Creepy Crawlers! Recognizing and Treating Lice , Scabies and Bedbugs OH MY!

PROCARE HOSPICE OF NEVADA INFESTIONS 1 Creepy Crawlers! Recognizing and treating Lice , Scabies and Bedbugs OH MY!

Fact of life, no matter how clean you are, lice do not just strike those with dirty scalps, if you have a school age child the odds are pretty high your child will probably be infested with lice! Here are the facts about lice.

 Parasitic insect that lives in your hair sucking up small amount of blood from the scalp.

 Harmless

 Common in group settings (school)

 Extremely contagious

 Their bites do not cause infection, the scratching from the bites cause scratching, inflammation that cause infection. Warning Signs

Persistent itching 1. Incessant itchy scalps caused by allergic reaction to lice bites, and the lice’s saliva and feces. Sometimes it takes several weeks for the child to start scratching their heads. Surprise you have already been infected and did not know it!

2. Inflamed scalp , check the scalp of the child/person who keeps scratching, look for inflammation.

3. Trouble sleeping, lice are more active at night, causing itching, keeping their victims awake scratching.

4. Nits, the eggs of lice appear as light tan, yellow or brown tiny dots in the hair close to the scalp, and they STICK to the hair, if they do not brush out. You most likely have a lice infection. Another hint, at night take a flashlight, turn the lights out and shine the light down on the person’s scalp the nits will have a silvery sheen to them.

RM VANDEE RN MSN 2015 1 PROCARE HOSPICE OF NEVADA

5. If you do not catch the Nits/eggs in time and they hatch, they will crawl, and bit leaving red sores on the scalp that can become inflamed, tender and crust over. 6. Most times you do not know you child has become infected until you get a note from school, as soon as you do start checking and treating before those nits hatch and become a real problem.

7. Problems from untreated head lice can lead to staph infection causing swollen lymph nodes in the neck

9. If one family member if infected, chances are all family members are infected an will need to be treated.

Getting rid of Lice

Head Lice Treatment The recommended treatment includes using an over-the-counter lice-killing product. These treatments include (1) "Nix"®, a cream rinse product which contains permethrin, a synthetic insecticide;

(2) RID, R&C, Triple X ( pyrethrin-based shampoo products)

RM VANDEE RN,MSN 2015 PROCARE HOSPICE OF NEVADA INFESTIONS 3 With these products, adult lice are usually killed with one treatment. However, these a second treatment 7-10 days later is recommended to ensure all of the freshly hatched head lice nymphs are killed. When using OTC head lice control products, it is important to carefully follow the directions as described on the product package

**Note it is important to read the instructions as some products have you apply product to DRY HAIR

Alternative Head Lice Treatment Strategies Many alternatives to OTC or prescription head lice control products have been suggested. Although there is little scientific information to support these methods, successful treatment has been reported using several alternative treatments. People often use alternative treatments when conventional treatments haven't worked, or when there is a concern about the toxicity of using head lice control products repeatedly.

The alternative treatments listed below are referred to as suffocants. When applied, the treatment may suffocate and/or create a habitat unfavorable to the head lice.

 petroleum jelly (Vaseline®)

 mayonnaise

 oil (e.g., vegetable, olive, or mineral)

General Instructions for Suffocant Treatment*

1. Apply the selected suffocant generously to the hair, making sure the hair and scalp are saturated (for petroleum jelly, approximately two ounces should be sufficient). 2. Cover the hair with a close-fitting shower cap. Leave the cap on for eight hours (the exact time needed to kill the lice is unknown. Some people have reported success with shorter times). Avoid treatment while the infested person sleeps, as the cap may become a suffocation hazard.

3. Remove the shower cap and wash the hair with shampoo to remove most of the suffocant (petroleum jelly may be hard to remove, and we

are not certain of the best method to do this, but commonly suggested methods include rinsing with a mild degreasing soap like Dawn®, or baby oil).

4. Remove all nits and any live lice as discussed under the Nit Removal section.

5. Wash hair thoroughly with shampoo to remove the remaining suffocant.

**While the optimal time to repeat alternative treatments is unknown, treatments should be repeated 7-10 days later to ensure that all freshly hatched nymphs and surviving adult lice are killed. The advantages to alternative treatments are the low costs and the non-toxicity. Disadvantages include the lack of established treatment procedures and scientific evidence demonstrating effectiveness, difficulty of removing petroleum jelly or oils from the hair, and the amount of time necessary for the procedure.

Removing those pesky Nits Nits do not fall off the hair after treatment, and can be difficult to remove as they are firmly cemented onto the hair shaft. Nits found near the scalp and up to 1/4 inch up on the hair shaft may still be viable and should be removed with a louse comb or fingernails to help end the infestation. The infested person's head should be checked regularly for two weeks following treatment.

 Work in an area with good lighting

 Use a head louse removal comb (metal may be better than plastic) for nit removal. Fingernails may also be used to remove nits from the hair shaft.

 Comb slowly away from the scalp to the end of the hair tuft. Wipe the comb with a tissue to remove accumulated nits.

Home Cleanup

Cleaning efforts should occur on the day of the first head lice treatment, and subsequently whenever live lice are found on the patient's head during the daily inspections. The effort should focus on areas frequented by the infested person.

RM VANDEE RN,MSN 2015 PROCARE HOSPICE OF NEVADA INFESTIONS 5

1. Wash bedding in hot water (above 130 degrees F) and dry in a hot dryer or iron with a hot iron. Wash and dry recently worn clothing (including coats, caps and scarves) in hot temperatures. Clothing or bedding that cannot be washed may be dry cleaned or sealed in a plastic bag for two weeks (the plastic bags contain the lice until they are dead, and prevent head lice from temporarily infesting these items again while the treatment process is taking place). While people often place bagged items outside in below freezing temperatures to kill the lice, we do not know how long it takes to freeze head lice.

2. Clean combs, brushes and similar items by:

 soaking in the medicated shampoo for 10 minutes, or

 soaking in a 2% Lysol® solution for one hour, or

 heating in water of at least 130 degrees F for 10 minutes.

3. Clean floors, carpeting and furniture by thorough vacuuming only. The use of insecticide spray is not recommended (Minnesota Department of Health 2015)

BED BUGS! Sneaky little critters.

How do you know if you are you patients have bedbugs? Bedbugs are very hard to see, but they leave a big mess behind on your mattress, sheets, box springs. This means you have to go looking for their dead eggs, shells, feces!

2)Bites - You should be seeing little red bites on you without really knowing why. People rarely catch bed bugs in the act - they come out when you are asleep, and only bite for a short period. Also, like many bugs, you cannot feel the bite until a few minutes after it happens.

3) Hiding places - Look in all the key spots where they could hide. This means the mattress and around it, folds in the linens, curtains, and nearby furniture. Look for the waste or dark spots. You probably won't see live ones, but they look like little mini-cockroaches.

4) Catch them in the act - Keep a flashlight by your bed, and turn it on about an hour before dawn and watch the sheets closely for movement. Bed bugs usually bite around then, but if you get up or move too much they will go back into hiding

RM VANDEE RN,MSN 2015 PROCARE HOSPICE OF NEVADA INFESTIONS 7 5) Carpet tape - This is a great way to do it. Get some double-sided carpet tape (it's tape designed to keep rugs stuck to the floor) and lay out strips around your bed, and on the sides of the mattress but where you won't run into it when you sleep. Leave it out for a few days. If you've got bedbugs, it's likely that at least a couple of them will get stuck on it.

Getting Rid of Bed Bugs:

Bedbugs are back in the news, you worry about them in hotel rooms but with knowledge comes power, so keep on reading!

Bed bugs are back in epic numbers after having once been nearly eradicated by dangerous pesticides. Since the pesticide that nearly wiped them out isn't used in the U.S. anymore, the bugs have made their way back into the mainstream. Part of why they travel so fast is because they're small and sneaky, and easy to pick up from someone's house or an infested hotel. If you know the signs of infestation and take proper precautions when you travel or visit friends, you can avoid inviting the pests into your bedroom.

How Bed bugs Travel Bed bugs come out at night and don't like to be disturbed, so they don't live on people. They prefer dark places, like under your mattress. Still, if bed bugs are hungry enough, they will come out in the daytime. If they do, it's possible to carry them home on your clothes. What's more common is to carry them home in your RM VANDEE RN MSN 2015 7 PROCARE HOSPICE OF NEVADA bags or luggage. If you climb into bed or plop down on a couch, you could disturb bed bugs and they may scatter into your baggage. One of the best ways to avoid bringing bed bugs home is to keep your bags off the floor and off of the bed. Place them on a luggage rack or on top of the piece of furniture farthest from the bed or suspected nesting place. When you come home, go to a place like the garage or entry way and take off your clothes. Place them in a bag, along with any clothes from your luggage, and put them right in the washer. Dry on high heat for at least 20 minutes at 120 degrees. Check your luggage and bags thoroughly before you bring them in the house

What do bedbug bites look like and to they carry disease?

 Bed bugs do not carry disease.

 They do suck blood from their host with piercing mouth parts but the bite is painless.

 The skin may become irritated or inflamed due to the salivary fluid injected by the bed bugs. A small, hard, swollen, white welt may develop at the site of each bite.

 It is important to recognize that not all bites or bite-like reactions are due to bed bugs. Bed bugs or their signs will be present if it is a bed bug bite.

 Bed bugs do not live under the skin. If you experience biting sensations during the day, it may be an allergy related condition.

Pretreatment

 Reduce clutter to make bed bug inspection easier. Be careful when removing items from the infested area to other areas because you may transfer the bed bugs.

