Guidelines Specific to Long Term Care

Guidelines Specific to Long Term Care

A good general resource:

Issues Specific to Long Term Care

• Patient or resident satisfaction• Family satisfaction for the welfare of their

loved ones• Reputation of a facility• Local, State, and Federal guidelines and

regulations regarding housing standards• Unique considerations of older adults and

other vulnerable populations

Unique Considerations for Older Adults

Limited Mobility?

Existing Skin Conditions?

Poor Vision?

Mental or Cognitive Difficulties?

Communication Difficulties?

Need Assistance to Prepare for Treatment?

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Special Considerations for Vulnerable Populations

• Lack of choice in housing, frequent relocation

• Lack of resources – Few sources of financial assistance at this time

• Inability to recognize an infestation– Elderly, disabled

• Require assistance to prepare for treatment

Have a Plan & Be Proactive!

Prevention

Facility Level Prevention

• Intake procedures that screen incoming clients for skin-condition (if medically appropriate), and their belongings for evidence of infestation

• Promptly respond to sightings or complaints

• Any donations to the facility should be screened

Develop a facility specific policy and policy statements

Facility Level Prevention

• The routine use of insect monitors may help to identify infestations early

• Facility repairs will help to keep bed bugs from spreading, and make treatment for bed bugs more efficient

• Certain types of furniture are more easily inspected, cleaned, treated, and may be less hospitable to bed bugs

• Maintain a “bed bug” vacuum

Education Prevents Infestations

• Train employees to recognize the signs of bed bugs– Early detection and follow-up will save much needed resources

• Educate clients to recognize bed bugs– Dispel the stigma– Be careful when visiting or travelling

• Facilities that may see the same clients that you are seeing should also be aware of bed bugs – local consortiums are good outlets for education and information sharing– A community approach is the only way to reduce the burden of

bed bug infestations– If all facilities are not “on board” you may still have epicenters of

spread

Observation & Monitoring• Visual inspection

– Time consuming, difficult to detect early infestation

• Monitors– Sticky traps, interceptors, dry ice baited,

CO2 + heat• Canine scent detection

– Very promising, high sensitivity– Dependent upon the team – trainer and

dog• Detection may be hindered by

hesitation to report by tenants• In multi-unit housing, must inspect

adjacent units

Document all observations

• Take action promptly• Report:

−Date

−What you found

−What you did

Got bed bugs? Now what?

If found and controlled early in the infestation, the spread of bed bugs can be stopped.

The first responses should be to:Report the problemDo NOT throw the mattress out—cover itDo NOT spray—leave this to the PMPPrevent carrying the bed bugs to other placesPrepare the unit for the PMPInspect adjacent unitsEducate your clients

Mattresses and furniture

don’t always have to be thrown out!

Use a Mattress Encasement!• Trap live bed bugs inside and make it more difficult for bed bugs to

hold onto mattress• Zip, seal, and check for rips• Leave it on (don’t let it rip)• Many PMP’s will require

Treatment Technologies• Insecticides

– Pyrethroids (liquids, dusts)

– Insect growth regulators (IGR)(hydropene)

– Diatemaceous Earth

• Heat Treatment– Steam (cracks/furniture)

– Dry Heat (can treat entire unit)

• Cold Treatment

(liquid CO2)

• Encasement

New TechnologyHeat is an effective treatmentNew technology allows us to raise the temperature of an entire home or unit. The upper thermal tolerance of the bed bug is ~117°F.

Requirements for Successful Treatment

• Scrupulous preparation

• Choice of treatment methodologies best suited to the situation

• Post-treatment monitoring and re-treatment if necessary

• Identification and remediation of high risk behavior to avoid re-infestation

One bed bug, HALF a year…

Management's role

• Find out the PMP’s requirements for unit prep and plan ahead! Example: Who takes apart and reassembles furniture?

• Have the professional inspect and treat units adjacent to the infested one.

• Communicate the situations/populations in units to the professional (respiratory problems, chemical sensitivities, pregnant women, the elderly, or children present).

The PMP's role

• ALWAYS thoroughly inspect the unit and the adjacent walls

• Provide preparation and follow-up instructions in multiple languages

• Follow the label—especially when treating mattresses!

• Return in three weeks to look for and treat hatched nymphs

Facilities, maintenance, and support service roles

• Be discreet• Empty dumpsters weekly • Mark and/or damage furniture left out for the trash

so it can’t be reused• Inspect the laundry room weekly• Help residents prepare—educate and provide

physical or financial support • Be very cautious when working in units—never

set items on or under beds, recliners, or sofas!

The resident's role

• Inspect regularly if possible• Report bed bug sightings immediately and seek

help from staff • Use plastic bags when transporting infested items• Don’t bring home furniture found on the street• Follow preparation instructions from the PMP

Challenges for Long Term Care

• Client may not tell you about the problem– They might not know or understand

– They may be ashamed

• Bed bugs may cause a a lot of distress– Client may be angry or depressed about it

– Bed bugs may compound other problems

• Health problems may necessitate an alternate treatment strategy

Strategies for Long Term Care

• Set (and follow) policies to prevent bed bugs at intake

• Constant vigilance! Don’t wait for clients to complain

• Use mattress encasements

• Hire experienced professionals for treatment

• Be able to identify infested units• Reduce the items you carry in/out• Items to be carried in/out

– Contained in a plastic bag– Left in places least likely to be accessible by

bed bugs• Avoid sitting down on infested furniture• Check your clothes and shoes after leaving

If you find them, Don’t take them home with you

• Areas least likely to have bed bugs:– Kitchens– Bathrooms– Well traveled walkways– Center of large clean areas

• Table tops

• Bare floors

• Bathtubs

Avoiding bed bugs

Guidelines and Resources

• Many resources are available online for use in education and planning:– Fact sheets– Training resources– Comprehensive manual

• For information specific to Michigan and as educational and training resources are developed, check:

www.michigan.gov/bedbugs

Resources

NEW!