Examination of a patient for scabies and pediculosis

The equipment needed to perform this skill:

• table for disinfection activities,
• containers for disinfection measures with working solution of chemical disinfection agent:
  • «Disinfection of dressing materials, PPE»,
• non-sterile gloves
• mask
• skin antiseptic solution
• anti-pediculosis paving:
  • Bags for collecting patient's belongings (cloth, lined)
  • Waterproof apron
  • Rubber gloves
  • Respiratory PPE.
  • Headwear (shower cap)
  • Scissors.
  • Hair trimmer.
  • A single-use razor.
  • Frequent crest.
  • Vata.
  • Table vinegar.
  • Pediculocidal insecticides.
  • A container for room disinfestation, labeled.
  • Sprayer for irrigation with pediculocide solution.
  • Magnifying glass.

Level of care:

Outpatient and hospital health care organization

Description of the clinical situation:

You are an emergency room physician. You need to examine an incoming patient for pediculosis and scabies

The order in which the skill is performed:

• Provide the patient with information about the upcoming study and obtain their consent
• Perform hygienic antisepsis on the skin of your hands
• Wear gloves
• It is necessary to have a well-lit workplace
• Check for pediculosis:
  • Inspect for hair lice using a magnifying glass.:
    • of the head (paying attention to the temporo-occipital area).
    • of the mustache, beard, eyebrows, eyelashes.
    • of the underarm skin.
    • of the pubic area
  • Patient's clothing and linen (seams, folds, collars, belts)
  • If pediculosis is detected, mark "P" on the front side of the "Inpatient Medical Record"
• Examine the skin for scabies.
  
  • for the presence of scabies passages (zigzag lines consisting of black dots a few millimeters long, resembling scratches on the skin) on the flexor surfaces of the upper and lower extremities: hands, interfinger spaces, wrists, elbows, feet, genitals of men, mammary glands of women.
  • the presence of scabs, erosions, bloody crusts on any skin area
  • Check for complaints of itching of the skin, which increases at night.
  • on the polymorphism of the rash:
  • Isolated, small vesicles without signs of inflammation on hands, wrists and feet
  • follicular papules on the torso: abdomen, chest, buttocks, antero-lateral thighs
  • bloody crusts on and around the elbows, in the intergluteal fold with a transition to the sacrum.
  • purulent crusts and pustules on and around the elbows

When scabies is detected:

• Submit an emergency notification in form 89/u to the territorial center of hygiene and epidemiology
• prescribe treatment with an anti-scabies drug according to the regimen
• If the diagnosis of scabies is doubtful, refer the patient to a dermatovenerologist for laboratory confirmation of the diagnosis, and involve contact persons in the examination.

When lice are detected:

• Wear an extra set of PPE:
  
  • robe,
  • headwear,
  • waterproof apron,
  • gloves,
  • mask.
• Conduct anti-pediculosis treatment of the patient using anti-pediculosis styling products 
• Process the patient's clothing
  
  • Place the patient's personal clothing in a cloth bag and then a Kleenex bag.
  • spray the outside of the bag with pediculocide.
  • send the bag to a health care organization for chamber disinfestation
• Process the patient's hair
  
  • Place a cloth on a chair (couch), sit the patient on it and cover his shoulders with a polyethylene diaper.
  • If necessary, trim the hair over the prepared basin.
  • treat the hair with a pediculocidal solution (Nittifor or any other pediculocide according to the instructions for use)
  • tie the head with a polyethylene headscarf and a towel on top, leaving it for a certain time (the time of wetting the hair depends on the type of solution used - permethrin, 20% benzyl benzoate solution, nitthyphor).
  • untie the head and rinse with warm running water (note: shampooing is contraindicated with some products).
  • dry your hair by the towel
  • treat the hair with a 6% solution of acetic acid.
  • rinse your hair with warm running water
  • towel dry
  • bend the patient's head over white paper, thoroughly comb out the hair strands by strands with a fine-toothed comb
  • re-examine the patient's hair.
  • wash with warm running water and soap, dry with a towel.
• Disinfect shorn hair and paper and dispose of by incineration
• Comb, scissors, clippers, shearing machine, treat the room with disinsecticide solution by irrigation method
• retreatment after 7 days

The use of disinsecticidal solutions is contraindicated in pregnant women, women in labor, nursing women, children under 5 years of age, scalp diseases

Sanitization of patients when pubic lice are detected.

• Wash the patient's body with hot water and soap.
  Shave off the affected hair.
  Wash the patient's body again with hot water and soap.
  Disinfect and dispose of the shaved hair.