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PubMed2004

Computer keyboard and mouse as a reservoir of pathogens in an intensive care unit.

OBJECTIVE: User interfaces of patient data management systems (PDMS) in intensive care units (ICU), like computer keyboard and mouse, may serve as reservoirs for the transmission of microorganisms. Pathogens may be transferred via the hands of personnel to the patient causing nosocomial infections. The purpose of this study was to examine the microbial contamination of computer user interfaces with potentially pathogenic microorganisms, compared with other fomites in a surgical intensive care unit of a tertiary teaching hospital. METHODS: Sterile swab samples were received from patient's bedside computer keyboard and mouse, and three other sites (infusion pumps, ventilator, ward round trolley) in the patient's room in a 14 bed surgical intensive care unit at a university hospital. At the central ward samples from keyboard and mouse of the physician's workstation, and control buttons of the ward's intercom and telephone receiver were obtained. Quantitative and qualitative bacteriological sampling occurred during two periods of three months each on eight nonconsecutive days. RESULTS: In all 14 patients' rooms we collected a total of 1118 samples: 222 samples from keyboards and mice, 214 from infusion pumps and 174 from the ward's trolley. From the central ward 16 samples per formites were obtained (computer keyboard and mouse at the physician's workstation and the ward's intercom and telephone receiver). Microbacterial analysis from samples in patients' rooms yielded 26 contaminated samples from keyboard and mouse (5.9%) compared with 18 positive results from other fomites within patients' rooms (3.0%; p < 0.02). At the physician's computer terminal two samples obtained from the mouse (6.3%) showed positive microbial testing whereas the ward's intercom and telephone receiver were not contaminated (p = 0.15). CONCLUSIONS: The colonization rate for computer keyboard and mouse of a PDMS with potentially pathogenic microorganisms is greater than that of other user interfaces in a surgical ICU. These fomites may be additional reservoirs for the transmision of microorganisms and become vectors for cross-transmission of nosocomial infections in the ICU setting.

Bacteria↗
PubMed1997

Papillomavirus is resistant to desiccation.

There is strong epidemiologic evidence for sexual transmission of high-risk genital human papillomavirus (HPV) types. However, it is unclear if infection may also be transmitted indirectly via fomites. To assess this possibility, the in vitro infectivity after desiccation was compared for pseudotype HPV-16 virions, a model for high-risk type genital HPV, and bovine papillomavirus type 1 (BPV-1), a papillomavirus known to be transmitted via fomites. The 2 viruses had similar resistance to desiccation in cell extracts, retaining approximately 100%, 50%, and 30% of infectivity when dehydrated for 1, 3, and 7 days, respectively, at room temperature. Pseudotype HPV-16 and BPV in cell extracts were completely inactivated by autoclave treatment and susceptible to 70% ethanol but were resistant to EDTA or incubation at 56 degrees C for 1 h. The data suggest that further study of nonsexual spread of high-risk genital HPV via fomites is warranted.

Bovine papillomavirus 1↗
PubMed2006

Prospective study of bacterial and viral contamination of exercise equipment.

OBJECTIVE: Transmission of bacterial and viral pathogens is known to occur by hand contact with fomites. Exercise equipment in public facilities may serve as such fomites. It is not known whether equipment disinfection might reduce microorganism colonization. We performed studies to address these issues. DESIGN: Observational study of bacterial and viral culture results from hand-contact surfaces of exercise equipment, pre-exercise and postexercise; prospective study of viral culture results before and after intervention with disinfection solution. SETTING: Two fitness centers in a military community. INTERVENTION: One week trial of twice-a-day equipment disinfection. MAIN OUTCOME MEASURES: Type and number of bacteria and type of viruses present on equipment before and after exercise; prevalence of viral culture positivity on equipment before and after intervention. RESULTS: Bacterial cultures of body contact surfaces on equipment revealed benign bacterial species (coagulase-negative staphylococci, diphtheroids, and so forth) but no pathogenic bacteria whether obtained pre-exercise or postexercise, or whether from aerobic versus weight training equipment. Viral cultures revealed the presence of viruses (generally rhinoviruses) on 63 of 100 (63%) hand-contact surfaces of equipment. Weight equipment was significantly more often contaminated than aerobic equipment (73% vs. 51%; P = 0.026). Disinfection of equipment did not lower the prevalence of virus isolation (48% positive before cleaning; 86% positive after cleaning). CONCLUSIONS: There is little risk of exposure to pathogenic bacteria on exercise equipment. Such equipment may commonly serve as fomites for the transmission of viruses. These data do not suggest that disinfection of exercise equipment will offer significant protective effects against virus exposure.

