Bed Bugs!!!

In the outpatient (clinic) and inpatient settings, we can't refuse care because of infestation, even if people have such bad infestations that the bedbugs are crawling out of the patient's sweater.

It's been a long time since I've done home care, but we had "roach precautions"- ie no bag on the floor, bag zipped up tight, or bring no bag into the home if possible. Bedbugs are a whole different thing though as is a 12-hour shift in the home vs. a skilled or supervisory visit.

Unfortunately there is no easy answer here.

It's really pretty easy to prevent bringing bedbugs home -- they can't climb bare metal, so put your bag on a chrome folding luggage rack like this one.

And they are unlikely to be chomping on you when you're awake and moving around... they tend to feed on people sleeping in bed.

I'd be so worried about taking them home to my beds and other stuffed furniture! Don't know much about them, just the scare stories. My grandmother used to tell some stories about them; I guess they were a real scourge in the early 1900s.

Well, the first case that had bedbugs, I told the company, they told me I had to tell the family so they can get it taken care of. I told the family & they were already aware of it, just 'forgot' to tell us nurses. This other case, my agency told me they had a problem with BB recently, but had gotten it taken care of, but I was there a few nights ago & I killed 2 as I sitting on a vinyl chair & killed a third on my leg as I was in my car getting ready to come home. I work 3rd so the majority of the time, I'm sitting there anyways & I've gotten bit at both cases before. I just thought that the agency shouldn't or couldn't send us somewhere that knowingly had an infestation. Just doesn't seem fair, but it guess that's life...thanks!

I had an instructor tell about when she was orienting for a home health agency (visits, not PDN). Her preceptor told her, "do what I do in this house, don't sit down, don't put anything on the floor".

They left their coats and everything not absolutely necessary in the car. When they entered and closed the door behind them, my instructor noticed that the walls moved when the door clicked shut. Because the walls were literally covered with roaches that flinched when the door clicked.

OMG!!!!

As for bedbugs, I think it behooves us all to take the time to educate ourselves about how to prevent cross-infestation. For example, the bugs don't typically live in beds and furniture... they just climb up at night for a meal, then they go back home to the walls where they live.

They can't climb bare metal, so using a metal table (or luggage rack) is good for preventing them from tagging a ride home in your bag.

To keep them off your patient, make sure bed linens don't drape all the way down to floor level, and you can make "traps" to keep them off the bed legs if they're not metal.

Bedbugs are very hard to get rid of once they've infiltrated a home, but they are relatively easy to prevent bringing home with you with just a few common sense provisions.

Its common. I refuse to work those cases. Its expensive to get rid of bed bugs and no agency is going to pay to have your home exterminated when you get them. If you feel the patient is in danger, call child protective services or the equivalent if its an adult patient. If you don't report it and something happens, you could be held responsible. All it takes is one to get into your home or into a trach/airway and you will have problems. Document it as well and document that you reported it to your supervisor and then document supervisors response. Document that you told the family and their response.

I had one client as a home health LNA whose apartment building was infested. I wore white scrubs so I could see if they got on me. Pant legs rolled up to my knees. Sprayed my calves and shoes with rubbing alcohol solution. Brought in only my plastic clipboard.

I can honestly say they were so bad they were crawling all over everything in sight. When I finished my shift I walked down to the street, got spare scrubs out of my car and stripped right there to change. Threw out scrubs and shoes in the sidewalk trash can. I never went back. One of the few that I refused to return to.

When my agency pushed I asked if they would reimburse me for treatment when they wound up in my home and car. They said no of course. I never had that client show up on my schedule again.

When agencies refuse to pay earnings such as overtime, reporting time pay, mileage, or travel time, you can bet they won't pay to get rid of roaches or bed bugs that you acquire on the job. They also like to tell their nurses how they won't pay for the parking tickets that come about because you have to park your car somewhere for one to eight hours while you care for their clients.

parking tickets

i've heard of those before - that is one problem we don't have in my area

the agency cannot force you to go to any home

that is one of the perks of PDN, you decide what assignments to accept

they can certainly pressure you or deny you other cases

but the choice is yours

in the case of bedbugs it's an easy one

no job is worth the risk and or expense

and by risk i also mean risk to other pt.s not just the nurse