LCHC Bed Bug Protocol
07/14/2014

Purpose

Due to the growing incident rates of bed bugs, particularly in healthcare settings, guidelines for reducing the risk of bedbug infestation to clinic spaces, patients, visitors and staff is becoming increasingly important. This document is intended to establish protocols for addressing a bed bug encounterusing the following guidelines and procedures:

  • Incident Procedures – To identify chain of command and personell needing involvement in a suspected bed bug incident
  • Education – To train clinic staff and management on bed bug facts, ongoing detection methods and preventative measures.
  • Identification and Detection/Documentation – To outline the procedures to manage patients identified as having bed bugs or a recent exposure to bed bugs.
  • Control – To establish procedures for cleaning a room or an area that has been exposed to a person infested with bed bugs to control, reduce and eliminate the risk of further contamination or a potential bed bug infestation.
  • Treatment – To eliminate a bed bug infestation through treatment by a pest management professional.
  • Management – To manage furnishings and materials infested with bed bugs after a treatment by a pest management professional.
  • Documentation–To ensure the incident has been documented properly to help reduce the potential recurrences.

Policy

It is the policy of LCHC to protect our patients, visitors and staff by preventing the spread of bed bugs within our facilities. Early recognition is the key to preventing the spread of bed bugs.

Upon admission, if a patient is suspected of having bed bugs, whether by admission, recent exposure, suspicious bites, or physical sighting, staff is required to immediately contact the Site Manager. If the Site Manager confirms the presence of any of these scenarios, the bed bug policy must be initiated. Unless the patient has previously been advised to address a potential bed bug infestation, under no circumstances will the patient be refused medical treatment based on bed bug exposure.

Incident Procedures

Chain of command:

  • Staff suspecting bed bug incident to notify Site Manager. Site manager must be trained in identifying and confirming presence of bed bugs.
  • If presence of bed bugs confirmed, Site Manager to notify Supervisor of EOC at 872.588.3143.
  • EOC Supervisor is responsible for determining appropriate control measures following the patient visit, as well as treatment and management actions, including determining if pest management professional services are warranted.
  • Site Manager is responsible for determinging appropriate control measures during the patient visit, as well as ensuring appropriate documentation takes place with regard to the incident.

Education

Bed Bug Facts

  • Immature bed bugs can range from 1mm (1/16”) to 4mm (1/4”).
  • Mature bed bugs take approximately a month to mature and are 5mm to 6mm (1/4”) unfed and up to 10mm (3/8”) when engorged.
  • A maturebed bug is reddish-brown and wingless. The head is distinct from the abdomen, unlike a cockroach.
  • Bed bugs can lay one to five eggs ina day and more than 500 in a lifetime.
  • Bed bug hatchlings are so small they can pass through a stich-hole in a mattress.
  • Bed bugs can withstand a wide range of temperatures, from nearly freezing to 122 degrees Fahrenheit.
  • Bed bugs can live for as many as six months without a host.
  • Bed bugs draw blood for about five minutes before retreating to digest.
  • Bed bugs can ingest seven times their own weight in blood, which would be the equivalent of an average-sized male drinking 120 gallons of liquid.
  • Bedbugs that have recently fed are brighter red and engorged. They look less flat and less brown.
  • Bedbugs prefer to feed on human blood, but will feed off of other mammals (e.g. dogs and cats).
  • Bed bug bites usually cause small, hard, white welts that are often itchy. Reactions to bedbug bites may result in bumps or welts that resemble mosquito or other insect bites. Not everyone will experience a reaction so history and other physical evidence must be considered.
  • Evidence of feeding and excreta (small blood stains and/or dark spots) can be found on sheets and mattresses. Heavy infestations are often accompanied by a sweet, sickly smell.
  • A bed bug with a host will feed every 5 – 10 days.
  • Bed bugs are nocturnal and tend to shy from light. They dislike movement and are rarely seen during the day or on a person’s body or clothing. They like to hide in the seams of mattresses and covers, but may also be present on items that are in extended/frequent contact with the individual (e.g. wheelchairs and seat cushions).
  • Bed bugs are attracted to warmth and may be found hiding around any mechanical device that produces heat. They may also be present in crevices in nearby furniture, walls or fixtures.
  • Bedbugs crawl. They do not jump or fly. They are considered “hitchhikers” hiding in personal belongings (i.e. pillows, clothing, luggage, bags, etc.) and are carried from one area to another.
  • Bed bugs have become increasingly resistant to many off-the-shelf pest-control chemicals.
  • Ordinary household insecticides and disinfectants are not effective in eradicating an infestation. The service of a licensed pest management professional may be required.

Training

Staff training on bed bug policy, including indentification, surveillance, control and prevention is critical to reducing the risk of a bed bug infestation. All designated staff, will be trained on the LCHC bed bug policy. There must be at least one designated staff member trained in addressing bed bugs on duty at all LCHC sites at all times during clinic hours. Training will include the following curriculum areas:

  • Bed bug identification and general facts.
  • Identification and detection procedures.
  • Ongoing control and management measures aimed at limiting the spread of bed bugs.