Bacteria↗
PubMed2006

Evidence-based model for hand transmission during patient care and the role of improved practices.

Hand cleansing is the primary action to reduce health-care-associated infection and cross-transmission of antimicrobial-resistant pathogens. Patient-to-patient transmission of pathogens via health-care workers' hands requires five sequential steps: (1) organisms are present on the patient's skin or have been shed onto fomites in the patient's immediate environment; (2) organisms must be transferred to health-care workers' hands; (3) organisms must be capable of surviving on health-care workers' hands for at least several minutes; (4) handwashing or hand antisepsis by the health-care worker must be inadequate or omitted entirely, or the agent used for hand hygiene inappropriate; and (5) the caregiver's contaminated hand(s) must come into direct contact with another patient or with a fomite in direct contact with the patient. We review the evidence supporting each of these steps and propose a dynamic model for hand hygiene research and education strategies, together with corresponding indications for hand hygiene during patient care.

Education↗
PubMed1994

Tinea capitis: epidemiology, diagnosis, treatment, and control.

Since the 1970s there has been a steady rise in the number of cases of tinea capitis in the United States, most of them caused by Trichophyton tonsurans. Although the infection is seen most frequently in black children, it can occur in white persons and can affect persons of all ages. Control of tinea capitis is difficult for several reasons, including subtle clinical infection, asymptomatic carriage of fungus, fomite spread, and the need for weeks to months of oral medications. Although griseofulvin remains the mainstay of therapy, preliminary studies of itraconazole and terbinafine suggest that these compounds may also be useful in the treatment of tinea capitis. Selenium sulfide shampoo, prednisone, and oral antibiotics are frequently used as adjunctive therapy. The role of fomites in the spread of tinea capitis has yet to be fully understood, as does the best means of decontamination.

Adolescent↗
PubMed1988

Prevalence of Sarcoptes scabiei in the homes and nursing homes of scabietic patients.

This study determined the prevalence of Sarcoptes scabiei in the home environment of 37 confirmed cases of scabies and in five nursing homes with scabietic patients. Dust samples from 44% of infested patients' homes contained scabies mites. Live mites at the time the dust samples were analyzed were present in 64% of these homes. Live mites were recovered most often from bedroom floors or overstuffed chairs and couches. The density of live and dead mites ranged from 1 to 5 mites/0.1 gm of dust or 1 to 9 mites/m2 of surface area sampled. The presence of mites in fomites coupled with survival and host-seeking behavior indicate that it is possible for a person to become infested by dislodged mites in contaminated home, school, and work environments. By contrast, only a small number of mites were recovered from beds, furniture, and floors of scabies-infested nursing homes. Mite-contaminated fomites may be less important in the transmission of scabies in nursing homes than in private homes.

Adolescent↗
PubMed1971

Protective isolation in a burns unit: the use of plastic isolators and air curtains.

The use of plastic isolators and of an ;air curtain' isolator for protection of patients against infection was studied in a burns unit.Preliminary bacteriological tests showed that very few airborne bacteria gained access to a plastic ventilated isolator; even when the filter and pre-filter were removed from the air inflow, settle-plate counts inside the isolator were much lower than those in the open ward, but the difference was smaller in tests made with an Anderson air sampler, which showed also that fewer large bacteria-carrying particles appeared inside the isolator than outside it. An open-topped isolator allowed virtually free access of bacteria from ambient air. The numbers of airborne bacteria inside an air curtain were appreciably lower than the counts of airborne bacteria in the open ward, but not as low as those in the plastic ventilated isolator.Controlled trials of isolators were made on patients with fresh burns of 4-30% of the body surface; the patients were given no topical chemoprophylaxis against Staphylococcus aureus or Gram-negative bacilli. Patients treated in plastic isolators showed a significantly lower incidence of infection with Pseudomonas aeruginosa than those treated in the open ward; this protective effect was shown by isolators with or without filters or with an open top. Ventilated isolators, which protected patients against personal contact and airborne infection, gave a limited protection against multi-resistant ;hospital' strains of Staph. aureus, but no such protection was given by an open-topped isolator, which protected only against personal contact infection, or by air curtains, which protected only against airborne infection; the air curtain gave no protection against Ps. aeruginosa, and there was no evidence of protection by any isolator against Proteus spp. and coliform bacilli.Both the controlled trials and evidence from the bacteriology of air, hands, fomites and rectal and nasal swabs taken on admission and later, supported the view that Ps. aeruginosa is transferred mainly by personal contact, Staph. aureus probably by air as well as by contact and coliform bacilli mainly by self infection with faecal flora, many of which are first acquired from the hospital environment in food or on fomites.The use of plastic isolators is cumbersome, and of limited value except in the control of infection with Ps. aeruginosa. For this reason and because of the effectiveness of topical chemoprophylaxis such isolators are unlikely to have more than an occasional use in the treatment of burns. Though air curtains greatly reduce airborne contamination, their use in a burns unit does not appear to protect patients against infection when the alternative (and, for Ps. aeruginosa, more important) routes of contamination by personal contact and fomites are left open.

