The team identified that one per diem nurse, had contributed to 10 of the 10 electronic medical records examined. Upon evaluation, 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. She also reported that she had been treated for scabies at least 5 times in the previous year. During the same 7-month period as the cluster, she reported that she also worked in a Florida hospital’s nursery. The staff at the Florida hospital stated that they had identified a cluster of scabies in infants in their institution also.
At NYP Hospital, they found that this nurse had cared for 392 patients including mothers and a letter was sent to each patient describing the outbreak investigation. This process identified 3 additional cases. I agree with their conclusion that "a single case of scabies in a newborn should be considered a sentinel event of a nursery outbreak.
Ross BG et al. ICHE May 2011