Scabies Action

Overview

Scabies is a skin infestation caused by mites that burrow into the skin. It spreads mainly through prolonged skin-to-skin contact.

• Symptoms of the first infestation may not appear for 4-6 weeks.
• In cases of reinfestation, symptoms can occur within 1-3 days.
• Common symptoms include:
  • Intense itching, often worse at night
  • Fine, visible burrows (thin, wavy, itchy lines on the skin)
  • Papules (small, raised bumps), often on the fingers, wrists, arms, waistline, legs, genital area, or breasts (in women)

Scabies Decision Tree

Step 1: Is this a single case of scabies?

Yes: Refer the case to the GP for diagnosis and prompt treatment (see NICE Scabies Guidance). Identify close contacts. Refer contacts for treatment and co-ordinate the treatment. The case may need to be treated again.

No: Move to Step 2

Step 2: Is this an outbreak? (2 or more cases in the same setting within 8 weeks)

Yes: Assess all individuals in the setting.

No: Manage as a single case (see Step 1 actions).

Step 3: Outbreak confirmed

 Identify contacts and potential further cases. Arrange a co-ordinated treatment for further cases and contacts. All diagnosed cases must be treated immediately and may need to be re-treated as part of the co-ordinated treatment. Warn and inform visitors.

Step 4: Ongoing infection prevention and control actions

Cases, contacts and staff to follow good IPC practice, including use of PPE as appropriate, until 24 hours after treatment. Risk-assess transfers to other settings or any new admissions planned before treatment completion.

Management of a Single Case

• Seek GP assessment to confirm diagnosis and arrange treatment.
• All identified contacts should receive treatment at the same time as the case. Two applications of treatment, 7 days apart, are required.
• Inform all staff and ensure Standard Infection Control Precautions (SICPs) are in place.
• Ensure timely treatment for the resident and identified contacts.
• Consider isolation of the case until 24 hours after the first treatment has been completed.

Suspected or Confirmed Outbreak

An outbreak is defined as two or more linked cases within an 8-week period.

• Immediately contact AWARe (All Wales Acute Response Service) on 0300 00 300 32 for advice and outbreak management.
• Once an outbreak is confirmed:
  • Notify residents, staff, and relatives to be vigilant for symptoms.
  • Inform GPs for diagnosis and treatment planning.
  • Ensure all cases and contacts are treated simultaneously.
  • Notify and advise external professionals/visitors (district nurses, podiatrists, hairdressers, etc.) who may have had skin-to-skin contact. They should avoid further close contact until treated and cleared.

Definition of Close Contacts

Close contacts include anyone who, within 8 weeks prior to diagnosis, has had:

• Direct skin-to-skin contact without PPE (e.g., during personal care)
• Shared a bedroom or household setting with the case
• Prolonged physical contact with the symptomatic resident

This may include:

• Other residents
• Staff providing direct care
• Relatives or visitors
• External professionals (district nurses, podiatrists, community health staff, etc.)

Co-ordination of Treatment

• All cases and close contacts must be treated at the same time.
• Treatment involves two applications, 7 days apart, even if asymptomatic.
• Residents: treatment prescribed via their GP or Pharmacist.
• Staff/visitors: treatment arranged via their own GP.
• Staff may only return to work 24 hours after the first treatment.
• PPE must be used when delivering personal care until 24 hours after the first treatment.

Outbreak Control Measures

• Isolate affected residents until 24 hours post-treatment.
• Ensure staff/visitors only return after 24 hours post-treatment.
• Carry out enhanced cleaning of the environment.
• Wash laundry and soft furnishings at ≥50°C, or seal/quarantine for at least 72 hours (3 days).
• Where possible, delay transfers; if unavoidable, inform the receiving service of the outbreak and treatment status.
• Outbreaks are considered over when no new cases are identified for 12 weeks after the last case was treated.

Resources 
NHS Wales - Scabies Information (via NHS 111 Wales): NHS 111 Wales - Health A-Z : Scabies 
NIPCM Scabies Back to Basics Presentation:National Infection Prevention and Control Manual: Care Home IPC Webinar: Scabies Back to Basics - 23 October 2024 Infection Prevention Control Scabies Action Plan:Action-plan-for-management-of-scabies-in-Health-and-Social-Care-settings-May-2025-Version-2.00.pdf 

References and Further Guidance Links: UKHSA - Management of Scabies in Communal Settings:UKHSA guidelines for the management of scabies cases and outbreaks in communal residential settings - GOV.UK