Staff mandated to receive policy training:

  • Infection Control Committee
  • EOC Management
  • Site Managers, and Assistant Site Managers
  • Providers
  • Medical Assistants

Identification and Detection

The following procedures should be implemented by the Site Manager should an individual be suspected of having bed bugs:

  • If any employee upon realization that a patient is suspected of having bed bugs, immediately notify the Site Manager.
  • If not already in an exam room, discretely, transfer patient to an openexam or procedure room.
  • Collect specimens in and place in a sealed container with rubbing alcohol for identification. Rubbing alcohol will kill mature insects.
  • The Site Manager must immediately notify Supervisor of Environment Of Care at 872.588.3143.
  • Respond sympathetically to patients and family members reporting bed bug problems.
  • EOC Supervisor will determine appropriate treatment and control measures following the patient visit.

Control

The following procedure should be implemented should a patient be confirmed to have bed bugs. To help prevent the infestation from expanding to different rooms, it is imperative to carefully follow these steps. If room/area has more than one patient, these steps must be followed for each patient potentially exposed to the infestation.

This procedure to be implemented ONLY IF A PATIENT HAS BEEN CONFIRMED TO HAVE A CASE OF BED BUGS.

During Patient Visit:

  • The Site Manager is responsible for appropriately managing the incident during the patient visit.
  • Tactfully inform the patient and family members about steps being taken to prevent the spread of bed bugs.
  • Patient will be asked a series of questions about their exposure to bed bugs.
  • Belongings will be bagged to prevent the spread of bed bugs.
  • Staff should only wear personal protective equipment (PPE) as needed for Routine Practice (protection against contact with body fluids / substances during care activities). Additional PPE is not recommended (e.g. gowns and gloves for casual contact). Shoe covers and hair coverings are not recommended.
  • If live bugs can be seen on the patient and only if patient requestswe can double bag and seal each patient belongings as determined by patient.
  • Give the patient informational brochure educating them on steps they can take to address a possible bed bug infestation. A letter can be provided by the provider to the patient if requested to formally document the case.
  • Inform the patient thatbed bugs on their person during future clinic visits may result in refusal of care.

Following Patient Visit:

  • The EOC Supervisor is responsible for managing the incident following the patient visit.
  • Inspect the room or treatment area for bedbugs.
  • Place two-sided tape around the entire doorway opening.
  • Close the room off and leave the room undisturbed until EOC or a pest management professional has treated the space and given the all-clear to again use the room.
  • Follow appropriate steps under “Treatment” procedure below.

Treatment

The following procedure should be implemented in all confirmed bed bug incidents.

In-House Treatment Procedure – If EOC Supervisor determines in-house treatment is satisfactory, the following procedures must be implemented:

  • Do not remove any items from bed bug infested rooms before inspection and treatment, whether by EOC or by pest management professional. This will help to prevent relocating bed bugs to other areas within the premises.
  • Spray all areas suspected of having been exposed to bed bugs using spray provided by EOC. Do not spray public areas such as waiting rooms, until after clinic hours.
  • Vaccum furniture flooring, carpeting and equipment to capture any dead or live bugs.
  • Treat vacuum bags containing dead or live bugs by…?
  • ?

Pest Management Professional Procedure – If EOC Supervisor determines pest management services are necessary, the following procedures must be implemented by the EOC Supervisor:

  • Follow all preventative steps listed under “In-House Treatment Procedure.”
  • Contact a licensed pest management professional to perform a detailed bed bug inspection.
  • Make available to the pest management professional, all rooms adjacent to the infested room as well as storage rooms, vacuum cleaners, service carts and hallways for bed bug inspection and treatment where necessary.
  • If the pest management professional confirms that live bed bugs are present and treatment is required, the room will be treated and remain closed until completion of the treatment.
  • Take pest management professional’s instructions on how to prepare the room for bed bug eradication under advisement.

Management

The following procedure should be implemented by the EOC Supervisor and addresses items and materials infested or potentially infested with bed bugs following a bed bug incident.

  • Do not remove infested materials designated for disposal until after the room is inspected and/or treated by the pest management professional.
  • Remove clothing, linens, and materials designated for disposal from a bed bug infested room in sealed plastic bags to prevent relocating bed bugs to other areas within the premises.
  • Wash infested items not designated for disposal in hot water and dry for 20 minutes using the hottest setting of the dryer to kill bed bugs and bed bug eggs.
  • Dispose of all vacuumed refuse from an infested room in a plastic bag (including the vacuum cleaner bag).
  • Do not unnecessarily dispose of furniture and/or equipment. Have a pest management professional service all furniture and equipment prior to disposal.
  • After treatment, any items marked for disposal should be wrapped in a protectivecover such as a sheet or plastic before removal from the infested room to thedisposal site and clearly mark infested items as “bed bug infested” prior todisposal, recycling or placing items curbside.

Documentation

The following procedure should be implemented by the Site Manager following a confirmed bed bug incident.

  • Fill out an incident report
  • Potential incidents, even if not confirmed to be bed bugs, must be documented.
  • Provider must document the confirmed incident in the patient’s chart and any follow up instructions given to the patient at the time of the visit (pamphlet handed out, address bed bug infestation at home, etc.) Please note that only CONFIRMED cases should be documented. Any unconfirmed cases should not be documented.
  • Site Manager must communicate bed bug incident to staff potentially exposed to incident.