A dirty compression glove worn by a healthcare worker is implicated in a scabies outbreak among newborns. In a study appearing in Infection Control and Hospital Epidemiology, Barbara G. Ross, of the Department of Infection Prevention and Control at New York-Presbyterian Hospital, and colleagues, report that after three cases of scabies in infants were identified by a pediatric dermatologist during a three-month period, an intensive investigation was launched to find additional cases by contacting local pediatric dermatologists and hospital-affiliated pediatricians.
Scabies is a contagious infestation of the skin caused by the mite Sarcoptes scabiei; it is transmitted through close personal contact with infested individuals or their personal items and can live on inanimate items for up to two days.
The researchers report that seven additional case patients, including three neonatal intensive care unit patients, were identified. Cases were diagnosed both by microscopic examination of skin scraping specimens and clinically. They add that environmental rounds were conducted in the newborn nursery, postpartum rooms, nursing stations and patient and staff lounges, and no cloth furniture or grossly contaminated fomites were found. The researchers then looked for a healthcare worker index case patient; six employees were identified as having contributed to the electronic medical record for three or more case patients; five were found to be without symptoms and they accepted prophylaxis.
Ross, et al. (2011) report further that a per diem nurse had contributed to 10 of 10 electronic medical records examined: When evaluated, she was noted to have a rash and wore a noticeably dirty compression glove for lymphedema while on duty, making it impossible for her to clean her hands effectively. This nurse reported that she had been treated for scabies by a private dermatologist at least five times in the previous year, although she had not reported this treatment.
The researchers hypothesize that the dirty compression glove that the nurse wore at work contributed to her re-infestation or was a means for transmission to patients and add, Staff who require hand or wrist braces or compression gloves or sleeves must be evaluated and reasonable accommodations considered by hospitals so that infection prevention policies can be followed. A single case of scabies in a newborn should be considered a sentinel event of a nursery outbreak.
Reference: Ross BG, Wright-McCarthy JK, DeLaMora PA and Graham PL. Transmission of Scabies in a Newborn Nursery. Infection Control and Hospital Epidemiol. Vol. 32, No. 5. May 2011.