Model Answer
0 min readIntroduction
Crusted scabies, also known as Norwegian scabies, is a severe and highly contagious form of scabies characterized by thick, hyperkeratotic crusts containing a massive number of mites and eggs. It often affects immunocompromised individuals, the elderly, and those with neurological conditions. In an institutional setting, outbreaks can spread rapidly, posing a significant public health challenge. Effective management requires a multi-faceted approach encompassing prompt diagnosis, rigorous isolation, aggressive treatment, and meticulous environmental control to prevent further transmission. This answer will detail the steps required to treat crusted scabies within an institutional framework.
I. Initial Assessment and Isolation
Upon suspicion of crusted scabies, immediate isolation of the affected individual is paramount. This should be a single room with dedicated bathroom facilities. Strict contact precautions must be implemented, including the use of gowns, gloves, and masks by all healthcare personnel entering the room. A thorough clinical assessment should be performed to determine the extent of the infestation and identify any underlying immunocompromising conditions.
II. Diagnostic Confirmation
Diagnosis is typically made clinically, but microscopic examination of skin scrapings confirms the presence of mites, eggs, and fecal matter. Multiple scrapings may be necessary due to the high mite load. A biopsy may be considered in atypical presentations.
III. Treatment Protocol
Treatment of crusted scabies is more challenging than typical scabies and often requires a combination of topical and systemic therapies.
- Topical Treatment: Keratolytics (e.g., salicylic acid, urea) are used to remove the crusts, allowing better penetration of scabicidal agents. Permethrin 5% cream is applied to the entire body, including under the nails, and left on for 8-12 hours before washing off. This is typically repeated weekly for several weeks.
- Systemic Treatment: Ivermectin is the preferred systemic agent. The standard regimen is 200 mcg/kg given orally, repeated weekly for 2-4 weeks. Higher doses may be required in severely immunocompromised patients. Caution is advised in patients with hepatic impairment.
- Supportive Care: Emollients are used to alleviate the intense pruritus (itching). Secondary bacterial infections are common and should be treated with appropriate antibiotics.
IV. Environmental Disinfection
The environment plays a crucial role in transmission. Rigorous cleaning and disinfection protocols are essential.
- Bedding and Clothing: All bedding, clothing, and towels used by the patient should be sealed in plastic bags and laundered in hot water (at least 60°C) and dried on a hot cycle. Items that cannot be washed should be sealed in plastic bags for at least 72 hours to allow the mites to die.
- Room Surfaces: All surfaces in the patient's room should be thoroughly cleaned with a hospital-grade disinfectant.
- Furniture: Upholstered furniture should be steam cleaned or covered with impermeable barriers.
- Ventilation: Ensure adequate ventilation in the room.
V. Staff Protection and Education
Healthcare workers are at high risk of infection. Comprehensive training on proper infection control practices is vital.
- Personal Protective Equipment (PPE): Strict adherence to contact precautions (gowns, gloves, masks) is mandatory.
- Hand Hygiene: Frequent and thorough handwashing with soap and water or alcohol-based hand sanitizer is essential.
- Monitoring: Healthcare workers should be monitored for symptoms of scabies.
VI. Monitoring and Follow-up
Treatment response should be monitored closely. Clinical improvement (reduction in crusting and pruritus) is expected within a few weeks. Repeat skin scrapings may be performed to assess for mite eradication. Patients should be educated about the importance of completing the full course of treatment and avoiding close contact with others until cleared by a healthcare professional.
VII. Institutional Outbreak Control
If an outbreak occurs, a comprehensive investigation should be conducted to identify all affected individuals. Contact tracing and mass treatment may be necessary to control the spread. Collaboration with public health authorities is crucial.
| Phase | Actions |
|---|---|
| Initial Response | Isolation, PPE, Diagnostic Confirmation |
| Treatment | Topical & Systemic Medications, Supportive Care |
| Environmental Control | Disinfection, Laundry Protocols |
| Staff Protection | Training, Monitoring, PPE Compliance |
| Follow-up | Monitoring Treatment Response, Contact Tracing |
Conclusion
Managing crusted scabies in an institutional setting demands a meticulous and coordinated approach. Prompt isolation, aggressive treatment with both topical and systemic agents, rigorous environmental disinfection, and comprehensive staff education are essential to prevent outbreaks and protect vulnerable populations. Ongoing surveillance and collaboration with public health authorities are crucial for long-term control. Early detection and intervention are key to minimizing morbidity and preventing widespread transmission.
Answer Length
This is a comprehensive model answer for learning purposes and may exceed the word limit. In the exam, always adhere to the prescribed word count.