Air Microbiology↗
PubMed1999

An epidemic outbreak of Malassezia folliculitis in three adult patients in an intensive care unit: a previously unrecognized nosocomial infection.

BACKGROUND: Malassezia is a lipophilic fungus commonly found in normal human skin. Infection of the hair follicle by Malassezia furfur occurs in patients with predisposing factors such as diabetes or immunosuppression, or who are undergoing antibiotic treatment. Malassezia furfur folliculitis is an infrequent nosocomial infection which may be associated with fomite transmission. METHODS: We reviewed the clinical files of three adult patients from an intensive care unit (ICU) who simultaneously developed folliculitis through Malassezia infection. We specifically analysed predisposing factors, possible transmission modes, characteristics of skin lesions, results of biopsies and cultures, treatment, and patient outcome. RESULTS: The three male patients were in neighboring beds and they all had factors that predisposed them to underlying immunosupression. Simultaneously, and within hours of each other, they developed erythematous follicular papules and pustules on the face and chest. The skin biopsies revealed an acute folliculitis with abundant round to oval yeasts of up to 5 microm in diameter. Stains for fungi (Schiff's peryodic acid, Grocott and silver methenamine) revealed numerous unipolar budding yeasts without hyphae, consistent with M. furfur. Conventional cultures were negative. The diagnosis of folliculitis by M. furfur was established and antifinigal treatment initiated, with adequate outcome of the dermatosis. After this outbreak, the aseptic and hygienic measures of the health care personnel of the ICU were reviewed and corrected. CONCLUSIONS: The simultaneous emergence of this superficial infection by M. furfur suggests fomite participation. This dermatomycosis is an infrequent nosocomial infection in adults, which to our knowledge has not been previously reported.

Adult↗
PubMed2002

Spatial and kinetic factors for the transfer of head lice (Pediculus capitis) between hairs.

Although the global increase in pediculosis is well known, little is known about the exact nature of head lice (Pediculus capitis) transmission. Several mechanisms have been proposed such as head-to-head and fomite transmission, but some contention remains concerning the primary transmission route. This study investigated spatial and kinetic factors influencing the dynamics of hair-to-hair transfer to clarify further how head lice transmit from head to head. Forty-eight factorial experimental trials, with 10 replicates each, were conducted using 480 freshly caught P. capitis from primary school children. In the trials, each louse was placed on a stationary suspended hair or a mobile hair and was presented with mobile or stationary hairs for transmission. All hair passes involved contact between the uninhabited hair and the lice. Hairs without a louse were presented dorsally, laterally, and ventrally to the louse. They were also passed from head to tail or from tail to head and were moved at speeds of 8 m and 4 m per min. The proportion of P. capitis transmission was highly dependent on the specific setting. The tail-to-head direction, slow movement, and a parallel direction all proved favorable for transmission. The highest transfer proportion of P. capitis (85%) was observed in the setting where the presented hair was laterally slow moving in a parallel way from tail to head. No transmission at all was observed under an angle of 90 degrees. Hair-to-hair P. capitis transmission occurred more frequently when hairs were in particular physical and kinetic relationships. This suggests that head lice are less likely to take advantage of many proposed fomite transmission scenarios and are most likely to rely on head-to-head contact for transmission.

Animals↗
PubMed2000

Computer keyboards and faucet handles as reservoirs of nosocomial pathogens in the intensive care unit.

