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Pt's home infested with bed bugs, fleas, etc..

It's long, I apologize in advance

Went to do a SOC today and the patient's house was not only a home that was tough to walk in due to the hoarding (which doesn't bother me. I've been in several hoarders homes), and realized within a minute that the place was infested. Every chair I tried to find to sit on had multiple bugs ( bed bugs, fleas, etc...) crawling on them. The floors had bugs on them. The walls, bed, everything. I was there to do a wound dressing change and noted a dead bed bug on the abdominal dressing. I was, to say the least, disgusted.

I completed the SOC, left, and called my company immediately to alert them of the situation. I said I didn't feel comfortable going back to do the daily wound changes unless they take care of the infestation ( I did try offer to call pest control and the pt refused. I offered to get them numbers of different pest places and the pt refused stating he sprays) . At first my director stated we still needed to provide the dressing changes. I called the LPN who would be splitting the days with me and she is justifiably refusing. I alerted the DON and she said she'll put the pt on hold. Which is good, but now I'm concerned. The pt does actually need someone to do his dressing changes.

QUESTIONS:

1-Is it right of me to refuse to go until the situation has been resolved, or is this what I should expect doing Home visits? (I'm new at the home visits) If I should still go, has anyone dealt with this and what precautions did you take?

2-Should I call the department of health? If I do that, will they assess and fumigate for free or will the pt be charged? I want to get the okay from the pt first, but doubt that will happen if he has to pay. (he'll probably refuse either way) If they won't fumigate for free, is there a way to get it done without the pt having to pay?

The house is probably going to be condemned if the DOH goes out there. The pt lives with 2 brothers. I would undoubtedly be ruining their lives. However, the Bedbugs ARE TRYING TO GET INTO HIS WOUND. (a very large abdominal (dehisced) wound).

ANY info, suggestions, opinions will be appreciated.

ocean.baby

Specializes in corrections and LTC.

You need to do the patient's wound care, that is your job as a home health nurse. Less than ideal living conditions do not mean the pt doesn't need help. Only take what you 'have' to take, no extra supplies, do not take your bag just cram your pockets full or better yet two disposable plastic bags, one with clean supplies and one for dirty. Throw them away in the house or outside dumpster. I would try and get disposable shoe covers. If possible I would make this my last visit so I could go home and shower and toss scrubs in washer. I like the Klogs shoes that are washable as opposed to shoes that are more difficult to clean.

Remember that hoarding and living like this come with depression and/or other mental illnesses.

SHGR, MSN, RN, CNS

Specializes in nursing education.

From the outpatient end, we have patients that I suspect live in similar situations that do not let anyone in. Ever. I am surprised this man let you into his home at all, he knows he needs help and is willing to accept yours.

We live in premises that are frequently infested. When reported to the building management, eventually they have the apartment treated at no cost to the tenant. If this person rents the home, the landlord can probably be forced to take action. If the landlord also chooses to evict the tenant, that would be a consequence of the tenant living like that. I imagine all leases/rental contracts have verbiage to the effect that the premises will be kept in a clean, vermin-free manner. If evicted, perhaps the authorities will see to having the patient admitted to a facility for the duration of his wound treatment. I do not know. Would recommend discussing this with the patient's physician and/or a social worker.

Laurie52

Specializes in SICU/CVICU.

You need to do the patient's wound care, that is your job as a home health nurse. Less than ideal living conditions do not mean the pt doesn't need help. Only take what you 'have' to take, no extra supplies, do not take your bag just cram your pockets full or better yet two disposable plastic bags, one with clean supplies and one for dirty. Throw them away in the house or outside dumpster. I would try and get disposable shoe covers. If possible I would make this my last visit so I could go home and shower and toss scrubs in washer. I like the Klogs shoes that are washable as opposed to shoes that are more difficult to clean.

Remember that hoarding and living like this come with depression and/or other mental illnesses.

I give you a lot of credit if you could go into a home like that. There is no force on this earth that would get me in that house a second time!

Be careful with refusing to go to a case. While all agencies will state to your face that you have the right to refuse a case or to ask to be removed from a case, do not be surprised when they tell the employment department personnel that you refused work when you attempt to collect unemployment benefits.

Caliotter3, I'm sorry to hear you live in infested housing. That is horrible. This pt however owns his home, so there is no landlord to contact.

From the outpatient end, we have patients that I suspect live in similar situations that do not let anyone in. Ever. I am surprised this man let you into his home at all, he knows he needs help and is willing to accept yours.
I agree. That is why I'm so bothered by it. I know he needs it, and he was so grateful. I have just never felt so uncomfortable in someones house. It's not just the bugs, there are other factors that go into me being uncomfortable in this house, but the bed bugs and fleas everywhere is what is keeping me from wanting to go back.

Be careful with refusing to go to a case. While all agencies will state to your face that you have the right to refuse a case or to ask to be removed from a case, do not be surprised when they tell the employment department personnel that you refused work when you attempt to collect unemployment benefits.

