Bedbugs, drug-resistant pathogens pose challenge

Monitor rates to reduce spread of infection

While it is important for home health agencies to prepare to handle a flu pandemic, there are other infection control issues that agencies face more today than in past years, says Barbara B. Citarella, RN, BSN, MS, CHCE, president and CEO of RBC Limited, a home care consulting firm located in Staatsburg, NY.

"There are new guidelines from the CDC [Centers for Disease Control and Prevention] that direct agencies to identify risks and incidence of multiple drug-resistant organizations for their specific area," says Citarella. "Not only do the guidelines require agencies to develop protocols to address the identification and care of patients with methicillin-resistant staphylococcus aureus [MRSA] and vancomycin-resistant enterococci [VRE] but the guidelines also require agencies to track the infection rates," she says.

At St. Francis Home Health in Poughkeepsie, NY, not only are the rates of MRSA and VRE tracked but clusters of any infectious disease are tracked, says Frances Traver, RN, BSN, quality improvement manager for the agency. "We track wound infections and infections associated with Foley catheters to identify reasons for increased infections, but we also track staff infections to minimize the spread of any illness," she says. "If we see a cluster of staff members reporting gastrointestinal symptoms that may be viral, we tell staff members that if they have those symptoms they are to stay home until they are symptom-free for 24 hours," she says.

Another increasing issue for home health patients is bedbugs, says Citarella. The most common bedbug, Cimex lectularius, is making its way into more homes because increased travel throughout the country and around the world makes it easy for the insect to hide in clothing or luggage, she points out. While the bugs don't transmit disease, for home health patients who already have a weakened immune system, allergic reactions or potentially infected bug bite sites can be a problem, Citarella points out.

There is no way to prevent bedbugs but home health nurses should be aware of the potential problem if they have patients who wake up in the morning with insect bites they did not have when they went to bed, says Citarella. "Clinicians should know how to check bedding and other furniture in the house to look for signs of infestation," she says.

Create tracking method

Because tracking infections among staff members and patient populations is the only way to identify increases in rates, it is important to have an effective system, says Traver. "I have tried relying on staff members to report infections as they occur but our nurses are so busy and they are focused on providing care, so reports were not also sent to me," she admits. "Now, I regularly go into our system and look at charts to determine if we are developing unanticipated infections," she says.

For example, one month Traver might pull wound care patient charts to look for additional antibiotics that are ordered after care has begun. If there is a new antibiotic, Traver reviews the chart further to see what type of infection developed. By monitoring infections on an ongoing basis, she adds, the agency has time to identify causes of a rising trend in infections and implement protocols to reduce the risk.

(Editor's note: For more information about bedbugs, go to and