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35 27.336.3 2. BUNcreatinine 3. 1. 2. 1:1 Ulex 10 CrotamitonBB solution 25 benzyl benzoate 1.

36 2. 50 90 5 0 2~6 1~3 visual analogue scale, VAS, 0~10 8~10 20072007 2007 2001 2002 20072007 2002 skin scraping KOH 2007

37 Dupuy et al., 2007 Levitt, 2008 Neynaber, 2008 1. benzyl benzoate 1025 24 2. Crotamiton 10 24 48 3. Lindane 1 8~12 Ivermectin 0.2 mg/kg 2005 2001 Benzyl benzoate BB solution 10 25 1:1 1:2 2007 3 60 2001 1:100 24 2002 1. 2. 3. 4. 5. 6. 7. 8. 2000 1~5 3 40 2008 1 3 2008 12 31 12 2008 1 3 2 29 1 3

5. 1. 2. 38 1. 1. 15 15 14 44 2. DVD 4 7 10 21 3. 9 6 9 24 4. 15 15 15 45 5. 15 13 15 43 6. 15 15 15 45 7. 15 15 15 45 2. 1. 15 15 15 45 2. 15 15 12 42 3. 12 9 5 26 4. 12 7 8 27 5 5 4 3 2 1 2008 1 2 3 4 5 6 7 8 9 10 11 12 1. 2. 3. 3-1 3. 3-2 3-3 3-4 3-5 3-6 3-7 4. 5 1. 2. 3. 4.

39 1 2 1 1.

40 0 1 2 10 3 4~6 7~10 0 1~2 3 1 2. 3. 1:1 Ulex+BB solution 24 BB solution Ulex 1:1 Ulex+BB solution 4. 5.

41 1:100 20 1. 1:1 Ulex+BB solution 2. 3. 4. 5. 1:10030 6. 60

42 1. 2. 3. 60 2008 3 1 12 31 2008 3 2008 3 10 11 100 1. / 24 5 32. 5 3

43 3. 2008 11 1 12 31 50 90 4.8 96 1 2 3.395 12 0 0 2008 1 12 N=11 1. 5 45.4 10 90.9 2. 2~6 5 45.4 10 90.9 3. 4 36.3 10 90.9 4. 2 5 45.4 9 81.8 5. 3 27.3 10 90.9 6. 7 63.6 11 100 7. 1:100 5 45.4 11 100 8. 10 90.9 11 100 9. 7 63.6 10 90.9 10. 5 45.4 10 90.9 50 90

44 N=11 1 7 4 0 0 0 4.64 4.80 2 8 3 0 0 0 4.73 3 10 1 0 0 0 4.91 4 9 2 0 0 0 4.82 5 10 1 0 0 0 4.91 2007 2008 12 1 2 3 4 5 6 7 8 9 10 11 12 6 4 2 1 1 0 0 0 0 0 0 0 0 54 61 59 59 59 63 60 59 59 61 60 60 59 11.1 7.57 3.39 1.69 1.69 0 0 0 0 0 0 0 0 0 1 0 0 0 2 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 11 11 11 11 11 11 10 10 10 10 10 10 10 9.1 9.1 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - - - - - - - - - - - - - - - - - - - - - Ulex BB solution 2010

45 Lindane 1 Gammabenzene hexachloride-bhc 8~12 Olley 2011 2001 19 155-160 2002 scabies 18 5 237-246 2010 5

46 3 http://www.cdc.gov.tw/ sp.asp?xdurl=disease/ disease_content. asp&id=2382&mp=1&ctnode=1498 2000 4 6708-713 2007 50 6266-272 2007 50 7320-332 2002 12 6337-344 2001 16 7160-163 2005 1 2 60-64 Dupuy, A., Dehen, L., Bourrat, E., Lacroix, C., Benderdouche, M., Dubertret, L., et al., (2007). Accuracy of standard dermoscopy for diagnosing scabies. Journal of American Academy of Dermatology, 56(1), 53-62. Levitt, J. O. (2008). Digital photography in the diagnosis of scabies. Journal of American Academy of Dermatology, 59(3), 530. Neynaber, S. (2008). Diagnosis of scabies with dermoscopy. Canadian Medical Association Journal, 178(12), 154. Olley, M. (2011). Why you need to know about scabies infections. Nursing & Residential Care, 13(6), 286-289.

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49 Improvement Project for Cluster Infection of Scabies in Hemodialysis Room A-Chen Lee Mei-Man Chang* Shu-Yuan Chu** Hsiu-Yu Sung*** Su-Fei Chang**** Abstract Scabies infection can exacerbate the sensation of itchiness among patients with renal failure. Patients may break their skin or even pull the dialysis catheter out accidentally when scratching. As the patient s turnover in a general dialysis ward averaged four hours per batch, a single patient infected with scabies can lead to cluster infection outbreak. In December 2007, a cluster of scabies infection occurred in our hemodialysis unit (the infection rate was 11.1%). The main cause of outbreak was a lack of cognition about scabies, and the absence of a standard operation procedure to effectively prevent their infection. The objective of this project aimed to increase the alertness of nursing staff to scabies and reduce the infection rate among hemodialysis patients. Project strategies included establishing a scabies assessment check list, in-service training programs, a flow chart based on the management of scabies infection, and the utilization of healthcare education leaflets and shift-handover logs for between family- institution intercommunication (hence providing a continuity of treatment). After the implementation of this project, the scabies infection rate dropped to zero for both patients and nursing staff in our hemodialysis unit (a record that has endured for nearly two years). The outcome of this project not only allowed increased alertness of hemodialysis staff on scabies prevention but also enabled early treatment to further preventing the spreading of the infection. As a result, the scabies infection rate among hemodialysis patients was successfully reduced, ensuring the safety of patients and staff alike. Key words: hemodialysis, scabies, cluster infection Former HN, Hemodialysis Room, Han Ming Hospital RN, Division of Infection control, Han Ming Hospital* Director, Department of nursing, Han Ming Hospital** Lecturer, School of Nursing, Hungkuang University*** Attending physician, Hemodialysis Room, Han Ming Hospital**** Received Jan. 3, 2011 Revised Jul. 25, 2011 Accepted for publication Sep. 21, 2011 Correspondence Hsiu-Yu Sung, No.34,Jhon-Gci Rd.,ShaLu Township,Taichung433,Taiwan Telephone04 26318652 ext 3152 E-mail sheu@sunrise.hk.edu.tw