PURPOSE: We postulate that computer keyboards and faucet handles are significant reservoirs of nosocomial pathogens in the intensive care unit (ICU) setting. METHODS: Sterile swab samples were obtained from 10 keyboards and 8 pairs of faucet handles in the medical ICU at Tripler Army Medical Center during a period of 2 months. Methicillin-resistant Staphylococcus aureus (MRSA) obtained from the environmental and patient specimens were sent for DNA identification by using pulsed-field gel electrophoresis. RESULTS: A total of 144 samples were obtained (80 keyboards and 64 faucet handles), yielding 33 isolates. The colonization rate for keyboards was 24% for all rooms and 26% in occupied rooms. Rates for faucet handles in all rooms and occupied rooms were 11% and 15%, respectively. The environmental isolates annd their prevalence were: MRS, 49%; Enterococcus, 18%; Enterobacter, 12%; and all other gram-negative rods, 21%. Fourteen individual patient isolates were recorded: MRSA, 43%; Enterobacter, 21%; other gram-negative rods, 36%; and Enterococcus, 0%. By using pulsed-field gel electrophoresis, an indistinguishable strain of MRSA was identified in two patients, the keyboards and faucet handles in their respective rooms, and on other keyboards throughout the ICU, including the doctors' station. CONCLUSIONS: The colonization rate for keyboards and faucet handles, novel and unrecognized fomites, is greater than that of other well-studied ICU surfaces in rooms with patients positive for MRSA. Our findings suggest an associated pattern of environmental contamination and patient infection, not limited to the patient's room. Pulsed-field gel electrophoresis results have documented an indistinguishable strain of MRSA present as an environmental contaminant on these two fomites and in two patients with clinical infections patients during the same period. We believe these findings add evidence to support the hypothesis that these particular surfaces may serve as reservoirs of nosocomial pathogens and vectors for cross-transmission in the ICU setting. New infection control policies and engineering plans were initiated on the basis of our results.

Cross Infection↗
PubMed1997

Stethoscopes and otoscopes--a potential vector of infection?

OBJECTIVES: We aimed to determine whether stethoscopes and otoscopes used in community paediatric clinics harboured pathogenic micro-organisms, and, if so, which measures could prevent this. METHODS: Fifty-five stethoscopes belonging to paediatric physicians working in 12 community clinics were sampled for bacterial cultures by two methods: (i) direct impression of the diaphragm and bell section of each stethoscope for 5 seconds onto blood agar plates and a mannitol-salt-agar plate; (ii) swabbing the entire surface of the diaphragm of the stethoscope with a sterile cotton-tipped applicator. Forty-two otoscopes from the same physicians were sampled by rubbing the handles of the otoscopes with cotton-tipped swabs. The plates were incubated at 37 degrees C for 48 hours and examined for colony growth at 24 and 48 hours of incubation. Culture results were recorded as mean numbers of colony-forming units (CFUs). Eight additional stethoscope diaphragms were chosen at random at the participating clinics and cultured as described above. They were then wiped with alcohol swabs (isopropyl alcohol 70%), allowed to air dry for approximately 10 minutes and cultured a second time. RESULTS: All the stethoscopes and 90% of the otoscope handles were colonized by microorganisms. Staphylococci were isolated from 85.4% of the stethoscopes and 83.3% of the otoscopes, with 54.5% and 45.2% respectively being S. Aureus. Methicillin-resistant S. aureus were found in four each of the stethoscopes (7.3%) and otoscopes (9.5%). Cleaning with alcohol reduced the colony count by an average of 96.3%. CONCLUSIONS: Fomites can harbour potentially pathogenic bacteria, and with the increasing trend for children with more complex medical problems to be managed in an ambulatory setting, often by physicians who also work in hospitals, there is a real risk of spreading potentially serious infections to such patients. Simple cleansing with alcohol effectively eliminates the bacterial contamination of the fomites, and should be encouraged.

Community Health Centers↗
PubMed1987

Aerosol transmission of rhinovirus colds.

