The management of scabies outbreaks in care homes in England: a review of current health protection guidelines

Introduction Scabies is an important public health problem in residential care homes for the elderly. The management of scabies outbreaks generally requires the simultaneous mass treatment of all residents and staff, which is stressful, time consuming and a drain on resources. The Department of Health recommends that care home managers report scabies outbreaks to local Health Protection Teams (HPTs) to assist with practical and logistical advice. Methods We undertook a mixed methods review of current local HPT guidelines for the management of scabies outbreaks in care homes in England to create a quantitative report of their variation in key dimensions. Guidelines were defined as any documents and resources used to help formulate support and advice. All guidelines currently in use were eligible for inclusion regardless of date, length or nature. Results Twenty four HPTs were operational at the time of review (July 2015); twenty guidelines were reviewed as four HPTs had not produced guidelines, and instead relied upon expert advice from within local infection control teams (ICTs). Although the guidelines were generally consistent on issues such as treatment protocols for individual patients, there was substantial variation in their recommendations regarding the prophylactic treatment of contacts, infection control measures and the roles and responsibilities of individual stakeholders. Most guidelines did not adequately address the logistical challenges associated with mass treatment in this setting. Recommendations There is a need for nationally produced guidance for the management of scabies outbreaks in care homes. Although local HPTs have attempted to fill this gap, guidelines are highly variable in their scope and content. National guidance would be the most comprehensive way of ensuring a thorough and cohesive response to outbreaks of this unpleasant and debilitating condition in the elderly population living in long-term care facilities.