Nurse's LE glove implicated in scabies

kira66715

I do a google alert on LE, and this came up:

http://www.infectioncontroltoday.com/news/2011/05/scabies-outbreak-linked-to-nurses-dirty-compression-glove.aspxcabies Outbreak Linked to Nurse's Dirty Compression Glove
Copyright 2011 by Virgo Publishing.
http://www.infectioncontroltoday.com/
By:
Posted on: 05/06/2011

A dirty compression glove worn by a healthcare worker is implicated in a scabies outbreak among newborns. In a study appearing in Infection Control and Hospital Epidemiology, Barbara G. Ross, of the Department of Infection Prevention and Control at New York-Presbyterian Hospital, and colleagues, report that after three cases of scabies in infants were identified by a pediatric dermatologist during a three-month period, an intensive investigation was launched to find additional cases by contacting local pediatric dermatologists and hospital-affiliated pediatricians.

Scabies is a contagious infestation of the skin caused by the mite Sarcoptes scabiei; it is transmitted through close personal contact with infested individuals or their personal items and can live on inanimate items for up to two days.

The researchers report that seven additional case patients, including three neonatal intensive care unit patients, were identified. Cases were diagnosed both by microscopic examination of skin scraping specimens and clinically. They add that environmental rounds were conducted in the newborn nursery, postpartum rooms, nursing stations and patient and staff lounges, and no cloth furniture or grossly contaminated fomites were found. The researchers then looked for a healthcare worker index case patient; six employees were identified as having contributed to the electronic medical record for three or more case patients; five were found to be without symptoms and they accepted prophylaxis.

Ross, et al. (2011) report further that a per diem nurse had contributed to 10 of 10 electronic medical records examined: "When evaluated, she was noted to have a rash and wore a noticeably dirty compression glove for lymphedema while on duty, making it impossible for her to clean her hands effectively. This nurse reported that she had been treated for scabies by a private dermatologist at least five times in the previous year, although she had not reported this treatment."

The researchers hypothesize that the dirty compression glove that the nurse wore at work contributed to her re-infestation or was a means for transmission to patients and add, "Staff who require hand or wrist braces or compression gloves or sleeves must be evaluated and reasonable accommodations considered by hospitals so that infection prevention policies can be followed. A single case of scabies in a newborn should be considered a sentinel event of a nursery outbreak."

Reference: Ross BG, Wright-McCarthy JK, DeLaMora PA and Graham PL. Transmission of Scabies in a Newborn Nursery. Infection Control and Hospital Epidemiol. Vol. 32, No. 5. May 2011.

FYI: Binney and I were contacted by a nurses' union, because someone filed a complaint about an ER nurse who had worn a sleeve/glove for 3 years. We believe she won the issue, but this does come up. If the nurse had had better hygiene, it would have been a non-issue. The reason there's strict rules in the UK--no white coats, no ties, "bare from the elbows down" is that most heath care providers' clothing is covered with bad germs.

A cautionary tale, and one I hope doesn't lead to a trend.

Kira

Suzybelle

Wow.  Makes me want to bleach my whole body, house, closet, etc.

I have a tendency to OCD behavior anyway...ewwwwww. 

Signing off so I can go defumigate and sanitize.

Sher

One thing I hate most about wearing lymphedema garments (I also tend to OCD as well as germophobe behavior) is worrying about what you may pick up by contact.  You can take your glove off and wash your hands, but not the glove, so I always carry the plastic food service gloves to put on over my compression glove.  At times when I can't do that, the minute I get in the house the glove comes off.  This nurse must not have been wearing a protective glove over her compression glove?

While we're on the subject of mites and germs, can I ask about the recent US outbreak of bedbugs?   I really don't like staying in motels, but if you want to travel they are necessary and knowing me, I'd probably stay up all night looking for bugs!   I have visions of the nasty critters hitchhiking inside my Tribute!  

Suzybelle

Sher:

I have to travel some for work and I ALWAYS check for bedbugs.  Look at the bed linens thoroughly - you're looking for brownish, red stains - in particular at the head of the bed.  Also, I never unpack my clothes out of the suitcase - they stay in the case, and raised on a stand - I never set the suitcase on the floor other than to roll it in the room.

During the summer, when I get home, I leave my suitcase in the trunk of the car a couple of days (I live in MS and it's hot as hades down here) which will kill any critters that might have hitched a ride with me.

I am totally obsessive over the bedbug situation.  EWWWWWWW.  Just thinking about it makes me want to get the bleach out again.  Thank you, kira and Sher!!!!!!  ARGHHHHHHHHHHHH.

