Scabies Management in Assisted Living Facilities

Isolation and Treatment Protocol

Residents with scabies should remain in contact isolation until 24 hours after completion of their first treatment application, at which point they are no longer considered contagious, according to the American College of Physicians 1, 2
Implement contact precautions immediately upon diagnosis and maintain until 24 hours after the first treatment application, as recommended by the American Medical Association 1, 2
After permethrin 5% cream application or oral ivermectin administration, the resident can be removed from isolation the following day, based on guidelines from the American Academy of Dermatology 1, 2
Extended isolation is required for crusted scabies due to extremely high mite burden and infectivity, as stated by the Centers for Disease Control and Prevention 1, 2

Machine wash and dry all bedding, clothing, and towels on hot cycles on the same day as treatment, as recommended by the American College of Occupational and Environmental Medicine 1, 2
Items that cannot be laundered should be removed from body contact for at least 72 hours, according to the National Institute for Occupational Safety and Health 1
Vacuum furniture and carpets; fumigation is unnecessary, as stated by the Environmental Protection Agency 2
All residents, staff, and frequent visitors must be treated simultaneously on the same day, regardless of symptoms, to control outbreaks, as recommended by the American Public Health Association 1, 2

Pruritus and rash commonly persist for up to 2 weeks after successful treatment—this does NOT indicate treatment failure or ongoing contagion, according to the American Academy of Dermatology 1, 2
Retreatment is indicated only if symptoms persist beyond 2 weeks AND living mites are demonstrated on skin scrapings, as recommended by the Infectious Diseases Society of America 1, 2
Re-examine residents at 1-2 weeks post-treatment, as stated by the American Geriatrics Society 2

In nursing home residents with unexplained generalized rash, scabies should be strongly considered, according to the American Geriatrics Society 3, 4
Diagnosis should be attempted by microscopic demonstration of mites, eggs, or fecal pellets from skin scrapings, as recommended by the American Academy of Dermatology 3, 4
Elderly and debilitated patients may present atypically without burrows or pruritus, showing only hyperkeratosis or papules, as stated by the American Medical Association 1
Misdiagnosing scabies can lead to pseudo-outbreaks with unnecessary mass treatment for psychogenic pruritus, according to the Journal of the American Geriatrics Society 3, 1