Background The optimal approach to managing institutional scabies outbreaks has yet to be defined. We report on outbreak managements are needed. Methods We report on a large outbreak of scabies in three acute care wards in a tertiary university teaching hospital in the Netherlands. Results The outbreak potentially effected 460 patients and 185 health care workers who had been exposed to the index patient. Conclusion 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. (c) 2015 Wiley Periodicals, Inc.