated fr ther skin cnditins, as this can lead t much distress fr the client and the carer. Fr example, sterid treatment may make scabies unrecgnisable and des nt imprve the eczematus respnse. There is a small risk f infectin thrugh uphlstered furniture, particularly in cmmunal areas, e.g. in nursing and residential hmes. 3.3 Tpical preparatin fr treating scabies Name Lyclear Dermal Cream (permethrin 5%) Descriptin Lw txicity. 8 hur treatment. Babies and children under 2 years t be treated under medical supervisin. Frm 2 mnths t 2 years nly use 1/8 th f a tube. Repeat treatment after 7 days Derbac M (Malathin) 24 hur treatment. Children under 2 years t be treated under medical supervisin. Repeat treatment after 7 days. Benzyl Benzate 24 hur treatment. Nt recmmended fr children. It is an irritant and is therefre t be used with care under medical supervisin. Itching can persist fr sme time after treatment. An anti-pruritic cream is helpful n intense areas f itching (e.g. Eurax). Ref IPC v2.1 Page 5 f 21 Apprved: 18 January 2019

6 3.4 Managing and treating scabies Individual treatment After diagnsis and prescribing f treatment, cream r ltin is best applied in the evening befre retiring t bed. If assisting the patient t apply ltin treatment wash and dry hands and wear glves and aprn Cream r ltin must be applied t cl dry skin t be mst effective. All bdy areas frm the neck dwn, including the palms f the hands and sles f the feet must have the cream/ltin applied. Cream/ltin must be re-applied t any parts f the bdy which have been washed ff (e.g. hands). Clients under 2 years r ver 65 years need the scalp and behind the ear lbes treated. Mites can harbur themselves under the nails. Ensure nails are cut and clean. After treatment (8 r 24 hurs - check manufacturer s guidance) shwer r bath as nrmal. After washing ff treatment prvide clean clthes and clean bed linen. Clthes can be washed as nrmal. All clse family cntacts f scabies t be treated whether a rash is present r nt. In health care situatins it is imprtant t perfrm an assessment befre thers are given treatment. A ht shwer r bath befre applicatin is nt recmmended. D nt put the same clthes back n Grup treatment It is imprtant that an utbreak is managed by treating all clients, staff and clse relatives at the same time. When an utbreak is cnfirmed (2 r mre cases) arrangements must be made fr treatment t take place at a specified time and date. It is reasnable and advisable t delay treatment until plans have been prperly made. Symptmatic relief can be given t clients, if required. Treat individuals as previusly described (7.4.1). Remve slippers frm clients and wash if apprpriate. Where this is nt pssible, place the slippers in a tied bag fr 24 hurs. They can then be used as nrmal. Remve any pts f cream frm the client s rm which are used n a day-t-day basis and destry (e.g. creams fr dry skin). Treat all clse cntacts f infected clients. This wuld nrmally include family, staff, visitrs and agency staff. This will be determined by IPCNs and OHD staff. After treatment, fllw as per individual cases. A secnd treatment may be required in sme cases but this requires assessment. Ref IPC v2.1 Page 6 f 21 Apprved: 18 January 2019

7 3.4.3 Treating crusted scabies Three treatments are required 24 hurs apart fr all cases f crusted scabies. This als includes scalp treatment. Clean the client s rm daily, paying particular attentin t all uphlstered areas such as chairs, bed heads and curtains. Cmmunal areas such as the sitting rm and dining areas must als be cleaned daily. All bed linen must be treated as infected. If linen is nt laundered n site, it shuld be placed in a red disslvable bag, int an uter linen bag and despatched t the laundry. Fllw up is essential after ne week t ensure that n further treatment is required Additinal infrmatin Apart frm crusted scabies laundry can be washed in the nrmal way. Identical mites can be fund n dmestic and stray animals. It is vital t advise n general health assciated with diet, and t ensure adequate intake f minerals and vitamins (particularly vitamin A). Educatin is an imprtant element fr clients, staff and their relatives and friends. Keep fingernails smth, runded and shrt t prevent traumatising the skin when scratching. 4 Fleas 4.1 What d fleas lk like? Adult fleas are between 1-3mm lng, brwnish-red in clur and are wingless. Their bdies are cmpressed frm side t side, helping them mve easily thrugh fur and hair. They have well-develped hind legs fr running and jumping. Flea eggs are pearl white in clur, val shaped and apprximately 0.5mm lng. 4.2 Hw d fleas affect peple? UK fleas d nt usually transmit disease. Flea bites are identified as a small dark red spt surrunded by a reddened area. Flea bites last 2-3 days and can be intensely itchy. Sme peple can becme immune t flea bites. Ref IPC v2.1 Page 7 f 21 Apprved: 18 January 2019

