Scabies cases prompt alert at Hopkins AIDS outpatient clinic temporarily closes

HIV ward halts visits

'No health hazard'

Two recent outbreaks of itchy skin disease infect staff members

September 22, 1996|By Ronnie Greene | Ronnie Greene,SUN STAFF

Johns Hopkins Hospital temporarily shut down an AIDS outpatient clinic and barred visitors from an HIV ward after the second outbreak in three months of scabies, an itchy skin infection that spread from a patient to two dozen doctors and nurses.

The outbreak was so severe Hopkins turned to an outside supplier for a cream to treat scabies, which is caused by a burrowing mite and characterized by severe itching and a red bumpy rash. The infection usually is spread by human contact.

Hopkins is contacting 150 patients who have been through the ward during the past three months to check their symptoms and offer free treatment.

The dual outbreaks -- in June and this month -- have prompted Hopkins to rewrite policies on handling scabies.

"This is not equivalent in any respect to [tuberculosis] outbreaks hospitals," Dr. Richard E. Chaisson, director of the AIDS Service at Hopkins, said yesterday. "But it nonetheless is incredibly annoying for the individuals who acquired this on the job."

Hospital officials said both outbreaks have been limited to one clinic and one ward. The outpatient clinic will reopen tomorrow, and visitors barred from the ward for eight hours Friday were allowed to return Friday evening and yesterday.

"In no way is patient care in any sense of the word being compromised," said Gary Stephenson, hospital spokesman. "This is annoying, certainly, but it poses absolutely no health hazard to patients, or visitors or staff."

Chaisson said such outbreaks at hospitals are not highly unusual.

"It's certainly common in day care centers. It's common in schools," said Dr. Georges Benjamin, deputy secretary for Public Health Services for the Maryland Department of Health and Mental Hygiene. "There's no reason why it wouldn't be something that would happen in a hospital, too."

The June outbreak has been linked to a human immunodeficiency virus patient who entered Johns Hopkins with severe rash. Eventually, the hospital diagnosed the patient's ailment as Norwegian scabies, a severe, highly contagious form of the infection.

But in the time it took to diagnose the case, several workers were exposed to the infection, Chaisson said.

"They thought the patient had a severe skin disease and were looking into it, and made the diagnosis and began the treatment without a lot of delay," he said. "This wasn't a period of many days or weeks. But it doesn't take very long for this form of scabies to result in transmissions to health care workers."

Within two weeks, eight or nine health care workers had developed scabies, which spread to their arms, chests, abdomens, thighs, lower legs or hands.

In the June outbreak, the hospital did not close its acquired immune deficiency syndrome outpatient clinic or HIV ward. Instead, it provided ointment to workers and patients who developed scabies.

In the second outbreak, at least a dozen workers became infected.

"That's when the decision was made to close our clinic for a day and to restrict visitors. That was primarily to give everyone on the staff an opportunity to be treated," Chaisson said.

Several workers who have developed scabies in the second outbreak declined to comment.

Chaisson said he expects only about six patients to develop scabies. Hopkins is more aggressively checking for potential cases, he said.

"We don't want to wear spacesuits and have no physical contact with our patients and isolate them," Chaisson said. "But, on the other hand, this is a lesson that it is possible for these minor and not dangerous, but certainly annoying and unpleasant, skin infections to be transmitted between patients and staff."

Pub Date: 9/22/96


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