Impact of a Hygiene Intervention on Virus Transmission in a Long-term Care Facility

Abstract

ISSUE: Unexpected bed bug infestations in patients are concerning in ambulatory care centers, as hospital and long-term care facility outbreaks have been described. Although there has been resurgence nationally, strategies for bed bug management in outpatient environments have not been well-defined. Bed bugs are of particular concern at our comprehensive cancer center, as many patients reside in on-campus housing and are seen in multiple locations throughout the center. PROJECT: In December 2011, a team which included Infection Prevention, Environmental Services, Social Work, Materials Management, Nursing and a Pest-Control Service, convened to develop an ectoparasite management policy for our outpatient oncology center. A flexible policy design was utilized to account for a variety of exposure scenarios. The policy’s main goals were timely case identification, proper isolation and containment procedures, and management of follow-up visits for patients with confirmed bed bugs. During policy implementation in June 2012 staff education was provided. Post-implementation, bed bug events were tracked, cases underwent review, and policies modified as needed. RESULTS: From June 2012 to October 2013, 8 bed bug events were reported. A total of 4/8 (50%) were confirmed patient infestations, including 3/4 (75%) identified during the patient’s clinic appointment; activating isolation, cleaning and inspection components of our policy. In each instance, a pesticide company inspected and found no evidence of spread within patient care areas and no transmission events were documented. Staff reported challenges in care coordination, especially for patients with multiple follow-up appointments. Tailored personal feedback reinforced policies in healthcare workers, and Environmental Service staff required additional training on linen management and cleaning procedures. LESSON LEARNED: While identification of bed bugs at our outpatient cancer center was infrequent, the impact on patient care was significant. Development of an organized centerwide policy enabled us to manage proven and possible bed bug events. Our policy was improved through simple learning tools, including quick reference guides and patient education sheets. Quality reviews and debriefing after events helped to disseminate best-practices, identified educational gaps, enhanced staff engagement and ultimately improved policy implementation.