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Out patient with active Bed bugs

  • 1.  Out patient with active Bed bugs

    Posted 12-12-2017 12:57
    Has any one had a patient with active bed bugs?  Dr. is asking patient to be treated in the clinic.
    Would love to hear from someone who is dealing with or has dealt with this issue

    Deb Hughes

  • 2.  RE: Out patient with active Bed bugs

    Posted 12-13-2017 03:19
    Our outpatient infusion center was treating a patient with daily IV therapy, who lived in her bed-bug infested van at the time.  We reserved a chair for her at the end of the day, and had her change into a "bunny suit" (looked like the standard haz-mat suit), with hair bonnet, shoe bonnet.  The chair was also covered with disposable sheeting and taped with double-sided tape, as well as double sided tape around the perimeter of her treatment area.  Housekeeping did a thorough terminal cleaning of the area after each treatment.  Very labor intensive, but effective.

    Cheryl Ching RN OCN®
    Straub Clinic & Hospital
    Honolulu HI

  • 3.  RE: Out patient with active Bed bugs

    Posted 12-13-2017 07:11
    We, unfortunately, have had a few patients with active bed bugs.  Unfortunately, they are becoming more and more prevalent.  I would check with your institution if you already have a policy regarding how to treat these patients.  
    Our SOP for treating these patients were as follows:
    - We treat this as contact isolation.
    - front office staff would notify staff when patient was here and would be brought immediately into an exam room.  This exam room is now off limits to anyone else except that patient until cleaned again.
    - There, a white sheet would be set out where the patient should be assisted to change out of their clothing (with a light shake) and into scrubs.  Patient is required to wear a surgery cap, as well as surgical booties.  Staff are gowned in a bunny suit with booties and surgical cap or a gown with booties and a cap.
    - The patients clothes are bagged and secured using a gooseneck knot as the sheet is inspected for any active bugs.  
    - Linens used (white sheet) is also bagged using a gooseneck knot.
    - All bags are left in that exam room.  
    - Patient is escorted to the treatment area and treated.
    - Patient is escorted back to the exam room they changed in.  
    - White sheet is again placed down where patients change back into their clothes and an inspection is completed to look for live/active bugs at that time.  
    - Patient remains in that exam room until their transportation is there and they are taken to their vehicle.  

    If bugs are found, we had special dogs come and sniff until it was clean.  If no bugs were found, then the room is cleaned using our usual methods and the exam room was used once again.  If bugs ware found, EVS came to steam the entire exam room.  Unfortunately, it is a rather cumbersome and tedious process for both the patient and the staff. 

    Hope this gives you some ideas.

    Shelley Forbus BSN, RN, OCN
    Froedtert Hospital, Drexel Towne Square

  • 4.  RE: Out patient with active Bed bugs

    Posted 12-13-2017 07:30
    Hi Deb & all-

    I recently joined a Pulmonary practice part time and the nursing team relayed a case about caring for a patient with unknown bed bug infestation and the resulting interventions they employed not only to aid the family and home, but to treat the outpatient department.

    If you are ok with me connecting you with the nursing team leader & practice manager, I can do that....and they can share with you their experience and suggestions for pro active management & resources required.

    Loving the community discussion for ALL types of solutions!   I dare say between us all.....we've seen about everything.

    Have a great day! 

  • 5.  RE: Out patient with active Bed bugs

    Posted 12-13-2017 09:16
    ​Our process is very similar to the others who have responded, private room, however, we don't require the patient to change, instead our staff are the ones to wear the bunny suit, shoe covers, cap ect. When the patient is discharged, the curtain is replaced, the room is cleaned as well as treated by an exterminator.  We have gone so far as to absorb the expense to have the patient home treated on a few occasions because of the immense impact this has on our operations and it's VERY prevalent in our population now.

    Susan Shaw MSN, RN, OCN
    Nurse Manager
    Bayhealth Medical Center
    Dover, DE

  • 6.  RE: Out patient with active Bed bugs

    Posted 12-13-2017 10:13
    ​We have had patients that have brought bed bugs into our outpatient infusion center.  Usually we find them after the patient has left and we are cleaning the area.  When we do find them, we capture the bug and call an exterminator.  They identify the insect and treat the area.  You will need to capture the insect so that the exterminator can verify that it is in fact a bed bug.  Hope this helps

    Teresa Allen RN, OCN, CRNI
    Rock Hill SC

  • 7.  RE: Out patient with active Bed bugs

    Posted 12-13-2017 10:15
    ​We encountered this recently.  If you have an infection prevention department, get them involved early.  Naturally, we try to room the patient quickly, and if we know they will be in the clinic for the provider, then off to infusion, we send them directly to infusion for the provider to see them there in a private room to minimize the number of places they travel.  Isolation of course (and even taping ones pant legs).  There is a stigma to patients having bed bugs and we reinforced education with the staff to ensure the patient is treated respectfully.