8 Others can becme hypersensitive t flea bites. Fleas are nrmally hst specific e.g. a dg flea will nly reprduce n a dg, but they will feed n an alternative hst. 4.3 Fleas f particular imprtance There are many species f fleas but in the UK it is cat and dg fleas that cause the mst prblems Ctencephalides Canis - dg flea. Ctencephalides Felis - cat flea. 4.4 Husekeeping and cntrl measures fleas Remve all bedding and seal in a water sluble bag. Send t laundry facility:- Place int a water sluble bag and secure Place int a laundry bag and secure Label "Infected clthes" and ward name Send t laundry facility Fr clthing, see Laundering and safe handling f linen and clthing. There is nt specific treatment fr the patient ther than bathing and clean clthes. Cntact Htel Services n , mbile t arrange fr a Pest Cntrl cntractr t advise r carry ut an eradicatin prgramme if envirnmental cntaminatin is suspected. Vacuum flrs, carpets, uphlstery etc. and treat with a residual insecticide if necessary. The Pest Cntrl Cntractr will arrange t treat inaccessible areas, i.e. ducting, under fixtures etc. with residual insecticide if necessary. Members f the family r clse cntacts f the hme envirnment shuld seek advice frm their General Practitiner. 5 Lice Lice are parasitic insects that feed n human bld. Humans can hst 3 different types f luse:- Pediculus Humanus - Capitis - (head luse) Pediculus Humanus - Crpris - (bdy/clthing luse) Ref IPC v2.1 Page 8 f 21 Apprved: 18 January 2019

9 Phthirius Pubis - (pubic luse) 5.1 What d lice lk like? Head lice 2-3mm lng, grey white in clur, wingless, elngated bdy. Mainly fund near the scalp but may ccur in armpits, beards, eyelashes and eyebrws. Eggs (nits) are pinhead size, val in shape and take 5-10 days t hatch. Transmitted by head-t-head cntact Pubic lice Crablike in appearance. White t brwnish in clur and val shaped. Fund in the pubic hair and may be detected by the presence f black pwder in under clthes and severe skin irritatin. May infect bdy hair e.g. beards, eyebrws and sparse hair n the head f elderly men. Transmitted by clse direct cntact usually sexual cntact. Pubic lice can nly survive fr a shrt perid f time away frm hst as they are temperature dependant Bdy lice Larger than head and pubic lice. Can be fund anywhere n the bdy, especially arund the waist and under the armpits. Lay eggs in clthing. Transmitted by persn-t-persn cntact. 5.2 Hw d lice affect peple? Head lice Head lice feel like a tickling sensatin alng the scalp, with the feeling that smething is mving arund in the hair. As the head luse bites the scalp, there is itching. This is an allergic reactin t the saliva. Sres can develp frm cnstantly scratching the head. Bacteria can spread frm fingers t scalp causing an infectin Pubic lice Sme peple can have pubic lice withut any symptms. Ref IPC v2.1 Page 9 f 21 Apprved: 18 January 2019

10 Mst peple cmplain f intense itching that becmes wrse at night. The bites f pubic lice can cause blue-gray marks n the inner thighs and pubic area Bdy lice Symptms include:- cnstant and intense itching a rash that lks like small welts. Itching is mst intense arund the waist, grin, and thighs. If a patient has had bdy lice fr a lng time, infectin can darken and thicken the skin. Ref IPC v2.1 Page 10 f 21 Apprved: 18 January 2019

