bedbug basics for homecare - hcaw conference/pp... · • wear simple clothing, avoiding buttons,...
TRANSCRIPT
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Bedbug Basics for Homecare
Rebecca Bartles, MPH, CIC, FAPICSystem Director, PSJH Infection Prevention
The Culprit
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• Common species: Cimex lectularius and Cimex hemipterus
• Reddish‐brown, oval, flat bugs, 4‐5 mm long
• Cannot jump or fly, but can run and climb
• Typical lifespan is 12 months, but can live much longer in cold environments and where food is scarce
Bedbugs Through History
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• Existed in concert with man since ancient times
• Introduced to the US by early colonists in 16‐1700’s
• Very common pest until the 1940’s• Mostly eradicated in the U.S. due to:
• Advent of DDT• More effective vacuum cleaners• Changes in home construction
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Bedbugs Through History
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• Remained prevalent in other countries• Have begun to increase in prevalence again in the U.S., due to:• No “magic bullet”
• DDT banned in 1972 as health threat
• Increased world travel• Underground economy• Increased second‐hand merchandise
Lifecycle
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• Can lay 200 to 500 eggs in a lifetime
• Eggs hatch in 10‐15 days
• Time from egg to adult ranges from 5‐16weeks
• Life cycle is highly dependent on availability of food and temperature (ideal temp is 70‐82 F)
• Adults can go without feeding for extended periods of time (400+ days)
• 3‐4 generations per year #of Days it takes for bed bug to go from egg to adult ° F (˚C)
128 64.4° (18°)
24 86.0° (30°)
21 71.6° (22°)
Epidemiology of Infestation
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• Hitch‐hikers!• Common sources of acquisition:• Motel rooms• Apartments• Homeless shelters• Second‐hand beds and couches• Clothing or shoes
• Rapid breeding results in quick spread throughout a building• Females deposit 2‐5 eggs per day in secluded areas, hundreds over a lifetime
• Eggs are hard to see without magnification• Blood meal required to progress through the stages of development
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Not Just on the East Coast
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Bedbug Behavior
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• Active at night, generally feeding while people are sleeping
• Attracted to humans by carbon dioxide and warmth
• Use an elongated beak to pierce the skin and withdraw blood
• A blood meal generally lasts 3‐10 minutes
• Do not usually live on their host, generally leave immediately after feeding and reside elsewhere during digestion
• Initially live around the mattress and bed area (or wherever the host sleeps), but expand quickly to infest an entire building
• Will feed from other domestic animals when humans are unavailable
Clinical Manifestations
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• Symptoms after being bitten vary with the individual: Itchy red welt
Localized swelling
Allergic reaction
No reaction at all in some individuals
Delayed reaction in others
Impossible to distinguish from other insect bites
• Indicators of infestation: Waking up with bites that were not there when you went to
sleep
Finding a bedbug on your body or in your home
Fecal spots, blood spots, or molts on sheets
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Clinical Manifestations
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• Treatment is usually limited to careof the bites, including: Reducing inflammation (anti‐
inflammatories)
Preventing/eliminating infection (antiseptics)
• Bedbugs are NOT known to spread disease
Prevention for Caregivers
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1. Know before you go2. Don’t be afraid to ask3. Know what to look for4. Confirm your suspicions5. Protect yourself, your car, and your home
Know Before You Go
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• Maintain a record of residences in which bedbugs have been identified in the past. In apartment complexes, bedbugs can easily spread from one apartment to the next.
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Don’t be Afraid to Ask
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Screen patients before your visit to ask if they are aware of any insect or rodent infestations. Fleas, mice/rats and roaches can also be very problematic and require preventative mechanisms.
Know What to Look For
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• Lower level infestations may not be obvious• The area where the patient sleeps is the most likely location to
find eggs, bugs, and their waste products. Focus on the seams and surfaces of the mattress, box spring, and frequently used couches/chairs.
• Look for:• Bugs• Fecal spots• Egg cases• Shed skins
Confirm Your Suspicions
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The only way to be sure is to capture a bedbug for identification. A urine collection cup works well.
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Protect Yourself, Your Car, and Your Home
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• General Infection Prevention practices to reduce your risk in all scenarios:• Wear simple clothing, avoiding buttons, cuffs, lots of pockets, or other design
elements that may be difficult to visualize or clean• Avoid jewelry and other accessories (scarves, etc.)• Wear shoe covers• Do not sit on upholstered furniture• Look closely at surfaces before placing any item down• Utilize barriers before putting down any bags or supplies• Keep personal items (cell phone, ID, keys) in a fanny pack or other protective
device to contain them while remaining on your person• Do not take upholstered items or clothing from a patient’s home
Protect Yourself, Your Car, and Your Home
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Keep a bedbug prevention kit in your car, including:a. Shoe covers, hair cover, glovesb. Change of clothes and shoes c. Thick (preferably white) plastic bagsd. Disinfectant wipese. Hand mirror
*If you are entering a home with a known infestation, also bring:a. Tyvek suit/coveralls b. A sealable device to hold any personal items that you need to bring into the homec. A portable hard‐surfaced chair or stoold. A plastic container with sealing lid to contain potentially infested itemse. Light‐colored duct tape
Protect Yourself, Your Car, and Your Home
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Scenario #1: You enter a home and identify during your visit that there may be a bedbug infestation. You are not wearing a Tyvek suit because you did not know in advance. The following will help to prevent transmission:1. Catch the bug if possible for identification2. Dispose of all disposable and unnecessary items within the home3. Collect all supplies and equipment that you will be taking out of the home with you. Exit the residence, taking only those items that
must be salvaged. 4. Place these items in a thick white garbage bag and GOOSENECK tie the top of the bag and white the outside of the bag with
disinfectant wipes5. BEFORE opening your car, conduct a self‐inspection of your clothing and body, starting with your shirt and working your way down to
your shoes. Use the handheld mirror to check the back of your legs and your hair. If any bedbugs are found on your body or clothing, remove and crush them. Screaming loudly will help with this task.