    Linda Penwarden MN RN AOCN® CNS
    St. Luke's Mountain States Tumor Institute
    Boise ID

  • 8.  RE: Out patient with active Bed bugs

    Posted 12-13-2017 10:18
    ​We have had several patients with active bed bugs come to our facility for treatment. Our process is to initially  restrict the patient to a confined area and to collect a bug for positive ID. If it is indeed a bedbug (which often times it has been some other type of small beetle or nit), the patient is advised and assisted by social work to have their home inspected and fumigated. We have a contract with a pest control agency that then comes out to spray all areas where the patient has been. Unfortunately, the patient cannot come back until their home has been sprayed and their is no further evidence of infestation. Our Social Workers are very helpful with coordinating all of this.

    Nancy Harrington RN MS
    RN Manager
    The University of Arizona Cancer Center
    Tucson AZ

  • 9.  RE: Out patient with active Bed bugs

    Posted 12-13-2017 11:15
    Edited by Kelay Trentham 12-13-2017 11:19
    ​We have had this problem. I believe It was determined that it was too great a risk to other patients to have the patient come in for treatment until/unless the bed bug situation was mitigated. Our social workers worked with the patient on mitigation measures. It was a very complicated situation, due to the patient also having limited financial resources, uncooperative landlord (other units were infested, so re-infestation occurred), schizophrenia (thus challenged to understand and comply) etc., and there were so many barriers to mitigation...  as well as other factors unrelated to this, that we were unable to manage to treat her - even though our SWs worked tirelessly to assist with the mitigation. Resources we tapped were our infection control department, public health dept, patient's church (for assistance with furniture, moving, clean up, etc.), remediation agencies, etc.

    Appreciate seeing what others have done. So many great strategies!

    Kelay Trentham MS, RDN, CSO
    Oncology Dietitian
    MultiCare Regional Cancer Center
    Tacoma WA

  • 10.  RE: Out patient with active Bed bugs

    Posted 12-13-2017 11:30

    The patient was met at the hospital entry door (the outpatient clinic is in the hospital) and transported per  chux lined wheelchair to the fifth floor outpatient infusion area. Once on the floor, he was taken directly to the shower. His clothing was placed and sealed in a plastic bag. The chux were inspected for bedbugs before being discarded in a separate plastic bag, and any bedbugs were placed in a sealed container for disposal by EVS.  After showering, he put on hospital scrubs and was transported per wheelchair lined with fresh chux, to his assigned treatment room. The chux were again inspected for bedbugs. the wheelchair stayed in his room during his treatment. After treatment, he changed back into his clothes and was discharged per chux lined wheelchair. Both his treatment room and the shower areas were closed until cleaned and approved by EVS for use.

    Transporting per wheelchair ensured the patient arrived and left by the most direct route, minimizing exposure.

    Kimberly Willford BSN, RN, OCN
    ProMedica Cancer Institute
    Education Co ordinator
    419-824-1113 office
    419-260-3665 cell
     "Pay careful attention to your own work, for then you will get the satisfaction of a job well done, and you won't need to compare yourself to anyone else. For we are each responsible for our own conduct." Galatians 6: 4,5

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  • 11.  RE: Out patient with active Bed bugs

    Posted 12-13-2017 12:28
    In my experience the patient was meet at the door to the building and he changed into clean clothes and other clothes were bagged
    Shoes were included in the removal of clothing
    The chairs were sprayed with alcohol before and after
    if bed bugs were found the area was isolated until ex terminator sprayed. Our facility required saving the bed bug so they could prove the problem. If you have a separate area that would be best. Unfortunately this is a problem for many patents. They cannot afford the bed bug treatments.
    Be careful to not bring home.

    Ruth Gholz RN MS AOCN
    Cincinnati VAMC
    Cincinnati OH

  • 12.  RE: Out patient with active Bed bugs

    Posted 12-13-2017 14:13

    Yes we have bed bug issues at least three to four times a year in our chemotherapy and radiation outpatient department.

    How we deal with it? While patient still needs to be treated? ...

    When a bug is identified we let the patient know and they have to exterminate their home and bring certificate

    Meanwhile when patient arrives we get them straight into a shower and they change into clean clothes that we have collected over the course of time

    We put their clothes in a double black plastic bag seal it and take to their car while patient gets treated.

    We will do this every day or every time the patient comes in until we get the certificate.


    Joy Hepkins RN BSN OCN

    Oncology Nurse Navigator

    Mercy Fitzgerald Hospital 

    1500 Lansdowne Avenue

    Darby PA 19023

    Phone: 610-237-2648

    Relax, have an open mind and heart, importantly  trust God....



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