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EDs trying not to let the bed bugs bite
Decontamination is a common procedure
The headlines of late might well have blared their own version of Paul Revere's warning: "The bed bugs are coming! The bed bugs are coming!" TV networks have run special reports on how bed bugs have been "invading" U.S. hospitals, and as the front door to these facilities, EDs have had their share of challenges.
Infestations became so widespread, in fact, that Bell Environmental Services, a pest control company based in Parsippany, NJ, has formed a Bed Bug Division that targets health care facilities, nursing homes, and animal research labs. "We've worked with many EDs," says Jennifer Erdogan, director of the division. "We got one call where a patient walked in with 200 bugs inside their wallet."
But even a single bed bug can, and should, engender a prompt response from an ED. Rosamond Payne, RN, is the administrator for the ED at Kings County Hospital Center in Brooklyn, one of the busiest EDs in New York City, with more than 106,000 visits in 2009. "Recently, a patient arrived and appeared to have a bed bug on them," Payne recalls. "Our triage nurse was very alert and took the precaution of placing the bug in a specimen cup for examination." The nurse then followed hospital protocol and these steps were followed:
Terri Martin, RN, BSN, MBA, the ED nurse director at Mercy Hospital in Anderson, OH, says, "It almost seems like we have some experience [with bed bugs] weekly. The way we started to manage it is if a patient comes in with just a bite, we do not take any special precautions, but if we see the bugs we do."
Martin notes that the bugs do not live on patients, but they can come in on belongings or clothing. "If we see bugs, we take the patient through to the 'decon' room, undress them, wash them, and keep them on the outside of the building," says Martin. The room has a separate outside entrance door. If the patient already is in an examination room when it is determined he or she is contaminated, housekeeping staff come in to clean the room after the patient leaves, using Rid 60 by Chandler, AZ-based Prochem or Misty Dualcide P3 by Amrep of Marietta, GA, she notes.
"The downside is that the room is closed off for 24 hours, so it's better if we can discover the bugs in triage and then take the patient to the decontamination room," Martin says. "In that case the nurse, perhaps with the assistance of a tech, will go out of the hospital and then back into that room from the outside."
If the bugs are discovered after the patient is in a room, in addition to cleaning the room, any staff members who have been infected have to change into hospital-provided scrubs and launder their clothes at the hospital. "If bugs are running around, we assume they are exposed," says Martin. "Everyone's pretty nervous about them and no one wants to take them to their homes."
The bottom line is that "we just try to keep the environment safe for everyone else in the department," she says. (See protocol with the online issue of ED Management.)
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Be proactive about bed bugs
The best way to minimize bed bug problems in your ED is to be proactive, says Jennifer Erdogan, director of the Bed Bug Division at Bell Environmental Services, a pest control company based in Parsippany, NJ.
"ED managers should know what to look for," says Erdogan, whose company provides inservices for that purpose. "For example, you can do routine dog inspections with dogs trained to sniff for bed bugs and viable eggs," she says. In addition, you can look for fecal droppings, which are little black specklings, or "cast skins," which are the exoskeletons that the bugs periodically shed, Erdogan adds.
"You should also look in cracks and crevices, such as joints in the furniture," she says. "The bugs do not like to be out in the open."