We investigated a cluster of skin rashes on an inpatient adult and pediatric eating
disorders treatment facility (EDTF) unit where group activities occur and include
An epidemiological investigation was launched after scabies was diagnosed in patient
A (occupying room X). An interprofessional team was engaged and included EDTF leaders,
dermatology, environmental services, and infection prevention. Patient A was treated
for scabies and persons with epidemiologic links were informed of possible exposure.
Within two weeks, patient B (occupying room X) was evaluated by dermatology for a
rash deemed inconsistent with scabies, but bed bug bites could not be excluded. Pest
control professionals assessed room X for bed bugs, none were found. Four weeks later,
a bed bug was visualized in room X (occupied by patient B). Pest control professionals
confirmed presence of bed bugs and treated the room with high temperature heat. The
investigation was expanded to persons with epidemiological links to patient B.
92 employees were informed of scabies exposure, no post exposure prophylaxis administered
as none reported skin-to-skin contact. 55 patients had a concurrent inpatient stay
with patient A. Of these, 9 had possible skin-to-skin contact and received prophylaxis.
25 were discharged and informed of possible exposure, none sought prophylaxis. Therapy
dogs were examined, no fleas identified. Heat treatment cost was approximately $1000.00.
There were no bedbugs identified outside room X and no additional patients with bed
bug-related rashes. Investigative data supports source of bed bugs was outside the
facility. Policies are under revision to restrict personal items, such as bedding,
brought to EDTF.
This investigation illustrates challenges with identifying etiology of arthropod-related
skin rashes in a special population and the need to reevaluate hypotheses as data
unfolds over time. An interprofessional team supported timely implementation of control