Rhinovirus infections may spread by aerosol, direct contact, or indirect contact involving environmental objects. We examined aerosol and indirect contact in transmission of rhinovirus type 16 colds between laboratory-infected men (donors) and susceptible men (recipients) who played cards together for 12 hr. In three experiments the infection rate of restrained recipients (10 [56%] of 18), who could not touch their faces and could only have been infected by aerosols, and that of unrestrained recipients (12[67%] of 18), who could have been infected by aerosol, by direct contact, or by indirect fomite contact, was not significantly different (chi 2 = 0.468, P = .494). In a fourth experiment, transmission via fomites heavily used for 12 hr by eight donors was the only possible route of spread, and no transmissions occurred among 12 recipients (P less than .001 by two-tailed Fisher's exact test). These results suggest that contrary to current opinion, rhinovirus transmission, at least in adults, occurs chiefly by the aerosol route.

Adult↗
PubMed2005

Transmission potential of the human head louse, Pediculus capitis (Anoplura: Pediculidae).

BACKGROUND: Millions of people are infested by head lice every year. However, louse transfer between hosts is not well-understood. Our goals were to determine: (1) which stages were most likely to disperse and why, (2) the likelihood of fomites transmission, and (3) if host blood gender affects louse development. METHODS: Various life stages of lice at differing densities were permitted to cross over a 15-cm hair bridge placed between two artificial blood-feeding arenas. Louse transfer caused by hot air movements, combing, toweling, and passive transfer to fabric was investigated. The ability of lice to oviposit on different foreign substrates and the hatching potential of eggs intermittently incubated for 8 h/night on a host were likewise investigated. Louse in vitro development following feeding on human female or male donor blood was compared. RESULTS: Adult lice were the most likely to disperse. Neither population density nor hunger significantly affected dispersal tendencies. Lice were dislodged by air movement, combs and towels, and passively transferred to fabric within 5 min. Females oviposited on a variety of substrates and 59% of eggs incubated for 8 h/night hatched after 14-16 days. There was no survivorship difference between lice artificially fed on female vs. male blood. CONCLUSIONS: Adult lice are the most mobile, indicating that they are most likely to initiate new infestations. Although head-to-head contact may be the primary route of transmission, less direct routes involving fomites may play a role and need further evaluation. Blood-borne factors do not appear to cause any gender-biased host preference.

Animals↗
PubMed1996

Immunomagnetic-electrochemiluminescent detection of Escherichia coli O157 and Salmonella typhimurium in foods and environmental water samples.

Hemorrhagic Escherichia coli O157:H7 strains and other virulent enteric pathogens can pose a serious health threat in tainted meats, poultry, and even drinking water. Traditional culture-based methods for assay of enteric pathogens in foods and water sources are relatively slow, and results can be ambiguous. Immunomagnetic separation (IMS) and detection methods have been investigated and appear promising for rapid bacterial assay of foods and environmental samples. In this work, a commercial sensor which combines IMS with electrochemiluminescence (ECL) detection is evaluated for detection of E. coli O157 and Salmonella typhimurium in foods and fomites. Results indicate that detection limits are in the range of 100 to 1,000 bacteria per ml in pristine buffer for E. coli O157 and S. typhimurium, respectively, or 1,000 to 2,000 bacteria per ml in food samples (depending on the sample) and that total processing and assay time is rapid (< 1 h) even in food samples. An immunologic "hook" or high-antigen-concentration prozone effect was observed above 10(4) and 10(5) bacteria per ml for E. coli O157 and S. typhimurium, respectively. IMS was accomplished in milk, juices, serum, supernatant fluids from ground beef, finely minced chicken, and fish suspensions as well as several freshwater sources and followed by ECL assay. Some samples, especially fish, gave unexpectedly high background ECL. Conversely, low ECL intensity was observed in nonfat and 2% fat milk samples, which appeared to be related to binding or entrapment of the antibody-coated magnetic beads by particulates in the milk, as revealed by microscopy. Results of this evaluation suggest the feasibility of immunomagnetic-ECL methodology for rapid, sensitive, and facile preliminary screening of various foods and fomites for the presence of virulent enteric pathogens.

Animals↗
PubMed2003

The impact of community psychological responses on outbreak control for severe acute respiratory syndrome in Hong Kong.

