Roughly 1,650 people have been treated for scabies after an infestation spread through Joseph Brant Hospital.

A further 1,200 former patients have been notified by letter that they may have been exposed to the "voracious little mite" that burrows into the upper layer of skin and lays its eggs, causing an itchy rash.

"We've been very diligent and aggressive in our approach," said senior vice-president Susan Wannamaker. "We've taken this very seriously … It's been the top priority for the organization."

The outbreak started Sept. 29 on the fourth floor with a patient who is believed to have got the bug from skin-to-skin contact with an infected person in the community.

It spread to a staff member and from there went through all the in-patient units at the Burlington hospital.

In total, 23 patients and 44 staff, physicians and volunteers were infected.

However, hundreds had to be treated because scabies has an incubation period of up to six weeks. During that time, the person is spreading it without even knowing they have it.

"It's a really long incubation," said Wannamaker. "That in itself has created a challenge and has really led the long period of time we've been managing this."

Up to now, about 1,200 staff, 150 doctors, 100 volunteers and 200 patients have been treated.

The treatment is a lotion or cream that has to be spread over the entire body and left on for 12 to 14 hours. It's done once for preventive treatment and twice for those infected.

The eight-legged microscopic bug doesn't cause any major health problems except for the pimple-like rash caused when the mite larvae work their way to the surface of the skin and start spreading to other parts of the body or other people. The itch is caused by an allergic reaction to the bugs, their eggs and waste.

"It's more of a nuisance," said Wannamaker. "For most, it's the ick factor."

To contain the spread, the entire hospital has been cleaned. Staff and visitors must wear gowns and gloves when visiting all patients. And anyone with a rash is put in isolation until it can be determined if the cause is scabies. The hospital also worked with public health despite scabies not being mandatory to report.

Joseph Brant has not had any new cases involving patients since Oct 5 or staff, physicians and volunteers since Oct. 7.

"We're going to be monitoring it very closely," said Wannamaker. "We're feeling very confident we've eradicated (it)."

Joseph Brant's experience will be written up to help improve the current guidelines for managing scabies in hospitals.

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We've learned a lot and I think we can help other organization in how they manage this going forward," said Wannamaker.