I am PRN. I can refuse any case I want. I'm not worried about that at all.

ocean.baby

Specializes in corrections and LTC.

I am PRN. I can refuse any case I want. I'm not worried about that at all.

I think that home health nursing is not for you. Also, PRN or not, if that resident is one of your assigned patients for that day, you 'are' expected to do the treatment.

I think that home health nursing is not for you. Also, PRN or not, if that resident is one of your assigned patients for that day, you 'are' expected to do the treatment.

That is a strong statement to make not knowing much about me nor my work. As I stated above, the agency wasn't able to get ANY other nurse to take it once they heard of the conditions of the home. Nurses who have done this for years refused the case.

motherof3sons

Specializes in LTC.

That is a very sad situation. I would call the MD and see if there could be a consult to a wound clinic perhaps for his dressing changes??

I have been in homes that are horribly filthy and that is uncomfortable but not infested as yours. However, the case I refused was one where there was a shotgun behind the door and playboy/girl magazines on the coffee table!

That is a very sad situation. I would call the MD and see if there could be a consult to a wound clinic perhaps for his dressing changes??

I have been in homes that are horribly filthy and that is uncomfortable but not infested as yours. However, the case I refused was one where there was a shotgun behind the door and playboy/girl magazines on the coffee table!

When I visit homes with weapons visible I ask the patient or family member to put them away. The company likely has a safety policy which addresses weapons and pets, and you can use that to require the pt/family to comply lest they risk appropriate discharge from service. Given that weapons and dogs are EXTREMELY common in homes here in AK, it is commonplace to encounter them. The vast majority of clients respond nicely to the request to secure weapons and pets in my experience.

I would not be put off by the reading/viewing materials of the household and would probably just put my bag on top of them. But that is just me...crotchety old nurse dude.

RN., MSN, RN

Specializes in Perianesthesia.

Where does OSHA enter into the equation?

I had a discussion about this topic with one my coworkers. I'm sorry but I do not care how badly someone needs care, if I cannot use a proper bag technique due to filth and bugs then I'm not starting the patient. I do not think we, as home health nurses, should have to "take just what you need" and worry about what bug fell into our pocket b/c homes are infested.

I had a discussion about this topic with one my coworkers. I'm sorry but I do not care how badly someone needs care' date=' if I cannot use a proper bag technique due to filth and bugs then I'm not starting the patient. I do not think we, as home health nurses, should have to "take just what you need" and worry about what bug fell into our pocket b/c homes are infested.[/quote']

Why can't you utilize proper bag technique? Is there no where for you to set your supplies on a clean cloth provided by you? Some of the homes I visit don't have running water or flush toilets although we don't have much in the way of cockroach infestations here.

I cannot guarantee that the cat won't climb into my bag while I am working. Or that the dog won't pee on my boots by the door.

I simply accept my patients where and as they are and then help them to set and achieve meaningful and obtainable health goals.

Are you certain that you want to visit poor sick people in their homes for a living?

To RN-DC: I disagree with most of the comments to your question. I have done home health for several years in inner city an suburbs, have done psych, hospice and cardiac home care. Hoarders are no problem for home health nurses. Drugs, guns, dogs, etc. are not a problem. Bringing disease and bugs home to my family is a problem. I have been the lucky recipient of fleas, scabies, crabs, bedbugs. My PPD now shows positive, cxr negative. Been mugged and got through an attempted carjack. Been chased by dogs and wild turkeys. My husband died suddenly and I still have a child to raise, I have decided I will not take any more chances with my health and life. Only you can decide what you will tolerate. Risking your health is NOT a requirement for any nursing job.

Tampa121

Specializes in ICU/CCU, Home Health, Case Management.

Yes, you can refuse to see patient if you are per diem. Seeing that the DON placed pt. on hold-is she attempting to problem solve the case. I agree a SW needs to go in, the MD needs to be called and yes-this pt. is an elder at risk d/t open wounds with insects in wound. Your agency should report this patient. Are there family members? I say he should go back to hospital and then to SNF-for wound care and state will possibly fumigate his house. I had a pt. whose home was infested, she had PICC line and bugs were crawling all over IV equipment, etc. I called MD, told him what was happening (I saw her two times), he said send her back to ER, so they can send her to SNF. I hope this helps!

I hope the MD intervened by calling the ER to speak to someone regarding discharge to nursing home, otherwise, that move would have been in vain. Good idea though, as long as you receive those instructions from the MD. I would then document that the MD instructed me to send patient to the ER.

Tampa121

Specializes in ICU/CCU, Home Health, Case Management.

Hi-yes, I did call MD-and he said he was going to call ER. I documented properly in EMR, including who and when each person was notified, including patient and her brother, who were in agreement with the plan to send her to hospital and that she probably will go to SNF. She might have stayed at hospital for IV antis, not sure.

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