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ESRD NETWORK PROGRAM  ·  NETWORKS 2 · 3 · 4 · 5 · 10 · 11 · 12

Bugs & Infestations

Managing Patient Care

Dialysis facilities offer a great environment for some bugs, including roaches, flies, and gnats. These are typically controlled and managed with regular extermination services and good facility maintenance practices.

Roaches, fleas, and lice are other bugs with which patients are known to present. This can be more difficult to address because it is an environment outside of the facility. However, they are fairly easy and inexpensive to eradicate.

Involuntary discharge is not an appropriate response to patients who present with bugs.

Instead, the following steps are recommended:

  • The Medical Director should be advised and involved.

  • Confirm what the insect is. An entomologist's confirmation is recommended.

  • Review policy regarding items patients are bringing in/out or storing in the clinic. Does the unit allow patients to store personal items in lockers, racks, or closets between treatments? What happens to the coats, blankets, bags of patients when patients are hospitalized, or leave the clinic?

  • Does the clinic have a pest control policy or resource?

  • Does the clinic have an agreement with the landlord or owners of the building to attend to any places adjacent to, but outside of the clinic area, that entice visiting vermin to set up residence? Any boxes unsealed and long forgotten? Any damp or damaged walls or floors (bicarb/acid storage/use areas)? Any leaky door or window seals? Places where food items are not sealed and waste containers not secured? Storage or cleaning closets that are not clean?

  • Assess whether the patient is safe. Is s/he mobile and independent? Is s/he clean, well-cared for, and living in a safe environment? Does s/he live in an area where the bugs in question are prevalent? Has s/he undergone functional, financial, support or housing changes recently?

  • BE COMPASSIONATE. Anyone would be mortified to be in this situation. It is possible that they are also suffering physically from itching and loss of sleep. Address the issue with as much delicacy, privacy, and expression of care as possible.

Bed Bugs

Bedbugs are making a comeback all across the United States. Though they are a nuisance, they do not pose a health risk. Outpatient dialysis settings are not hospitable environments for bedbugs, therefore the risk of infestation is low. The following steps are recommended:

1
Cover the Dialysis Chair

Cover dialysis chair with white paper to easily identify bed bugs.
2
Use Bed Bug Monitors

Utilize active bed bug monitors to determine if bed bug infestation is present in facility. Traps such as those that emit carbon dioxide, may be used to monitor bed bug populations. Bugs captured can be evaluated.
3
Educate Patients and Staff
Provide instructions to the patient for treatment of home and belongings that have had bed bugs.
4
Limit Personal Belongings

Limit personal belongings being brought into clinic (blankets, bags, purses, clothing, etc.). This also includes wheelchairs from infested home. Use large containers with smooth inner surface and lockable lids to hold patient belongings and patient clothing if needed while receiving dialysis. Bedbugs cannot climb smooth surfaces very well.
5
Bag Belongings or Change Clothes
Bag all of the patient’s belongings and have them dialyze in a disposable gown. Or as a less embarrassing alternative, give the patient directions to wash/dry the clothing s/he wears to dialysis on hot; put the clean clothes in a sealed container or garbage bag; s/he must take a shower and wash his/her hair/mustache/beard before putting on the clean clothes and coming to treatment (also assure that his/her shoes, coat, etc. are bed bug-free).
6
Isolate the Dialysis Chair
Use dialysis chair at end of floor to best isolate bed bugs. Keep everything off of floor in vicinity of chair to isolate bed bugs. and restricting the chair for only that patient’s use, if possible.
7
Use a Heating Box
Consider investing in a heating box to treat the patient’s belongings. Dialysis facilities have used Portable heating units with success. All stages of bed bugs are susceptible to temperatures above 120°F. You can do a search on Amazon for ZappBug Oven or The Enviro CaseTM. There are many sizes/costs.
8
Help with Home Treatment
Assist the patient in identifying sources of assistance for home fumigation. Provide community resources to assist patient with home treatment (Dept. of Health and Dept. of Aging, AKF, NKF, Salvation Army or Goodwill, Church groups).
9
Inspect Common Areas
Waiting rooms, visitor lounges, common areas, laundry rooms, and equipment such as wheelchairs and food carts, should be regularly inspected for bed bugs.
10
Use Approved Treatment Products

There are a number of products on the market to treat bed bugs. Isopropyl alcohol is quite effective at killing bed bugs. 91% alcohol is recommended. Facilities should review MSDSs of proposed insecticides/pesticides for safe applications in health care occupancy and on items in affected areas (i.e. – flame retardant properties of dialysis chairs, molecular size and absorption rate, etc.)
11
Protect Staff Clothing
While bed bugs do not jump, they are excellent hitchhikers. Staff handling patients may have bed bugs transferred to their clothing. Therefore, the staff should practice changing into clean scrubs and putting the old scrubs into a hot dryer for 30 minutes. Shoes can also be put into the hot dryer.

Resources for Bed Bugs

For Patients:

  • Maryland Department of Health & Mental Hygiene's Bed Bug Fact Sheet

  • Baltimore City Health Department Healthy Home Bureau's Battling Bed Bugs Safely: A Guide to Preventing and Eliminating Bed Bugs Manual (English, Spanish)

For Staff: