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

Posted
by RN-DC RN-DC Member

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. Has 25 years experience.

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. Has 36 years experience.

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. Has 25 years experience.

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. Has 22 years experience.

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!