Infection Prevention and Control – Unsanitary Home Environment
Strength of Evidence Level: 3
PURPOSE:
The purpose of this procedure is to protect patients and
agency staff from injury or illness due to the presence of
unsanitary conditions in the environment.
2.
CONSIDERATIONS:
1. Patients have a right to live in their environment of
choice. However an unsanitary condition may place
the patient in peril of which the patient is unaware or
unable to resolve without special assistance.
2. Agency staff has a right to work in a safe
environment.
3. Unsanitary conditions are evaluated for safety and
staff is not exposed to unsafe conditions. Refer
unsafe conditions to public health and other
agencies responsible for patient welfare.
4. Determination of what is unsanitary:
a. Conditions that may prevent staff from safe
delivery of patient care, such as flea or bed bug
infestations, mold, absence of potable water
and sewage system failure are included in
unsanitary conditions.
b. Cultural differences/economic status may
influence the patient’s environmental tolerances
leaving local public health regulations to define
what is unsanitary.
5. Fleas (Ctenocephalides felis) are commonly related
to the presence of household pets such as dogs and
cats. Fleas have been known to transmit disease.
Consider veterinarian assistance in treatment of the
host pet as well as professional help in clearing
fleas from the environment.
6. Bed bugs (Cimex lectularius) are not considered to
transmit disease. The itching and inflammatory
response to the bed bugs bite is the chief medical
concern. Bed bugs are night feeders, preferring to
hide in folds and crevices during the day. After
feeding, a bed bug can survive for weeks without
food or water. Infestations are associated with
overcrowding.
7. Cockroaches, common to households, are not
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(3) Mold.
(4) Non potable water.
(5) Septic system failure.
(6) Vector related illness.
Personal Protective Equipment (PPE) has not been
recommended by the CDC. The CDC does not
recommend that staff or patients attempt to alleviate
unsafe, unsanitary conditions. Spraying pesticides
for cockroaches, fleas or bed bugs creates
dangerous chemical exposure and should be done
only by pest removal professionals. Simply
sweeping Hanta Virus contaminated rat droppings
can aerosolize and transmit the virus.
PROCEDURE:
Assessment and Response:
1.
Staff will report unsanitary conditions immediately to
administration and not attempt to correct the
condition. Attempting to clean up rodent droppings
or mold can expose staff to serious illness;
attempting to eliminate roaches or fleas exposes
staff to unsafe chemicals.
2. Determination that an environment is unsafe
involves prompt assessment of the environment
followed by dialogue between the patient, staff and
agency administration.
3. Once it is established that unsanitary conditions that
impact upon patient health or safety or the delivery
of services to the patient exist, an agency action
plan will be developed to address the conditions
identified.
4. The action plan will involve the patient or the
patient's designee(s) and include recommendations
for remediation of the unsanitary conditions and
offer a time line for completion.
5. Refer patient to professional services for unsanitary
conditions or the local Public Health Department.
6. Services to the patient may need to be interrupted
or the patient temporarily removed from the
environment until correction of the unsanitary
condition is completed.
7. Environment needs to be evaluated before services
resume.
8. Where remediation is not achieved, determination
as to the safety of continuing services lies with
administration.
9. If the environmental assessment does not
substantiate the initial concern, administration will
review the situation with the staff that initiated the
concern and determine if staff will continue
providing services or be reassigned.
10. To complete a visit in a home considered unsafe
with flea, bedbug or cockroach infestation:
a. Make last visit of the day.
b. Look for signs of bedbug infestation such as
bites on patient’s skin, blood spots on sheets or
clothes, brown stains on seams or crevices of
bed/couch.
generally considered to transmit disease. No
current studies are available regarding
cockroaches and multiple drug resistant
organisms spread by direct or indirect contact.
Cockroaches and their droppings are known to
trigger asthma attacks.
EQUIPMENT:
1. Phone and computer with Internet access to utilize
the following resources:
a. Public Health Department’s and/or Centers for
Disease Control and Prevention’s WebSite
www.CDC.gov offer information on identification
and resources regarding, but not limited to the
following:
(1) Flea, bed bug and cockroach infestation.
(2) Rodent infestation.
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Last Update 9/10
Infection Prevention and Control – Unsanitary Home Environment
Strength of Evidence Level: 3
c.
d.
e.
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further infestation, place in a plastic or Rubbermaid
container.
10. After mattress cleaned and sealed, to prevent
further bites:
a. Pull bed away from wall and other furniture (like
island in center of room). Place double-sided
sticky tape on all legs of bed frame.
b. Place bed frame legs in small dish and either:
Vaseline [or other sticky substance – tangle
trap, pine tar] outside and inside of dish or
Vaseline outside of dish and mineral oil inside
dish.
11. Continue to monitor bed and edges of carpet/room
for evidence of bed bugs.
12. If bed bugs are still biting, the bed is still infested
and must be re-cleaned. Be sure to SCRUB the
bed frame.
Wear a light colored, snug fitting, cotton uniform
such as a “scrub suit” that is easy to launder
and dry.
(1) Clothing should not be loose
(2) Clothing can be sprayed with Steri-Fab to
destroy bedbugs
Minimize what is transported into and out of the
home:
(1) Cockroaches: Keep any supplies in home
in plastic bin with snap top, if appropriate.
(2) Avoid taking coat/sweater into home if
possible; use washable cotton lab coat if
necessary.
(3) Avoid taking bag into home. Assure that
any reusable equipment taken into the
home is not harboring fleas, bedbugs or
cockroaches. If equipment must be used,
place on a barrier on a metal or plastic
table or chair pull into the middle of the
room
(4) Avoid sitting upon or putting supplies
upon upholstered furniture.
Before getting into your vehicle, check crevices
of anything brought into the home, including
your PDA, clothing and shoes. Use alcohol or
Steri-Fab to wipe down items to disinfect.
Minimize concerns about transporting vermin
home when a uniform is worn:
(1) Upon removal, place uniform/clothing and
shoes in a plastic bag.
(2) Launder uniform separate from family
laundry.
(3) Use detergent and hot water and dry using
hot dryer setting for 20-30 minutes.
AFTER CARE:
1. Educate the patient and caregiver on maintaining
household free of unsanitary conditions.
2. Educate staff returning to the home on signs of the
unsanitary condition and how to identify and report a
potential recurrence.
PATIENT EDUCATION:
1. To assist patients in long term bedbug control:
2. Work with landlord/exterminator to reduce clutter in
patient's home/apartment.
3. May use IC2 (or mix of
rosemary/peppermint/mineral oil) on edge of carpet
and/or edges of room.
4. If possible have the mattress, box spring,
upholstered edges of carpet and any crevices on
walls steam cleaned. An industrial strength steam
cleaner must be used.
5. The bed frame should be scrubbed with
bleach/water solution.
6. Other household items can be wiped down with
alcohol or other disinfectant.
7. Have the client seal the mattress and box spring
with a plastic mattress cover. Cover the zipper with
duct tape.
8. If the landlord has not fixed cracks/crevices on
walls, have the client/family duct tape all
cracks/crevices in walls and furniture.
9. Wash all clothing in hot water, dry in dryer at least
20-30 minutes on hottest dry cycle. To prevent
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Last Update 9/10