Occupational risk of scabies among healthcare workers: problem focus and personal experience

Background: scabies (causative agent: Sarcoptes scabiei var. hominis) is a contagious parasitic disease, widespread in the general population, which can cause hospital outbreaks, with possible involvement of sanitary staff, and considerable economic and managerial implications. The Policlinico San Matteo of Pavia (Italy) adopts (since 2005) a protocol for the management of index cases, based on early patient isolation, identification of close contacts, and their prophylactic treatment (with temporary removal from duty). Objectives: acquiring descriptive data on reported cases of scabies in the hospital under study, and on the preventive effectiveness of the operative protocol adopted for their management. Methods: retrospective study (2005-2014) of the index cases, collected in ad hoc computer archive. For each case, personal and clinical data were collected, as well as information on the healthcare workers who had dealt with the patient within the 6 weeks (maximum scabies incubation period) preceding the diagnosis. Results: 30 index cases were identified: 11 females and 19 males; mean age 60 years; range: 2 months - 92 years. 9 patients had been transferred to the Policlinico from other health facilities. 11 were immunosuppressed: of these, 3 were suffering from Norwegian scabies (or crusted scabies: a highly contagious variant, difficult to diagnose, in which the number of mites on the patient’s skin is very high, up to several millions). Close contacts included 894 health professionals, mainly nurses, physicians and students; of these, 158 had provided assistance to cases of Norwegian scabies: 15 (1.7% of the entire sample) were infected. This percentage is below the rates of infection (sometimes > 30%) reported in other case series. Almost all involved personnel received (prophylactic or therapeutic) acaricide treatment. Conclusions: scabies is a major occupational hazard in hospitals, especially for nursing staff, including students in training. Caution is particularly needed for immunocompromised patients, since they develop with greater frequency Norwegian scabies. The operative protocol adopted by the Policlinico San Matteo is effective for risk containment.