NEW YORK NURSE: December 2009
Q.: During the colder weather, more homeless people come to the emergency department, bringing with them a variety of parasites. We recently had an infestation of bedbugs that spread to a co-worker’s home. What can be done to stop this?
A.: Due to an increase in worldwide travel and a ban on the use of synthetic pesticides, a number of pests have re-emerged as problems in society. Healthcare workers are seeing more cases of body lice, mites (scabies), and, notably, bedbugs. The nation is experiencing its largest outbreak of bedbugs since World War II.
Lice and mites are spread through close or direct body contact with an infected individual and are rarely transmitted by animals other than humans. Bedbugs, on the other hand, can live on household pets and be carried in clothing and other personal items, such as luggage and backpacks.
The presence of lice or bed bugs can be determined by finding bites, eggs, or the actual bugs themselves on the individual. Scabies is confirmed by light microscopic identification from skin scrapings.
Prevention and treatment are different for each parasite. Lice and bedbugs bite and suck the blood of their hosts, but live elsewhere. Bedbugs hide in mattresses, crevices, and cluttered areas. Body lice live in clothing and head lice on the scalp. Mites use human hosts as their breeding ground, living under the skin and feeding on dissolved tissue.
Bedbugs are able to live off of their hosts for weeks or months, so prevention and treatment includes environmental strategies such as vacuuming, fumigation, or dusting with chemical insecticides. Often the services of a professional exterminator are needed. Treatment may include caring for the bites and itching with a topical anti-inflammatory. Scabies should be treated with a specific antiscabietic agent. Head lice should be eliminated with a pediculicide.
Proper utilization of personal protective equipment (PPE) and standard precautions are invaluable in preventing transmission of parasites from patients to healthcare workers. All three parasites are common enough to be experienced across age, ethnicity, financial, and social status. Follow facility policy for providing hygiene and clothing for the patients and make sure that bedding and equipment is cleaned thoroughly after caring for an affected individual.
If you are provided uniforms that are left at the facility for cleaning after each shift, take advantage of this service. If this is not available to you, change out of your work clothes before you go home and seal them in a plastic bag until they are cleaned. Keep personal bags or backpacks away from patient areas and keep them off the floor. Contact your infection control department with your concerns if you see parasites in your facility; seek immediate treatment if you have scabies.
More information on parasites is available from the Centers for Disease Control and Prevention at www.cdc.gov.