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Page 4 Briefings on Infection Control January 2011

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What to do when bedbugs invade your facilityFirst sign of bedbugs requires immediate action

revealed that one in 10 Americans say they or some-

one they know has had a bedbug problem. That statis-

tic jumps to two in 10 in the Northeast, where areas

such as New York City have experienced more exten-

sive outbreaks.

The bad news is there is no real way to prevent these

bugs from entering your facility. However, quick and

effective interventions can stop the spread and reduce

the risks of a serious infestation in patient rooms,

lounges, waiting rooms, or virtually anywhere else in

your healthcare facility.

Bedbugs are here to stay; the trick is learning to

spot them and then quickly resolving the issue, says

Jeffrey B. Tucker, BCE, a consulting entomologist

Continuing Education | Learning Objectives

After reading this article, you will be able to:

➤ Explain the appropriate steps to resolve a bedbug

problem

➤ List ways to identify a possible infestation

Unfortunately, due to the nature of the hospital set-

ting, it’s almost a guarantee that you will have to deal

with a bedbug infestation at some point.

Numerous hospitals across the United States have

reported problems with bedbugs in the past few

months. A recent survey conducted by Infogroup/ORC

on behalf of Enforcer® brand pest control products

doctors, and nurses were actively involved in preven-

tion efforts. For example, he established a hand wash-

ing certification program in which staff members had to

demonstrate correct hand hygiene techniques. He also

gave managers in the facility “gold silver dollars,” which

they carried around and awarded to staff members who

were observed correctly washing their hands or follow-

ing correct IC procedures.

“It was interesting to see surgeons—who really

didn’t need a gold silver dollar—and how they reacted

when they were handed one by the OR charge nurse

and how proud that they were doing the right things,”

Daniels says.

This shift ultimately relies on the very basic focus of

healthcare: All patients should be afforded the opportu-

nity for safe and reliable care in any facility. Daniel says

he has been involved in healthcare for 40 years, 30 of

those years as a senior manager, and this concept has re-

mained constant. A strict focus on simple prevention

procedures will improve all aspects of your facility. Your

reputation will soar, finances will improve, and physi-

cians will want to work for your facility. “In all that time,

one thing has not changed, and that is the importance

of taking good care of our patients and making it your

No. 1 priority—ensuring our patients have a safe, clean,

properly run, high-quality medical treatment facility

where they do not have to worry about contracting an

infectious disease while under our care or treatment, nor

fear for their well-being or personal safety,” he says.

Although stricter healthcare regulations have sparked

a focus on infection prevention, this commitment to a

cultural shift among ASCs will ultimately help smaller

facilities improve. “It’s one thing for us in government

to say it shall be so, but to make it so takes a lot of work,

and some facilities are not as far along as Lakeland Sur-

gery,” Perz says. “We need to get to the point where

there is an even playing field so that patients can be con-

fident when they walk into any ambulatory care setting

that there is a minimum standard of safety that is being

provided with respect to infection prevention.” n

APIC award < continued from p. 3

January 2011 Briefings on Infection Control Page 5


for Entomology Associates, Inc., in Houston who has

served as a bedbug consultant for hospitals around the

country.

“It’s important to understand that there is no building

that is occupied by humans that is [resistant] to bedbug

infestation,” Tucker says. “They have been found in every

type of human residence and every mode of transporta-

tion. Bedbugs don’t care.”

Developing a plan

Hospitals are susceptible to a bedbug infestation sim-

ply because of the sheer number of people (patients,

staff, visitors, etc.) who pass through the doors night

and day.

No area is off-limits to bedbugs, says Tucker. He has

seen infestations occur in patient rooms, waiting areas,

staff areas, doctors’ and nurses’ lounges, booths in

hospital cafeterias, and in the cubicles for secretarial

and support staff.

Knowing that bedbugs are an imminent threat, hos-

pitals need to build a policy regarding what to do if an

infestation occurs. “A policy for bedbugs has to first ac-

knowledge they are a problem—and they are likely to

> continued on p. 6

Bring the heat

Without an exterminator and a number of pesticides,

there aren’t very many ways to kill bedbugs if you discover

an infestation in your facility. However, heat is one imme-

diate option if you identify a problem, particularly on a

patient’s clothing.

Temperatures need to reach 140ºF for 30 minutes to

effectively kill off any bedbugs and their eggs, says Paul

Wenning, chair of the Central Ohio Bed Bug Task Force.

