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Just the words scabies, lice, and bed bugs can make you start to itch. But by passing along some tips to patients and families, these common creepy crawlies can be treated and prevented.

Scabies is an infestation of the skin caused by a mite burrowing into the top layer of the skin forms a slightly raised tunnel. The mite is passed from person to person by skin contact or by sharing bedding, clothing, or other linens with a person who has scabies. It is possible to spread scabies from the moment of first contact until after all treatment is completed. Persons with symptoms should be checked and treated by their doctor as quickly as possible.

The most common symptom is an itchy rash, mostly at night. It can appear anywhere on the body, but is usually on the hands, wrists, elbows, breasts, armpits, waistline, and groin. Elderly persons, persons in institutions, and persons whose immune system is weak may not feel itchy.

Lice (head, body, or pubic lice) do not spread diseases, and are not usually spread by contact with clothing (such as hats, scarves, coats) or other personal items (such as combs, brushes, or towels). The diagnosis of a head lice infestation is best made by finding a live adult louse on the scalp or hair of a person. Because adult lice are very small, move quickly, and avoid light, they can be difficult to find. Using a magnifying lens and a fine-toothed comb may be helpful to find live lice.

Treatment for lice requires an over-the-counter medication, cream, or prescription medicated shampoo. All household members and other close contacts of the person who has a lice infestation should also be checked. All infested persons and their bedmates should be treated at the same time. Recently, researchers have found a strain of mutant lice in 25 states that is resistant to over-the-counter treatments.

Bed bugs are small, reddish brown, flattened, wingless insects that feed solely on the blood of humans and other warm-blooded animals, usually at night. Bed bugs do not transmit disease, but their saliva causes intense itching. Bed bugs form nests in cracks, furniture seams, bed frames, and mattresses and can survive for several months without feeding. They can hide within crevices and other small spaces such as headboards, baseboards, mattress seams, and areas of clutter. People with bedbugs will often see small drops of blood on bed sheets or pillows; this is caused by engorged bed bugs that were crushed. Bed bug infestations also emit an odor.


What you can do:
Advise patients that the best way to prevent scabies is to avoid skin-to-skin contact with someone who is infested and avoid using their personal items (such as bedding and linens). A patient who has scabies will need a scabicide to treat the infestation. Rooms occupied by patients with crusted scabies should be thoroughly cleaned and vacuumed after use. Environmental disinfestation using pesticide sprays or fogs generally is not needed or recommended.

Recommend that patients not share personal items such as combs and brushes, hair accessories, hats, scarves. Checking children’s hair and scalp regularly will catch an infestation early on so that treatment can start right away.

Patients should not scratch the bites. Bed bug infestations can be treated by insecticide spraying. Preventing bed bugs is easier than treating an existing infestation. Bed bugs are known to “hitch-hike” on suitcases, soft furniture, and clothing. If you discover bed bugs in a patient room, recommend that the patient bathe, change clothes, and be transferred into another room. Their belongings and the equipment in the room shouldn’t leave the room until the room is deemed free of bed bugs. Clothes and linens should be carefully removed, sealed tightly in plastic bags, and laundered immediately on the hot setting (dryer) to destroy all stages of bed bugs. If you find bed bugs on the patient’s belongings, inform them that their household may be infested.


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