NSW Health is struggling to contain an outbreak of scabies at four hospitals, all of them in the Illawarra region.

Because scabies has an incubation period of up to six to eight weeks, hospital patients from mid-May are being urged to be mindful of symptoms.

This suggests the scale of the outbreak is potentially large.

So far, though, about 40 people have been identified with the infection, most of these hospital workers.

Given those workers need to stay away from work, the hospitals may find themselves stretched just coping with day-to-day events.

The situation is exacerbated by the high level of surveillance and hot washing of linen required to keep wards scabies-free.

What is scabies?

Scabies is a highly-contagious parasitic infestation.

Tiny eight-legged mites, Sarcoptes scabiei, burrow and tunnel into the skin and lay eggs.

According to the Better Health Channel, scabies is spread by direct, prolonged physical contact including sexual activity.

The mites create tunnels under the skin. These are prone to infection. Photo: Getty

Scabies mites can survive away from humans for about 24 to 36 hours.

It’s possible to get scabies from infected belongings (such as bed linen and clothing), although this is much less common.

When the eggs hatch, the newborn mites spread to other parts of the skin.

The infection triggers an immune response.

This involves a rash that “may affect much of the body or may be limited to common sites such as between the fingers, wrists, elbows, penis, nipple, waist, buttocks and shoulder blades”.

The head, face, neck, palms and soles are often involved in infants and very young children, but not usually in adults and older children.

The problems caused by scratching

The most difficult symptom is an intense itching.

Patients are discouraged from scratching, because it spreads the newborn mites and caused the affected patches to grow.

Scratching can also lead to bacterial  infections, some of them serious.

According to a report from Australian Family Physician, “scabies lesions are often secondarily infected” with Streptococcus and/or Staphylococcus “because of breaches in the skin barrier”.

These organisms “have the potential to cause local soft tissue infections such as impetigo, cellulitis and abscesses, and can also lead to potentially fatal bloodstream and other sterile site infections”.

The scabies rash will infect the folds in your skin, but also hands, arms and torso.

According to Health Direct, cellulitis is a bacterial infection of the skin spreading to the tissues under your skin.

It can become serious if it’s not treated quickly with antibiotics. If you have cellulitis, you can quickly become very unwell.

Impetigo, also known as ‘school sores’

A very common skin infection that causes skin sores and blisters, impetigo usually affects young children.

The infection can easily spread in places such as schools and childcare centres.

If children are already infected with scabies, and then impetigo, you could have a double-whammy situation to deal with.

More bad news: Scabies itching may continue for two to three weeks after treatment.

Itching is usually worse at night or after a hot bath or shower.

Length of infection and treatment

Symptoms usually develop three to four weeks after infection.

However, people who have previously been exposed may develop symptoms within 24 to 48 hours, because the immune system takes less time to respond.

Generally, a person is no longer infectious 24 hours after treatment.

A common topical treatment for scabies is permethrin cream, which can be obtained without a prescription. Permethrin kills the mites and their eggs.

It’s generally considered safe for adults, people who are pregnant or breastfeeding, and children over two months old.

Prevention

According to the Mayo Clinic, to prevent scabies from coming back and to keep the mites from spreading to other people, do the following:

• Wash all clothes, towels and linen used in the past three days in hot, soapy water before beginning treatment. Dry with high heat that kills mites
• Starve the mites by placing items you can’t wash in sealed plastic bags and leave them in the garage or shed for a week. Mites die after a few days without food
• Clean and vacuum furniture, carpets and floors to remove scales and crusts that may have scabies mites.