PURPOSE: Due to the Growing Incident Rates of Bed Bugs, Particularly in Healthcare Settings

9249 W. Lake City Road
Houghton Lake, MI 48629 / Authorization & Approval: /
James Rachke, Executive Director
Title: Bed Bug Protocol
Jeff Strickler, M.D., Medical Director
Effective Date:
3/5/15 / Reviewed: / Supercedes:

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 encounter using the following guidelines and procedures:

·  Incident Procedures – To identify chain of command and personnel 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 MidMichigan CommunityHealth (MMCH) 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 their immediate supervisor/team leader. If the supervisor/team leader 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.

PROCEDURES

Incident Procedures

Chain of command:

·  Staff suspecting bed bug incident to notify their direct supervisor/team leader. The supervisor/team leader must be trained in identifying and confirming presence of bed bugs.

·  If presence of bed bugs confirmed, the supervisor/team leader is to notify environmental services through the Building & Facility Coordinator at 989-422-2179.

·  The Safety Officer 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.

·  The supervisor/ team leaders is responsible for determining 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 mature bed bug is reddish-brown and wingless. The head is distinct from the abdomen, unlike a cockroach.

·  Bed bugs can lay one to five eggs in a day and more than 500 in a lifetime.

·  Bed bug hatchlings are so small they can pass through a stitch-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.

·  Bed bugs 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.

·  Most clinic and hospital settings are not conducive to bed bug infestations. Rooms are designed to discourage harborage of potentially infectious pathogens and surfaces are cleaned regularly. Furniture is typically metal and rooms are sparsely furnished and free of clutter, for ease of cleaning. Bed Bugs brought into the clinic setting are typically transient introductions and infestations is unlikely to result in the modern setting.

Training

Staff training on bed bug policy, including identification, surveillance, control and prevention is critical to reducing the risk of a bed bug infestation. All designated staff, will be trained on the MMCH bed bug policy. There must be at least one designated staff member trained in addressing bed bugs on duty at all MMCH 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:

·  Safety Committee Members

·  ? CAT members

·  Site Managers/Supervisors, and Assistant Site Managers/Supervisors

·  Providers

Identification and Detection

The following procedures should be implemented by the Manager/Team Leader 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 Team Leader.

·  If not already in an exam room, discretely, transfer patient to an open exam or procedure room.

·  Collect specimens in and place in a sealed container with rubbing alcohol for identification. Rubbing alcohol will kill mature insects.

·  The Team Leader must immediately notify, or delegate the notification of Building & Facility Coordinator at 989-422-2179.

·  Respond sympathetically to patients and family members reporting bed bug problems.

The Safety Officer 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 is to be implemented ONLY IF A PATIENT HAS BEEN CONFIRMED TO HAVE A CASE OF BED BUGS.

During Patient Visit:

·  The Team Leader 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.

o  Patient will be asked a series of questions about their exposure to bed bugs.

o  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 requests we 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 that bed bugs on their person during future clinic visits may result in refusal of care

Following Patient Visit:

·  The Safety Officer 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 housekeeping 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

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

In-House Treatment Procedure – If the Plant Services lead 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 Safety Officer 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 housekeeping (located in each department). Do not spray public areas such as waiting rooms, until after clinic hours.

·  Vacuum furniture flooring, carpeting and equipment to capture any dead or live bugs.

·  Housekeeping will treat vacuum bags containing dead or live bugs in accordance with proper disposal per their guidelines.

Pest Management Professional Procedure – If the Safety Officer or housekeeping determines pest management services are necessary, the following procedures must be implemented::

·  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 housekeeping 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 protective cover such as a sheet or plastic before removal from the infested room to the disposal site and clearly mark infested items as “bed bug infested” prior to disposal, recycling or placing items outside the unit .

Documentation

The following procedure should be implemented by the Supervisor/Team leader following a confirmed bed bug incident.

·  Fill out an incident report or designate a team member to do so.

·  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.

·  The Safety Officer must communicate bed bug incident to staff potentially exposed to incident.

Addendums:

Ø  Claire Bed Bug, lice and dust mite spray instructions (Clair Mfg., Addison, IL)

Ø  Bed Bug management (MDCH publication)

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