Examination for Ectoparasites (Scabies and Pediculosis) and Microsporia (Ringworm)

Authors: Simulation and Certification Center

Editor: Rednenko V.V.

Equipment for the practical skill (Gather prior to starting)

• Personal Protective Equipment (PPE): Disposable gloves, disposable apron/gown, face mask. A respirator (e.g., N95, FFP2) is recommended if aerosolizing sprays are used.
• Lighting: A strong, adjustable examination light.
• Magnification: A magnifying glass or loupe.
• Detection Aids: Fine-toothed comb (nit comb), disposable wooden tongue depressors (for hair parting).
• Patient Items: Disposable patient gown, paper sheets.
• Documentation: Patient chart/forms for documentation.
• For Confirmed Cases (Kit): Sealed plastic bags for belongings, pediculocide, shower caps, cotton balls, vinegar (for nit removal), and a waste bag for clinical waste.

Clinical situation:

• Routine screening upon admission to a healthcare facility.
• Patient reports pruritus (itching), especially nocturnal.
• Visible signs of rash, excoriation, or nits in hair.
• Known contact with an infested individual.

The procedure for performing a practical skill

Integrated Nursing Admission Screening & Treatment: Ectoparasites and Dermatomycoses

Clinical Procedure: Comprehensive Skin, Scalp, and Hair Examination and Treatment upon Patient Admission

Objective: To perform a rapid, thorough screening for contagious skin conditions and to execute immediate, evidence-based nursing interventions to treat infestations, preventing nosocomial outbreaks.

I. Key Principles

• Infection Prevention is Paramount: This is a primary defense for healthcare workers and other patients.

• Patient Dignity & Consent: Explain all steps, obtain consent for treatment, and maintain privacy to reduce anxiety.

• Systematic Approach: Follow a consistent head-to-toe sequence for screening and a strict protocol for treatment.

• Nursing Autonomy: In many settings, treatment for ectoparasites based on clear findings is a standing nursing order or protocol.

II. Equipment
A. For Screening:

• PPE: Non-sterile gloves.

• Lighting: Strong, adjustable light.

• Magnification: Magnifying glass.

• Detection Aids: Fine-toothed comb (nit comb), tongue depressor.

B. For Treatment (The "Pediculosis/Scabies Treatment Kit"):

• Enhanced PPE: Waterproof gown, nitrile gloves, N95 respirator (or mask and goggles), disposable hair cap.

• Patient Protection: Large waterproof disposable apron or sheet.

• Hair Treatment:

  • EPA-approved pediculocide shampoo/lotion (e.g., Permethrin 1%).

  • Disposable shower cap.

  • White paper or towel.

  • 6% acetic acid (vinegar) solution or commercial nit remover.

  • Wide-toothed and fine-toothed combs.

• Environmental Control:

  • Sealed plastic bags (2: one transparent, one opaque) for patient belongings.

  • Insecticide spray for surfaces (following facility policy).

• For Scabies: Topical scabicide lotion (e.g., Permethrin 5%) as per physician's order or protocol.

III. Procedure

Step 1: Preparation

1. Introduce yourself to the patient and/or guardian.

2. Explain the procedure: "As part of our standard admission process, I need to do a quick check of your skin and scalp for any common conditions. This helps us keep everyone in the hospital safe. It will only take a few minutes."

3. Obtain verbal consent.

4. Ensure complete privacy (close curtains/door).

5. Perform hand hygiene and don gloves.

6. Position the patient comfortably on an examination chair or bed. Ensure the lighting is excellent.

Step 2: Comprehensive Scalp and Hair Examination
(This single step combines screening for pediculosis and microsporia)

1. Using a tongue depressor, part the hair in multiple sections under bright light.

2. Scan for Pediculosis (Lice):

   • Look for: Small, mobile, sesame-seed-sized insects (adult lice) and tiny, oval, yellowish-white nits (eggs) firmly cemented to the hair shaft, especially near the scalp at the nape of the neck and behind the ears.

3. Scan for Microsporia (Ringworm):

   • Look for: Circular or irregular patches of hair loss (alopecia). Within these patches, check for:

     • Black dots (broken-off hairs).

     • Scaly, red, or inflamed skin.

     • Brittle or dull hair.

   • Gently feel for tender, boggy, or pus-filled areas (a kerion).

Step 3: Full Body Skin Examination
(This step combines screening for scabies and body-level microsporia)

1. Ask the patient to remove outer clothing, providing a gown for modesty.

2. Scan for Scabies:

   • Inspect: Pay close attention to the webbing between fingers, flexor surfaces of wrists, elbows, axillae (armpits), waistline, genitalia (males), and areolae (females).

   • Look for: Tiny, linear, grayish-white burrows (2-10 mm long), red papules, and evidence of scratching (excoriations, crusting).

3. Scan for Tinea Corporis (Body Ringworm):

   • Inspect: All skin surfaces.

   • Look for: Characteristic annular (ring-shaped) lesions with a raised, red, scaly, or vesicular border and a clearer center. Lesions can be singular or multiple.

Step 4: Focused Interview
Ask targeted questions while examining:

• "Do you have any itching, especially at night?" (suggests scabies)

• "Has anyone in your family, school, or close contacts had a similar rash or itchy scalp?" (assesses for outbreak)

• "Have you had any contact with animals lately? Cats, kittens, or dogs?" (key risk factor for microsporia)

• "Have you noticed any flakes, scaling, or patches of hair loss?" (directly addresses microsporia)

Step 5: Action Plan for Positive Findings

V. Documentation
Document clearly and objectively in the patient's medical record:

• Findings: "Live lice and nits observed in scalp."
• Actions Taken: *"Informed consent obtained. Treated with Permethrin 1% lotion per protocol. Nit combing performed. Belongings bagged. Patient educated on 7-day follow-up."*
• Precautions Initiated: "Patient placed on Contact Precautions."
• Notifications: "Dr. [Name] notified for scabies treatment orders."

• Your name and title.