11 5.3 Husekeeping and cntrl measures - lice Head lice Affected area Actin required Patient Hair disinfectin (see sectin 6). Clthing Bedding Envirnment Rutine laundering Ruting laundering Rutine cleaning Pubic lice Affected area Actin required Patient Hair disinfectin (see sectin 6). Apply the apprpriate ltin directly t the pubic hair, between the legs and arund the anus, accrding t the manufacturer's recmmendatins. Aqueus slutins are recmmended as ther types may be painful. Clthing Bedding Envirnment Partner Rutine laundering Ruting laundering Rutine cleaning Advise sexual partner t attend GP fr advice if apprpriate Patient s cnsent given Bdy lice Affected area Patient Clthing Actin required N specific treatment except bathing and putting n clean clthes See Laundering and safe handling f linen and clthing Bedding Place int a water sluble bag and secure. Place int a laundry bag and secure. Label "Infected Linen" and ward name. Send t laundry facility. Envirnment N specific actin needed Family and clse cntacts It may be necessary t advise them t seek advice frm their GP. If apprpriate patient s cnsent given Ref IPC v2.1 Page 11 f 21 Apprved: 18 January 2019

12 6 Dealing with clthing and linen 6.1 Why deal with clthing and linen? T prevent the spread f ectparasites t ther patients and health care wrkers. 6.2 Hw t deal with clthing fr bdy lice nly Event Actin required When remving the patient s clthing. Wash and dry hands, Wear glves and aprns.(bdy lice nly). Destrying clthing. Check clthes as valuables may be sewn int linings. It is rarely necessary t destry patient s clthing. If destructin is advised, btain the patient's r relative's written permissin. If the patient/resident refuses permissin t destry the clthes Seal the clthes in a plastic bag and return t relatives Remve PPE and wash and dry hands Advise them hw t clean the clthes t effectively kill lice and eggs: Wash at a temperature f 60 C fr lnger than 15 minutes. Or turn dry clthes inside ut and tumble dry fr at least 45 minutes n a ht setting, then wash as nrmal. Or turn clthes inside ut and dry clean. When sending clthing t the laundry Ntify the laundry and make arrangements fr delivery: Place int a water sluble bag and secure; Place int a laundry bag and secure; Label "Infected clthes" and ward name; Send t laundry facility. Heat labile clthes may be damaged during the heat prcess in the laundry. Make patients aware f this and btain written permissin t cver the event f clthes being damaged. Fr pubic lice and head lice nrmal washing and tumble drying f patients clthing separate frm ther patients clthing is sufficient. Ref IPC v2.1 Page 12 f 21 Apprved: 18 January 2019

13 6.3 Hw t deal with bed linen Wash and dry hands, apply glves and aprn; Place bedding int a water sluble bag and secure; Place int a laundry bag and secure; Label "Infected Linen" and ward name; Send t laundry facility; Wash mattress, pillws and duvets if applicable with detergent and water and fully dry. 7 Hair disinfectin 7.1 Why carry ut hair disinfectin? T remve lice and nits frm the scalp and hair T prevent secndary infectins frm scratching and skin cnditins such as impetig etc. T prevent infectin t ther patients and health care wrkers. 7.2 Hair disinfectin equipment checklist Aprn and glves (fr nurse) Twels Prescribed ltin Lice detectin cmb 7.3 Hw t carry ut hair disinfectin Tactfully explain t the patient the prcedure and the reasn fr it. Ensure the patient is cmfrtable and privacy prvided (the bathrm is preferable). Ensure the area is well ventilated. Apply ltin and leave n the hair as per the manufacturer's instructins (d nt dry with a hair dryer and keep away frm heat) After the recmmended time cmb the hair t remve dead lice, then shamp. The patient may feel mre cmfrtable having clean night clthes and bedding. Treatment must be repeated after 7 days using the same preparatin. Ref IPC v2.1 Page 13 f 21 Apprved: 18 January 2019