Binney4

Time for a quick review of compression garment hygiene! Here's the StepUp-SpeakOut section on it -- if anyone has further suggestions PLEASE post them and let us know:

http://www.stepup-speakout.org/#GLOVES_AND_HYGIENE

When we were putting that page together we wrote to all the compression garment makers to ask for their suggestions. One told us never, never to wear them two days in a row without washing, but beyond that they had no suggestions. Several told us they'd never been asked that question.

Bleeeeack!
Binney

hymil

Thank you for posting this. I think the issue of patient-contact healthcare workers with LE would come under Special needs protection on the StepupSpeakout page along with dog-groomers, or mayebv even its own section. With one woman in eight going to get BC, and the majority of healthcare workers being female, that must be a lot of nurses etc....dealing with it. Cancers used to be mostly for retired people but now so many younger women are getting it and still in employment.

kira66715

When I re-read this: her glove was noticably dirty--that takes a lot of not washing, in my experience, and if she was treated 5 times for scabies without resolution, she must have had a lot of mites on her.

Still, it's an important point, both for the protection of others, and ourselves. It's so hard to wear a glove in public and not touch germ central areas like the pens at credit card stations, or door knobs.

It's the reason I don't wear my glove at work: because I examine patients and have to wash my hands before and after I touch them. I do wear my glove at my desk, and wonder about what nasty germs are on my pen and make sure to wash them daily.

Wouldn't it be nice if there were glove covers that could be easily slipped on and off. I've worn white cotton gloves, but more to protect my glove when I'm painting than for hygiene.

Kira

Binney4

Kira, I wear the white cotton gloves for Curves and anything else where I'm touching what other people touch a lot. Probably would be a good idea even if we didn't have LE!

Hymil, I agree, a section of suggestions specifically for healthcare workers would be very helpful -- these questions do come up a lot.
Binney

toomuch

KIRA-You know this article struck a cord with me. Fortunately with wrapping every night, I have gotten my LE under reasonable control I have worn no sleeve or glove at work my last 4 or 5 shifts and only have mild hand swelling at the end of the day. I previously tried wearing my sleeve and no glove and my hand had significant swelling at the end of my shift. I hope that I manage to keep the LE in check with wrapping because I have yet to figure out a way for good patient hygiene and wearing a glove.Thanks for posting.

hymil

toomuch, if you can't keep it down with night wrapping, you might see whether your employer can give you non-contact duties instead, or maybe at least for the afternoons? As it's a consequence of cancer and treatment for, they are obliged to make some allowances. You shouldn't have to compromise your own health.

toomuch

Hymil-My employer has actually been great through my cancer treatment this year. A significant portion of my job is now administrative. I'm sure that they would allow me to work less clinical hours but that's the part of the job that I love. I'm not ready to give it up because of BC. Now that I'm wrapping every night, even my LE therapist thinks it looks great. The only swelling I have is on the palm side of my wrist and between my 3rd & 4th and 4th & 5th metacarpal bones. It's only visable if I make a fist and you look at the knuckles so it is mild. I'm really hoping that if I'm consistant at night with wrapping and MLD, it will stay this way. Ofcourse, I'm already learning that LE is unpredictable to my fingers are crossed!

kira66715

Toomuch--we sound similar--I wrap every night, and the swelling is in the web spaces between my MCP's--especially between the index and middle finger, and there's a little palm swelling below the index finger.

I did have issues with the palm side of the wrist a couple of years ago, but they settled down.

If I wrap every night, I can get away with no glove while doing clinical work. I do feel my hand swell at times, later in the day, but I wear the glove for the drive home.

The compromises we make...

Kira

cookiegal

The think I hate the most about my current glove is that is looks dirty...even though I wash it every night in a washing machine. I rub soap into the fingers and it just looks grubby.

Any advice?

Leah_S

toomuch, if the swelling is in your hands you might not want to cross your fingers too tight...

Leah

toomuch

Leah- LOL!

Leah_S

OK, what I've been wondering about this - how can a nurse (with or without LE and a glove) work in a newborn nursery when she has scabies? I would question the ethicsof a nurse who does NOT call in sick in that situation.

Leah

Sher

My granddaughter picked scabies up from school when she was young (mostly on her hands) and it was definitely something that could be seen.  Maybe the nurse worse the glove to hide the scabies? 

I agree Leah and how could a nurse NOT know about scabies and the risk of infecting the babies?

kira66715

Leah, years ago when I was working at a hospital, there was an outbreak of staph infections in the newborn nursery, and I remember one of the nursery nurses had fake nails with gem stones glued to them, and I kept looking at her hands, and thinking "how do you clean under those?"

Sometimes people just don't get it. 

The nurse in the article, with the filthy glove and unresolved scabies after 5 treatments, was a per diem nurse, so she took the shifts she got...

I teach with a psychologist who works in a children's psychiatric hospital and the CDC was called in this year due to an outbreak (they kept it out of the papers) and they were given long lectures about appropriate handwashing--that was the primary intervention.

Kira