OBJECTIVE: To examine the public's knowledge and perception of SARS and the extent to which various precautionary measures have been adopted. DESIGN: Cross sectional survey. SETTING: General population of Hong Kong at the height of the SARS outbreak (29 March to 6 April 2003). PARTICIPANTS: 1115 ethnic Chinese adults. MAIN RESULTS: Forty per cent did not recognise fomites as a possible mode of transmission whereas 55.1% believed that the infection could be transmitted airborne. A large proportion (30.1%) believed they were very or somewhat likely to contract SARS while only one quarter believed they were very likely to survive if they contracted the disease, benchmarked against an actual case fatality ratio of 2.8% at the time of the survey and 15%-20% according to current best estimates. Precautionary measures directed against person to person droplet spread were generally adopted by most while the prevention of transmission through fomites was not practised as frequently. Respondents with higher risk perceptions and a moderate level of anxiety were most likely to take comprehensive precautionary measures against the infection, as were older, female, more educated people as well as those with a positive contact history and SARS-like symptoms. CONCLUSIONS: The findings demonstrate that the promotion of protective personal health practices to interrupt the self sustaining transmission of the SARS virus in the community must take into account background perceptions of risk and anxiety levels of the public at large. Continuing public education about preventive measures should be targeted at the identified groups with low current uptake of precautions.

Adaptation, Psychological↗
PubMed2003

Lateral transmission of equine arteritis virus among Lipizzaner stallions in South Africa.

REASONS FOR PERFORMING STUDY: A serological study conducted in 1995 revealed that 7 stallions at the Lipizzaner Centre, Gauteng, South Africa, were seropositive for antibody to equine arteritis virus (EAV). A Lipizzaner stallion imported into South Africa from Yugoslavia in 1981 had previously (1988) been confirmed to be an EAV carrier. Despite being placed under life-long breeding quarantine, EAV had been transmitted between stallions at the Lipizzaner Centre. OBJECTIVES: To investigate the phylogenetic relationships between the strain of EAV shed in the semen of the original carrier stallion and strains recovered from the semen of 5 other stallions; and to investigate the means whereby lateral transmission of EAV occurred among 7 in-contact, nonbreeding stallions at the Centre. METHODS: EAV was isolated from semen collected from the seropositive stallions using RK-13 cells. Viral RNA was reverse transcribed and amplified by polymerase chain reaction using ORF 5-specific primers, subjected to sequence and phylogenetic analysis. RESULTS: Phylogenetic analysis of strains of EAV recovered from the semen of 6 persistently infected stallions confirmed that all viruses were closely related and probably derived from a common ancestor, i.e. the stallion imported from Yugoslavia. Lateral transmission subsequently occurred among 7 in-contact, nonbreeding stallions at the Centre. It is speculated that these stallions may have been exposed to virus from bedding or fomites contaminated with semen. CONCLUSIONS: These data confirm that lateral transmission of EAV can occur from shedding stallions to susceptible, in-contact horses, including other stallions, which may become persistently infected with the virus. POTENTIAL RELEVANCE: The findings are consistent with lateral spread of a single, unique strain of EAV among a group; and suggest that transmission of EAV may be initiated by infection of one or more stallions with virus on bedding or other fomites contaminated with EAV- infected semen.

Animals↗
PubMed2005

Viral load distribution in SARS outbreak.

An unprecedented community outbreak of severe acute respiratory syndrome (SARS) occurred in the Amoy Gardens, a high-rise residential complex in Hong Kong. Droplet, air, contaminated fomites, and rodent pests have been proposed to be mechanisms for transmitting SARS in a short period. We studied nasopharyngeal viral load of SARS patients on admission and their geographic distribution. Higher nasopharyngeal viral load was found in patients living in adjacent units of the same block inhabited by the index patient, while a lower but detectable nasopharyngeal viral load was found in patients living further away from the index patient. This pattern of nasopharyngeal viral load suggested that airborne transmission played an important part in this outbreak in Hong Kong. Contaminated fomites and rodent pests may have also played a role.

Adult↗
PubMed2000

An epidemiologic and therapeutic reassessment of scabies.

Scabies is a highly contagious infestation that causes considerable discomfort. Newer information concerning therapeutics and epidemiologic dogma needs assessment. An epidemiologic evaluation of available world data is analyzed, as well as an assessment of therapeutic alternatives. Using epidemiologic techniques, the following points are proven: scabies is not primarily a sexually transmitted disease; 30-year cycles of scabies do not exist; scabies spreads in households and neighborhoods in which there is a high frequency of intimate personal contact or sharing of inanimate objects; and fomite transmission is a major factor in household and nosocomial passage of scabies. Epidemiologic evaluation proves the necessity of fomite precautions and of treatment of asymptomatic family members and physical contacts of all cases of scabies. Single oral-dose therapy of ivermectin (Stromectol) appears to be the treatment panacea for this infestation.

Animals↗