14 Fr children under 6 mnths f age, r children with allergic cnditins, asthma etc. cntact Phamarcy fr advice. The Pharmacist will recmmend the current treatment as utlined within Clinical Knwledge Summaries headlice and scabies. The same preparatins may be used fr pubic lice. Ensure cntact tracing is cmpleted thrughly t identify any clse cntacts that may require treatment (this is usually ver a 4-8 week perid). 8 Definitins Term Ectparasites Ectparasitsis Definitin A parasite that lives n r in the skin but nt within the bdy. Fleas and lice are ectparasites. Infestatin with an ectparasite Ref IPC v2.1 Page 14 f 21 Apprved: 18 January 2019

15 9 References and further reading WILLIS, J. (1990) Cmmn Pests. Cmmunity Outlk. Sept. pp UNIVERSITY OF YORK (1999) Treating Head Lice and Scabies Fundatin, Effectiveness Matters, Vl. 4, Issue1. MAUNDER, J. Headlice - Recgnising The Signs. Reprinted frm the Chemist and Druggist (Persnal cpy). MAUNDER, J. (1989) Refractry Pseud-Scabies. The Practitiner. Vl.233, pp MAUNDER, J. (1995) Scabies Update. Medical Entmlgy Centre. Cambridge. NHS Library CKS 2008 Treatment Guidelines Headlice JENKINS, M. (2001) Scabies. Nursing Times Plus. Vl. 97, N. 22. LAWRENCE J & MAY D (2003) Infectin Preventin and Cntrl in the Cmmunity (Chapter 13 pp Churchill/Livingstn. Lndn & Edinburgh WALKER J. A. & JOHNSTONE P.W. (2000) Interventins fr Treating Scabies. Cchrane Library issue 3 Department f Health (2008) The Health and Scial Care Act 2008 Cde f Practice fr the Preventin and Cntrl f Health Care Assciated Infectin Lndn DH Ref IPC v2.1 Page 15 f 21 Apprved: 18 January 2019

16 10 Equality Analysis Screening Frm Please nte; The Equality Analysis Plicy and Equality Analysis Guidance can be fund n InTuch n the plicies page Name f Service area, Directrate/Department i.e. substance misuse, crprate, finance etc. Nursing and Gvernance/IPC and Physical Healthcare Name f respnsible persn and jb title Name f wrking party, t include any ther individuals, agencies r grups invlved in this analysis Elizabeth Mdy, Directr f Nursing and Gvernance Elizabeth Mdy, Dr R Bellamy, IPC Team and the Infectin Preventin and Cntrl Cmmittee Plicy (dcument/service) name Is the area being assessed a; Plicy/Strategy Service/Business plan Prject Prcedure/Guidance Cde f practice Other Please state Gegraphical area Trustwide Aims and bjectives Start date f Equality Analysis Screening (This is the date yu are asked t write r review the dcument/service etc.) End date f Equality Analysis Screening (This is when yu have cmpleted the analysis and it is ready t g t EMT t be apprved) T set standards in practice t ensure the delivery f patient care is carried ut safely and effectively by the trust staff. T cmply with the HCAI Cde f Practice f the Health and Scial Care Act th December th January 2019 Ref: IPC v2 Page 16 f 21 Ratified date: 27 July 2016 Fleas Lice and Scabies Management f Patients Last amended: 27 July 2016

17 Yu must cntact the EDHR team as sn as pssible where yu identify a negative impact. Please ring Sarah Jay r Tracey Marstn n / Wh des the Plicy, Service, Functin, Strategy, Cde f practice, Guidance, Prject r Business plan benefit? Trust staff and patients 2. Will the Plicy, Service, Functin, Strategy, Cde f practice, Guidance, Prject r Business plan impact negatively n any f the prtected characteristic grups belw? Race (including Gypsy and Traveller) Yes/N N Disability (includes physical, learning, mental health, sensry and medical disabilities) Yes/N N Gender (Men, wmen and gender neutral etc.) Yes/N N Gender reassignment (Transgender and gender identity) Yes/N N Sexual Orientatin (Lesbian, Gay, Bisexual and Hetersexual etc.) Yes/N N Age (includes, yung peple, lder peple peple f all ages) Yes/N N Religin r Belief (includes faith grups, atheism and philsphical belief s) Yes/N N Pregnancy and Maternity (includes pregnancy, wmen wh are breastfeeding and wmen n maternity leave) Yes/N N Marriage and Civil Partnership (includes ppsite and same sex cuples wh are married r civil partners) Yes/N N Yes Please describe anticipated negative impact/s N Please describe psitive impacts/s N barriers t access r implementing this prcedure Ref IPC v2 Page 17 f 21 Ratified date: 27 July 2016 Fleas Lice and Scabies Management f Patients Last amended: 27 July 2016

