Research and knowledge exchange

Developing a multi-stakeholder network to improve scabies outbreak control in residential care

Principal Applicant: Professor Jackie Cassell (Director of Research and Knowledge Exchange and Chair in Primary Care Epidemiology, Brighton and Sussex Medical School)

Co-Applicants: Dr David Orr (Lecturer in Social Work, Social Work and Social Care)

Amount awarded: £40,002

Project dates: January 2016 – October 2016

The issue

Scabies outbreaks in residential care homes for the elderly is an important public health concern. Scabies is an intensely itchy and distressing skin infection caused by a tiny mite. It is primarily spread by skin to skin contact and is outbreaks commonly occur in residential care homes and although relatively easy to treat, it is often underreported due to stigma or misdiagnosis.  This project aims to improve practice within the care sector to enable early recognition, and so reduce the size and length of outbreaks.

The research

Public Health England (PHE) health protection teams provide advice and guidance to care home managers and healthcare professionals, but our survey (REF 1 below) showed that guidance is highly variable. 

Recently published mixed methods research by the project team (1-4)  found that delayed diagnosis, misdiagnosis and incorrect treatment is common which can result in outbreaks lasting for several months. We have recently completed a clinical study which describes the appearance of scabies in elderly skin.  It provides clues to why diagnosis is so often delayed, and identifies ways this could be improved.

Having collected research project’s key objective is now to build a network of key stakeholders, in partnership with Public Health England, and to work with them to develop awareness and understanding of the condition.  They will work to develop evidence based practices to manage scabies outbreaks better in residential care homes.

The team is working with a team of stakeholders to develop national guidance on outbreak management which can be published and shared with healthcare professionals, care home staff, residents and their families. The research will also inform local educational events and online resources to raise awareness and to promote learning and the reduction of stigma.

Impact goals

The project seeks to develop and publish guidelines to improve the early detection and quality of management of scabies in residential care homes.

Through these guidelines healthcare professionals will have better knowledge and skills to diagnose and manage scabies in residential care settings and staff will have greater confidence and competence in identifying possible scabies outbreaks.  As a result, greater knowledge and confidence about scabies will lead to reduced stigma and distress when outbreaks occur in residential care homes.

Impact outputs

  • Knowledge is currently being co-produced with care home users, staff and members of the public with experience of scabiesto better understand what good practice might look like.
  • A stakeholder working party is being developed to consider dissemination across the health sector. 
  • A public engagement programme is being developed, with the help of humanities colleagues, to help people understand scabies, and to ensure guidelines and educational materials are fully informed by the needs of those affected. The project team held a Scabies exhibition at a medieval pilgrim's hospital in Canterbury. Visit the Scabies Dream Twitter page, to find out more.


Further information

If you would like to know more about this project, please contact Professor Jackie Cassell: 

Further information on the ESRC IAA SSSIF can be found hereAlternatively please contact Nora Davies, ESRC IAA External Partnerships Project Manager: