How long should someone with scabies be quarantined in an assisted living setting?

Scabies Quarantine Duration in Assisted Living

Residents with scabies should remain in contact isolation until 24 hours after completion of their first treatment application, at which point they are no longer considered contagious.

Isolation Protocol

Standard (Non-Crusted) Scabies

• Implement contact precautions immediately upon diagnosis and maintain until 24 hours after the first treatment application 1, 2
• After permethrin 5% cream application (left on for 8-14 hours) or oral ivermectin administration, the resident can be removed from isolation the following day 1, 2
• This 24-hour post-treatment period ensures the scabicide has eliminated transmissible mites 3

Crusted (Norwegian) Scabies

• Extended isolation is required due to extremely high mite burden and infectivity 1, 2
• Maintain contact precautions throughout the intensive treatment course (topical permethrin daily for 7 days plus oral ivermectin on days 1,2,8,9, and 15) 1, 2
• Continue isolation until skin scrapings demonstrate no living mites and clinical improvement is evident 4, 5
• Debilitated elderly residents are at highest risk for this presentation and require hospitalization for treatment 5

Critical Outbreak Management Components

Simultaneous Treatment Requirements

• All residents, staff, and frequent visitors must be treated simultaneously on the same day, regardless of symptoms 4, 6, 5
• This is the single most important factor in outbreak control—failure to treat all contacts simultaneously is the leading cause of treatment failure 1, 2
• In documented nursing home outbreaks, 35-92% of residents may be infested, with many being asymptomatic 6, 5

Environmental Decontamination

• Machine wash and dry all bedding, clothing, and towels on hot cycles on the same day as treatment 1, 2
• Items that cannot be laundered should be removed from body contact for at least 72 hours (mites survive 1-2 days at room temperature) 1, 3
• Vacuum furniture and carpets; fumigation is unnecessary 2, 3

Post-Treatment Expectations

Normal Post-Scabies Symptoms

• Pruritus and rash commonly persist for up to 2 weeks after successful treatment—this does NOT indicate treatment failure or ongoing contagion 1, 2
• Retreatment is indicated only if symptoms persist beyond 2 weeks AND living mites are demonstrated on skin scrapings 1, 2

Surveillance Requirements

• Prolonged surveillance for at least 2-4 weeks after treatment is essential to detect treatment failures or reinfestations 4, 7
• Re-examine residents at 1-2 weeks post-treatment 2
• Any new cases suggest either treatment failure or inadequate contact tracing 7, 5

Common Pitfalls in Institutional Settings

Why Outbreaks Persist

• Failure to coordinate simultaneous treatment of all exposed individuals leads to ongoing transmission cycles 4, 5
• Inadequate topical application (missing scalp, face, under nails, body folds) allows mite survival 1, 3
• Not repeating ivermectin at 2 weeks fails to eradicate newly hatched mites 1, 3
• Misdiagnosing scabies can lead to pseudo-outbreaks with unnecessary mass treatment for psychogenic pruritus 8, 1

Diagnostic Confirmation

• In nursing home residents with unexplained generalized rash, scabies should be strongly considered 8
• Diagnosis should be attempted by microscopic demonstration of mites, eggs, or fecal pellets from skin scrapings 8
• Elderly and debilitated patients may present atypically without burrows or pruritus, showing only hyperkeratosis or papules 1