“It’s very easy to take a patient’s clothes once they have

put on a hospital gown and put them in the dryer for

30 minutes, and that would immediately kill any bugs and

their eggs,” says Jennifer House, public information offi-

cer for the Ohio Department of Health in Columbus. “There

are some hospitals that are considering policies like that in

Ohio, but at this point it’s basically trying to figure out what

would work best for you and what’s most cost-effective for

the hospital.”

Warning signs

The following are a few indications that bedbugs may be

present in your facility:

➤ Patients complaining of bites. If a staff member—

or, particularly, a sedentary person who is not walking

around—complains of bites, especially from the waist

down, it could be a case of bedbugs, says Jeffrey B.

Tucker, BCE, a consulting entomologist for Entomol-

ogy Associates, Inc., in Houston. “These need to be

investigated by someone who knows the difference be-

tween a mosquito bite, something that is not a bite at

all, or [something that has] the potential for bedbugs,”

Tucker says.

➤ Visual evidence. If a nurse walks in the room and sees

something shoot across the bedsheets or the floor, he or

she should alert the IC department for further investiga-

tion. It may just be a harmless insect, but a quick reac-

tion to a potential problem is the best way to prevent

further spread.

➤ Brown spots. Bedbugs are hard to see, so it’s often eas-

ier to identify them by the feces they leave behind, says

House. “[It] basically looks like little brown spots, but

they show up all over mattresses or pillowcases, so if the

bugs are hiding in crevices or against the wall or behind

baseboards, you would still see the evidence that they

were there while an individual was sleeping,” she says.

Be especially aware of an outbreak if your facility has an

in-house long-term care facility or a psychiatric ward where

patients stay for an extended period of time, says Tucker.

You can also prevent a possible infestation by barring as

many personal items as possible. Wheelchairs are especial-

ly prone to bedbugs, so some hospitals choose to make pa-

tients use hospital wheelchairs exclusively.

For more information on identifying bedbugs, refer to the

Ohio Department of Health Bedbug Fact Sheet on pp. 6–7.

> continued on p. 8



January 2011 Briefings on Infection Control Page 7




become a problem at one time or another in the hospi-

tal,” Tucker says. “They need to know that anyone that

works in the hospital can bring bedbugs from home in

their purse, in their personal belongings, even on their

clothing, and bring them into the facility.”

The policy should include warning signs of bedbugs in

the hospital, training requirements for frontline staff and

environmental services, and protocol for treatment of the

room or area (e.g., a HEPA-filtered vacuum to clean fur-

niture, and appropriate, Environment Protection Agency-

approved pesticides in cracks and crevices).

Other considerations include closing off a patient’s

room, dealing with personal belongings, scheduling ap-

propriate times for pest management, and the possibility

for multiple treatments.

Many hospitals use an outside pest management

contractor or entomologist to develop their policy, says

Tucker.

“Get your contractor in right now and have a meeting

and say, ‘Okay, as far as we know we don’t have any bed-

bugs, but I want a plan from you as to what you’re going

to do if I call you, because I want to be ahead of the curve

on this,’ ” he says. “[Establish a] contact person, someone

who has additional bedbug training, and make sure your

contractor is up to speed and knows immediately what

they need to do.”

Training staff and taking the appropriate steps

Environmental staff members, along with front-

line staff members, the IP, and the IC team, should

be able to identify warning signs of bedbugs. The

earlier you catch an infestation, whether it’s in a

patient room or a common area, the easier it will be

to quickly contain it. The Ohio Department of Health

has made it a goal to better educate hospitals and the

general public to recognize bedbugs in any environment,

says Jennifer House, public information officer for

the Ohio Department of Health in Columbus. “I think

the first part is just letting [staff] know what [bed-

bugs] look like because there are so many bugs, and

I think a lot of times people don’t realize that if there

is something that looks like an apple seed, it could

actually be a bedbug,” House says.

If you discover an infestation, your first course of ac-

tion should be to get a contractor or exterminator to

the facility as soon as possible to begin decontamina-

tion procedures, says Paul Wenning, chair of the Cen-

tral Ohio Bed Bug Task Force, an independent volunteer

group that offers resources and best practices for iden-

tifying and exterminating bedbugs. “Because of the na-

ture of the hospital setting, it’s a lot easier to control the

bedbugs than it would be in any other facility,” Wenning

says. n

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What to do when bedbugs invade your facility - HCProblogs.hcpro.com/osha/wp-content/uploads/2011/09/BOIC_0111_4-8.pdf · What to do when bedbugs invade your facility First sign of