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The optimal approach to managing institutional scabies outbreaks has yet to be defined. We report on outbreak managements are needed.We report on a large outbreak of scabies in three acute care wards in a tertiary university teaching hospital in the Netherlands.The outbreak potentially effected 460 patients and 185 health care workers who had been exposed to the index patient.Containment of an outbreak relies on a quick and strict implementation of appropriate infection control measures and should include simultaneous treatment of all infested persons and exposed contacts to prevent secondary spread and prolonged post-intervention surveillance. Am. J. Ind. Med. 58:577–582, 2015. © 2015 Wiley Periodicals, Inc.