6. OPTIONAL/ ADDITIONAL STEPS: Remove your shoes, socks, accessories, jewelry, and any other item that can be removed from your body and place it in a thick white garbage bag. GOOSENECK tie the top of the bag. Using a disinfectant wipe, wipe the exterior surface of the garbage bag. If you are not concerned about the clothing that you are wearing, you can wipe it down with a disinfectant wipe as an extra precautionary step. You can also utilize the Tyvek suit in your bedbug prevention kit to place over your clothes for the drive.
7. Place the bags in your vehicle.8. Upon arrival at the office or your home, remove current clothing, place into a bag, and gooseneck tie the bag. Do this in the garage if
possible. Recheck your body before getting dressed. Place your clothing into a dryer on high heat for at least 15 minutes to kill any bugs or eggs remaining on your clothing.
9. Remove the bags from your vehicle and wait until you have appropriate PPE before opening them.
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Protect Yourself, Your Car, and Your Home
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Scenario #2: You must enter a home in which a known or suspected infestation is occurring. The following will help to preventtransmission:1. Bring only those supplies and equipment that are necessary for the task. If disposable items are available, use those instead of
reusable.2. Prepare your bedbug prevention kit (including supplemental materials from slide 17) and utilize the practices outlined on slide 16. If
possible, leave the following components of the bedbug prevention supplies outside of the home (white plastic bags, sealable plasticcontainer, duct tape)
3. Before entering the residence, don the Tyvek suit and hair cover. Check to ensure Tyvek suit is in good repair.4. Do not place items on upholstered surfaces or on the floor. Utilize barriers to provide a clean surface upon which to place equipment
and supplies.5. If you must sit, only do so on the hard‐surfaced chair or stool that you brought with you. Minimize the amount of time spent in the
environment.6. After the visit is complete, dispose of all disposable and unnecessary items within the home.7. Collect all supplies and equipment that you will be taking out of the home with you. Exit the residence, taking only those items that
must be salvaged. 8. Outside of the residence, place these items in a thick white garbage bag and GOOSENECK tie the top of the bag.9. If you utilized a portable chair or stool, visually inspect and then disinfect the entire stool with disinfectant wipes, removing and
crushing any bugs found.10. Conduct a self‐inspection of the Tyvek suit, starting as high as possible and working your way down to your feet. If any bedbugs are
found on your person, remove and crush them. Remove the Tyvek suit carefully, rolling it in on itself from top to bottom as you remove. Carefully remove the hair cover and place both in a white garbage back. GOOSENECK tie the top of the bag and using a disinfectant wipe, wipe the exterior surface of all garbage bags. Place the garbage bags in the sealable plastic container.
11. At this point, all potentially contaminated items should be contained. You can refer to step 6 in the previous slide and conduct any of the following steps based on the situation.
Protect Yourself, Your Car, and Your Home
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Decontaminating potentially infested items:• Heat: At least 140 degrees F for two hours or 130 for 3 hours or 30+ minutes in a household dryer on high
heat• Steam: Portable steam cleaners can be used for upholstered surfaces, but they must penetrate completely• Insecticides: Varying degrees of success due to chemical resistance, consult an exterminator.
Protect Yourself, Your Car, and Your Home
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• Practicing these steps in advance can increase your level of comfort and efficiency.• If you have concerns that breaches in the process might have resulted in infestation of your car or home, notify
your supervisor immediately.• For extra protection at home:
• Vacuum your vehicle routinely, and empty the vacuum into a gooseneck tied bag• Consider using a mattress protector• Consider using a passive device like an interceptor monitor
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Extermination
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• Under Washington state law, landlords are obligated to manage infestations in rental units, with an exception: in single family residences and
in cases where the infestation is caused by the tenant
• In addition to being registered in King County, all professionals applying restricted pesticides must be licensed by the Washington State Department of Agriculture.
• Ask for a copy of their Pest Applicator's License or call the Washington State Department of Agriculture at 877‐301‐4555, or check their license at: http://agr.wa.gov/pestfert/licensinged/search
Extermination
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• Inspections of the home can take 1‐4 hours
• Use of steam/heat before any pesticides
• Clutter removal
• Vacuuming
• Washing of all surfaces that would not be damaged by moisture
• Washing of all linens, etc
• Treatment can take several visits
• Typical costs can range from $1000 ‐ $10,000
• Washington State Department of Health http://www.doh.wa.gov/CommunityandEnvironment/Pests/BedBugs
• King County Public Health http://www.kingcounty.gov/healthservices/health/ehs/bedbugs.aspx
• Guidelines for Prevention and Management of Bed Bugs in Shelters and Group Living Facilities https://ecommons.cornell.edu/bitstream/handle/1813/43862/guidelines‐bed‐bugs‐group‐
NYSIPM.pdf?sequence=1&isAllowed=y
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Resources for More Information
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