Managing Bed Bug Infestation - (30 min)

Over the last several years, bed bugs have made a dramatic resurgence and may pose a problem for home health and hospice clinicians. In addition to the distaste of working with patients who suffer from bed bugs, clinicians are also at risk of transferring bed bugs to other patients and their own homes. This job aid provides best practice guidelines for avoiding the spread of bed bugs, as well as strategies to assist patients in preventing bed bug infestations or managing an established infestation.

Question Title

Bed Bugs After Feeding

The bed bug most commonly found in the United States is from the species, Cimex lectularius. It is a parasitic insect that prefers to feed on the blood of humans and other warm‐blooded animals. They are not known for transmitting communicable diseases, although their bites can lead to skin rashes, allergic reactions and secondary infections.

DESCRIPTION:
Bed bugs are brown in color but develop a reddish hue after feeding. They have a flat back and stomach, do not have wings, and resemble an apple seed. They are typically less than 7 mm (1/4 inch) in length. Severe infestations may be associated with a sweet, musty odor.

Bed bugs are attracted to people by their warmth and the carbon dioxide exhaled when breathing. They normally feed late at night or early morning when the person is in deepest sleep. However, they may feed and move around at any time. Although they will bite any part of the body, they prefer uncovered skin. After feeding, bed bugs move to their protected hiding place where the blood meal is digested. During this process, they will defecate, leaving reddish brown spots on walls, linens and other nesting areas. These reddish brown spots are characteristic of bed bug infestations.

Question Title

What To Look For - Bed Mattress

Risk Factors for Bed Bug Infestations

The following factors may increase the risk of a bed bug infestation:

Bringing uninspected, used or second‐hand furniture, mattresses, linens, and clothing into the home.
Frequent travel with overnight stays at hotels and other lodging facilities.
Occupations that require exposure to homes and facilities at risk for bed bug infestations.
Residing in congregate, overcrowded and unsanitary conditions.
Poverty that precludes individuals from taking necessary actions to prevent or resolve an infestation.
Housekeeping services in which vacuum cleaners and other cleaning supplies are used in multiple homes.

Once a home is known to have had a bed bug infestation and has been appropriately treated, the Home Care staff must continue to use the following measures to protect themselves for a period of 6 months. If, during that 6 month time, there are no further signs of infestation, the precautions can be discontinued.

Fort Hudson reserves the right to serve clients in a safe setting. In the event that it is evident that measures are not being taken to eradicate the infestation, Fort Hudson Home Care may withdraw from the case with an appropriate discharge referral.

Preparing for Visits to Clients with Possible Bed Bug Infestations

Being prepared for a bed bug infestation is critical to preventing the spread of the pests. Caregivers can take the following steps to decrease the risk of transferring bed bugs from an infested home:

Before making a client visit, the Nurse should ask clients whether they’ve had any pest infestations in the past six months. Use a matter‐of‐fact manner as if the topic was a routine one asked of all clients.
Wear appropriate personal protective equipment (PPE) when entering homes at risk of infestations. Personal protective equipment should be applied prior to entering the patient’s home and removed after leaving the patient’s home.
Appropriate PPE to reduce the likelihood of spreading bed bugs include:

Disposable booties
A gown or Tyvek suit for use in the presence of severe infestations or when the clinician must lean on the bed when providing care
Although gloves are PPE that are routinely used in the home and may be important when inspecting for bed bugs, glove changes within the home should follow the Agency hand hygiene guidelines. Hands should be decontaminated before leaving the home and contaminated gloves should not be worn outside the client’s home.

Wear form‐fitting clothing with as few pockets and buttons as possible. Avoid wearing cargo pants, pants with cuffs, and hems that touch the floor. Accessories such as scarves, jewelry and handbags should not be worn. Simple shoes are recommended that can easily be thrown in the dyer. Shoes with deep treads and laces should be avoided.
Only take supplies necessary for the visit into the patient’s home. Do not carry the supply bag into the home.
Supplies may be placed in a sealable plastic bag or fanny pack. Place supplies on a barrier in the home and inspect them carefully for bed bugs after the visit.
Carry supplies in the trunk to manage potentially infested materials, such as sealable garbage bags and a large plastic container with a sealable lid.
Bring an extra set of clothing in the event clothes may have become contaminated during the visit.
Bring your own hard chair to sit on during the visit. A light‐colored metal or plastic chair is recommended. Avoid sitting on the bed or upholstered or wicker furniture in the patient’s home.

Question Title

In the Event of Actual or Suspected Contact with Bed Bugs

If a caregiver or nurse finds insects on their clothing during a post‐visit inspection or suspect that their clothing has been contaminated, the following precautions are necessary to reduce the possibility of spreading the infestation:

The caregiver should stop at a public restroom and remove their contaminated clothing. Precautions should be taken to avoid contaminating the restroom.
Removed clothing should be placed in a sealed bag and then secured in a plastic container with a sealed lid in the clinician’s trunk.
A plastic covering should be placed on the car seat
After arriving home, the contaminated clothing and the caregiver’s shoes should be immediately machine‐washed and dried at the hottest temperature for at least 30 minutes.
Discard the plastic covering used to cover the car seat in a sealed bag and thoroughly vacuum the car.
The caregiver should then shower with warm, soapy water.
On an ongoing basis, caregivers should keep their cars clean, clutter‐free, and regularly vacuumed to prevent the spread of bed bugs and other insects and pathogens.

Supporting Clients with Bed Bug Infestations

If a bed bug infestation is identified in a patient’s home, actions can be taken to minimize the problem until formal measures to eradicate the infestation can be implemented. These include:

Thoroughly vacuum the client’s home to reduce the number of bed bugs present, especially around and under the bed and in the sleeping areas.
Eliminate clutter in the home.
Vacuum, scrub and disinfect headboards, bedframes, side tables and other hard surfaces in the sleeping area.
Encase the mattress and box spring in a bed bug‐approved plastic casing.
Move the bed and other furniture away from walls and remove bed skirts and other linens that touch the floor.
Place petroleum jelly or double‐sided tape on parts of the bed that touch the floor to prevent bed bugs from climbing onto the bed.
Replace wooden beds with metal framed beds, since bed bugs have difficulty climbing up metal surfaces.
Caulk or seal cracks and crevices around the room and on furniture.
Store clothes, shoes, plush toys, pillows, and bedding into large, sealed plastic bags or plastic tote bins with airtight seals. Thoroughly inspect these items for bed bugs before removing.
Launder all clothing, shoes, linens and area rugs at the hottest heat settings for washing and drying as possible.

Integrated Pest Management

Long‐term management of bed bugs requires an Integrated

Pest Management process. This includes:

Early detection of bedbugs
Removing clutter
Vacuuming and cleaning the environment
Washing and drying infested linens and clothing at the hottest temperature
Extermination by an experienced professional.

Extermination may include use of pesticides, steaming, vacuuming, and freezing.

Since bed bugs have become resistant to many pesticides, it’s important to consult a pest control company with expertise managing bed bugs. It may take several applications and several weeks to completing eliminate the bed bug infestation.