Jimenez-Lucho V E, Fallon F, Caputo C, Ramsey K
Infection Control Program, Department of Veterans Affairs Medical Center, Northport, NY 11768, USA.
Am J Infect Control. 1995 Feb;23(1):44-9. doi: 10.1016/0196-6553(95)90008-x.
Although general guidelines for control of institutional outbreaks of scabies have been published, little information is available on the long-term efficacy of these measures in extended care facilities. An epidemic of scabies occurred in a comprehensive care Veterans Affairs facility as a result of an unrecognized case of crusted scabies, with a total of 112 persons affected during a 12-month period. The initial outbreak occurred in the acute care units, with highest attack rates among roommates of the index patient (11/14, 78%) and nursing staff (27/55, 49%). Despite sustained infection control measures, secondary outbreaks continued to occur in the extended care units. Factors contributing to the persistence of the epidemic were transfer of patients with unrecognized infestation within the facility, prolonged latency period and atypical manifestations in elderly patients, and failure of scabicide treatment. In addition, a role may be played by carriage of scabies mites by infested staff members before they have symptoms. Control of the epidemic was only achieved with the following: increased awareness and better scabies recognition, restriction of staff rotation in the facility, and improved communication among primary providers and infection control personnel. Prolonged surveillance may be required for eradication of nosocomial scabies in extended care settings.
尽管已经发布了控制机构内疥疮暴发的一般指南，但关于这些措施在长期护理机构中的长期效果的信息却很少。在一家综合护理退伍军人事务设施中，由于一例未被识别的结痂性疥疮病例，发生了疥疮流行，在12个月内共有112人受到影响。最初的暴发发生在急性护理病房，指数患者的室友（11/14，78%）和护理人员（27/55，49%）的发病率最高。尽管采取了持续的感染控制措施，但长期护理病房仍不断出现二次暴发。导致疫情持续的因素包括设施内未被识别感染的患者的转移、老年患者潜伏期延长和非典型表现，以及杀疥剂治疗失败。此外，受感染的工作人员在出现症状之前携带疥螨可能也起到了一定作用。只有通过以下措施才能控制疫情：提高认识和更好地识别疥疮、限制设施内工作人员的轮岗，以及改善初级医疗服务提供者和感染控制人员之间的沟通。在长期护理环境中根除医院内疥疮可能需要长期监测。
