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

[RN-DC]

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.

[toomuchbaloney]

Thank you for advocating for the care of this/your patient.

[Libby1987]

We wouldn't have taken the patient under care. And would have contacted APS to help him out after notifying his dr.

We have a right to refuse to provide care in an unsafe and/or inappropriate care environment. If I can see the bugs crawling all over everything, it's inappropriate.

[Gooselady, BSN, RN]

I renewed my CPR last night so this is probably why my first thought for this OP from November was "is the scene clear??"

Paramedics won't begin their thing if the scene isn't clear. The point being if the caregiver is impaired, now there are two victims and no caregiver. In this situation, fleas, bed bugs and roaches aren't quite like dodging bullets or gushing gasoline and open flame, but STILL! Bed bugs are so darn hard to get rid of! And scabies? How about some time off work!!

I'd have to do some SERIOUS PPI (lol), as in a complete change of clothing, hair net and seat cover for my car, not to mention what I'm going to do with my equipment and charting!

Exactly to what extent are we obligated to inconvenience ourselves, much less get infested??

Good question all around. And knowing that the patient and his brothers may lose their home and all that is comfortable for them . . . what a dilemma I don't give myself permission to judge to quite that extent Tough call for sure.

[RN In FL]

I had a patient who was a hoarder, little Ms. Johnnie. She had roaches pretty bad. We established a relationship, I went out 5x/wk for wound care and med teaching. Well I asked her if I could bring in roach spray, and she agreed, I was able to get them under control in her small kitchen, somewhat. I sprayed, every time I went there. She had an itty bitty apt. She was thankful. Sometimes its all in your approach. We are all these little people have. Its such a good feeling to "do the right thing".

[Libby1987]

I renewed my CPR last night so this is probably why my first thought for this OP from November was "is the scene clear??"

Paramedics won't begin their thing if the scene isn't clear. The point being if the caregiver is impaired, now there are two victims and no caregiver. In this situation, fleas, bed bugs and roaches aren't quite like dodging bullets or gushing gasoline and open flame, but STILL! Bed bugs are so darn hard to get rid of! And scabies? How about some time off work!!

I'd have to do some SERIOUS PPI (lol), as in a complete change of clothing, hair net and seat cover for my car, not to mention what I'm going to do with my equipment and charting!

Exactly to what extent are we obligated to inconvenience ourselves, much less get infested??

Good question all around. And knowing that the patient and his brothers may lose their home and all that is comfortable for them . . . what a dilemma I don't give myself permission to judge to quite that extent Tough call for sure.

It shouldn't be a judgy issue. The environment has to be safe for the patient, the staff and whatever care we're providing.

In these situations we have been able to get these folks social services and assistance, if they're receptive. We've also been able to force their hand to transfer to a safer place by refusing to abide an unsafe/unhealthful environment.

That said, it has to be something that's actually unsafe/unhealthful, what might be gross by my own personal standards is irrelevant. I'm not afraid of plain ol dirt and cobwebs, I have carved out clean storage and a sterile field in some pretty icky places. But bugs that will leave sores and come home with me, or to another patient, no way.

And it is terribly sad at times, but for the grace of god and all that.

[caliotter3]

I have discussed infestations as well as other "third party intervention" type problems with my clinical supervisors and was told very pointedly that it is not their job to contact social services. I added that surprising statement to their inability to process a piece of paper, or make a follow-up phone call, to establish an opinion of the employer. There is a point when the field worker is out there all by themselves when they want to do what is right and keep their job at the same time.

[Libby1987]

I have discussed infestations as well as other "third party intervention" type problems with my clinical supervisors and was told very pointedly that it is not their job to contact social services. I added that surprising statement to their inability to process a piece of paper, or make a follow-up phone call, to establish an opinion of the employer. There is a point when the field worker is out there all by themselves when they want to do what is right and keep their job at the same time.

Really?

From your other posts you must have a very different work experience than mine.

[kool-aide, RN]

I am not a home health nurse--I work in acute care. My opinion is that you couldn't get me into that type of environment even if you were threatening me with a hot poker.

I care for my pts very much, and want the best for them, but I refuse to be a martyr for my profession. I love my work and view it as my calling but I am also doing it to pay my bills. And honestly, I don't make enough money to be exposed to those types of conditions, in my opinion.

Before someone accuses me of being uncaring or otherwise unfit for my job--don't bother. If you feel the need to tear down others on an online forum, you need to take a good, long look at your character.

[caliotter3]

Really?

From your other posts you must have a very different work experience than mine.

I guess there are just different manifestations of lazy and I am just lucky enough to encounter them. I have also found it very strange that in all these years I can only immediately recall one excellent nursing manager in home health who not only spoke a good game, but followed words with appropriate actions. Others have expressed the opinion that hh attracts the less desirable employees, I suppose they were also making a negative comment about me in that opinion. Kind of hard to argue with them using my own experiences.

[vampiregirl, BSN, RN]

Paramedics won't begin their thing if the scene isn't clear.

At least where I'm from, roaches don't qualify a scene as "unsafe" for EMS:( (I hate bugs that crunch when you step on them). I will say though that it is probably pretty likely that most care will be done in the ambulance (if possible). The job of EMS (and nurses) is to provide non-judgmental, high quality care to the people we serve.

We would though make sure we check all equipment and ourselves to make sure we don't have any "hitchhikers". We've put ambulances out of service to allow crews to shower and change after exiting certain residences.

This thread caught my eye because I just encountered my infested home as a nurse providing care in a patient's home. An awesome patient and family, just unfortunate living circumstances. It is so far out of my comfort zone I can't even begin to tell you! So far the family has no idea my aversion to the critters, in fact they complimented me on my lack of [outwardly apparent] fear of the roaches.

I'm in the process of working with my manager to explore what policies we need to put in place especially related to bag technique to protect ourselves and our other patients. I'm guessing that a roach isn't going to stop at a bag barrier and know that they shouldn't go there!

[NurseCard, ADN]

Whether or not I refuse a patient depends on the degree of infestation. I've been in several houses with bugs crawling around but I just go on about what I have to do.

I had one patient that had a pretty severe problem; roaches everywhere you looked. I eventually stopped seeing this patient because my area that I worked in shifted a bit.. and another nurse was being sent to the home. That nurse eventually refused to see the patient; I understand the infestation had gotten much worse and the bedbugs had gotten out of control.

I can actually handle roaches before bedbugs. Once you get those things on you and into your home... it's over.

Im not ever going into a home infested with those daggone house centipedes. I'm terrified of those things.

[MauraRN]

We would though make sure we check all equipment and ourselves to make sure we don't have any "hitchhikers". We've put ambulances out of service to allow crews to shower and change after exiting certain residences.

Yeah, Paramedics and EMT's are further up the food chain than RN's,(LOL) It would be a cold day in hell before a Home Health manager allowed the RN to "go out of service" to clean up equipment, car, go for a shower, change clothes. Pity the next patient when the hitchhikers find themselves a new home.

BTW, the night I was mugged in a drug infested project building, and it was at night, my manager said that if I didnt go see the next 2 psych patients on my schedule that I would be fired for "abandonment". I took a good punch to the side of my face which broke my glasses and knocked my jaw out of alignment but I kept working. Had rent to pay, food for my child.