18 3. Have yu cnsidered ther surces f infrmatin such as; legislatin, cdes f practice, best practice, nice guidelines, CQC reprts r feedback etc.? If N, why nt? Surces f Infrmatin may include: Feedback frm equality bdies, Care Quality Cmmissin, Equality and Human Rights Cmmissin, etc. Investigatin findings Trust Strategic Directin Data cllectin/analysis Natinal Guidance/Reprts Yes N Staff grievances Media Cmmunity Cnsultatin/Cnsultatin Grups Internal Cnsultatin Research Other (Please state belw) 4. Have yu engaged r cnsulted with service users, carers, staff and ther stakehlders including peple frm the fllwing prtected grups?: Race, Disability, Gender, Gender reassignment (Trans), Sexual Orientatin (LGB), Religin r Belief, Age, Pregnancy and Maternity r Marriage and Civil Partnership Yes Please describe the engagement and invlvement that has taken place N Please describe future plans that yu may have t engage and invlve peple frm different grups Nt relevant t this prcedure Ref IPC v2 Page 18 f 21 Ratified date: 27 July 2016 Fleas Lice and Scabies Management f Patients Last amended: 27 July 2016

19 5. As part f this equality analysis have any training needs/service needs been identified? Yes/N Please describe the identified training needs/service needs belw N Nt relevant t this prcedure A training need has been identified fr; Trust staff Yes/N N Service users Yes/N N Cntractrs r ther utside agencies Yes/N N Make sure that yu have checked the infrmatin and that yu are cmfrtable that additinal evidence can prvided if yu are required t d s The cmpleted EA has been signed ff by: Yu the Plicy wner/manager: Type name: Elizabeth Mdy Date: 18/1/19 Yur reprting (line) manager: Type name: Angela Ridley Date: 18/1/19 If yu need further advice r infrmatin n equality analysis, the EDHR team hst surgeries t supprt yu in this prcess, t bk n and find ut mre please call: /6542 r traceymarstn@nhs.net Ref IPC v2 Page 19 f 21 Ratified date: 27 July 2016 Fleas Lice and Scabies Management f Patients Last amended: 27 July 2016

20 11 Dcument cntrl Next review date: 19 January 2022 This dcument replaces: IPC v2 Fleas lice and scabies management f patients Lead: Name Title Angela Ridley Head f IPC and Physical Health and Back Care (Nursing) Members f wrking party: Name Title Angela Ridley Senir Nurse IPC and Physical Health and Back Care This dcument has been agreed and accepted by: (Directr) Name Elizabeth Mdy Title Directr f Nursing and Gvernance This dcument was apprved by: An equality analysis was cmpleted n this dcument n: Date Name f cmmittee/grup 18 Jan 2019 Infectin Preventin and Cntrl Cmmittee 4 February 2019 Change recrd Versin Date Amendment details Status 1 7 Mar 2013 Withdrawn 2 26 July 2016 Full revisin Withdrawn Jan 2019 Change t the title f the prcedure. Apprved Ref IPC v2 Page 20 f 21 Ratified date: 27 July 2016 Fleas Lice and Scabies Management f Patients Last amended: 27 July 2016

21 12 Examples f fleas and lice Lifecycle f a luse Head luse Bdy luse Egg (nit) Flea Scabie Mite Pubic luse Ref IPC v2 Page 21 f 21 Ratified date: 27 July 2016 Fleas Lice and Scabies Management f Patients Last amended: 27 July 2016