QWhat do you tell your medical assistant about their risk of contracting scabies from a patient?

When I was doing a dermatology rotation in Kenya, our team spent part of the time traveling to rural towns of the Maasai Mara to screen local school children for dermatologic disease. During these visits, we discovered a significant number of the children were suffering from scabies. For most of us, this seemed like the right opportunity to review the pathogenicity of scabies and its transmission. I did not know until that time but scabies is endemic in many resource-poor tropical settings, with an estimated average prevalence of 5–10% in children.¹ The highest rates of infestation occur in countries with hot, tropical climates, especially in communities where overcrowding and poverty coexist, and where there is limited access to treatment. Despite my exposure to patients with scabies, I did not contract it.

At the beginning of my clinical training, I noticed that when a patient comes in with scabies, medical assistants seem as if they have their own protocol for ‘detoxifying’ an exam room and quarantine it off for the rest of the day. Losing an exam room seemed inefficient to me because, although highly contagious, scabies requires 15-20 min of direct skin to skin contact for transmission.² Currently, for a single case of non-crusted scabies, the CDC recommends heightened surveillance for early detection of new cases, proper use of infection control measures when handling patients, confirmation of the diagnosis of scabies, early and complete treatment and follow-up of cases, and prophylactic treatment of staff, other patients, and household members who had prolonged skin-to-skin contact with suspected and confirmed cases.³ Armed with education about the transmission of scabies, my medical assistants are now not as concerned about contracting it and feel safe continuing to use the room.

References:

1. World Health Organization, Scabies. 2020.
2. Elston DM. Dermatologic Therapy. 2009.
3. CDC, Scabies. 2010.