 Personal items (stuffed animals, soft toys, blankets) should be removed, cleaned with a vacuum cleaner, and bagged in plastic for a couple of days You can also bag laptops, phones and radios as well.

 Dismantling bed frames in infested areas may expose additional bedbug hiding sites.

 Remove drawers from desks and dressers, and turn furniture over to inspect and clean all hiding spots. All furniture should be pulled away from the walls.

 Stand up the box spring and shine a flashlight through the gauze fabric to expose bed bugs. If the fabric is torn (possible hiding place), remove fabric to prepare for spraying. If the mattress and or box springs are infested, you may want to consider Encasements by Mattress Safe Once covered with these encasements, bed bugs can not enter or exit. There is no need to treat the mattress or box spring when using these encasements. Keep them on for a year.

 Caulk and seal all holes where pipes and wires penetrate walls and floor, and fill cracks around baseboards and molding to further reduce harboring areas.

 Since infested garments and bed linen can't be treated with insecticide they will need to be laundered in hot water (120 degrees Fahrenheit minimum). If washing is not available, sometimes heating the garments or bed linens for several minutes in a clothes dryer may work.

 Thoroughly clean the infested rooms. Scrub infested surfaces with a stiff brush to dislodge eggs.

 Vacuum areas of bed bug infestation with a vacuum attachment. Vacuum along baseboards, furniture, bed stands, rails, headboards, foot boards, bed seams, tufts, buttons, edges of the bedding, as well as the edges of the carpets (particularly along the tack strips). A good vacuum cleaning job may remove particles from cracks and crevices to encourage greater insecticide penetration. Bed bugs cling tightly to surfaces, so it is best to repeat vacuuming by scraping the end of the vacuum attachment over the infested areas to pull out the bed bugs. It is not good to use a bristle attachment, because you may transfer bed bugs to other areas since they cling to the brush. Dispose of vacuum cleaner bags after you are finished.

 Caulk cracks and crevices in the infested building exterior, and also repair openings to exclude birds, bats, and rodents that can serve as alternate hosts for bed bugs. (Getting rid of bedbugs, 2015)

Treating Mattress : Look carefully at the folds and seams of the mattress, the headboard, foot board (if present), box spring/support platform, frame, etc for bedbugs and treat these area after vacumming. The following residual insecticides and dusts are labeled to spray and dust mattresses:  Cimexa Dust

 Bedlam Aerosols

 Temprid SC Insecticide

 Steri-Fab Bed Bug Spray RM VANDEE RN,MSN 2015 PROCARE HOSPICE OF NEVADA INFESTIONS 11 Dusts last longer than aerosols, but the crack and crevice tips on the Phantom and Bedlam areosols enable you to get into the smallest cracks. It is a good idea to use a combination of sprays and dusts. Temprid SC may be used on the tufts and seams of mattresses. It works well as a residual insecticide sprayed in other recommended treatment areas such as night stands, chests, dressers, couches and chairs.

Treat all baseboards and furniture (Night Stand, Chests, Dressers, Couches and Chairs) Bed Bug Treatment: Sprays and Dusts There are several products on the market that work well for bed bugs: Apply residual liquid, aerosol or dust residual insecticides such as

 Temprid SC  Temprid Ready Spray Aerosol  Optimate CS  Cimexa Dust  Alpine Pt Areosol  Transport Mikron  Beldlam Plus Aerosol  Phantom Areosol

SCABIES!!!

Scabies is an itchy skin condition caused by a tiny burrowing mite The presence of the mite leads to intense itching in the area of its burrows. The urge to scratch may be especially strong at night. Scabies is contagious and can spread quickly through close physical contact in a family, child care group, school class, nursing home or prison. Because of the contagious nature of scabies, doctors often recommend treatment for entire families or contact groups. (Mayo Clinic 2015)

Norwegian or Crusted Scabies: A more severe form of scabies, called crusted scabies, may affect certain high-risk groups, including:

 People with chronic health conditions that weaken the immune system, such as HIV or chronic leukemia

 People who are very ill, such as people in hospitals or nursing facilities

 Older people in nursing homes

Crusted scabies, also called Norwegian scabies, tends to be crusty and scaly, and to cover large areas of the body. It's very contagious and can be hard to treat.

Symptoms: include severe itching worse at night, with burrow tracks made up of tiny blisters or bumps on your skin

The burrows or tracks typically appear in folds of your skin. Though almost any part of your body may be involved

Adults and older children scabies is most often found:  Between fingers

 In armpits

 Around your waist

 Along the insides of wrists

 On your inner elbow

 On the soles of your feet

 Around breasts

 Around the male genital area

 On buttocks

 On knees

 On shoulder blades

In infants and young children, common sites of infestation include the:

 Scalp

 Face

 Neck

 Palms of the hands

RM VANDEE RN,MSN 2015 PROCARE HOSPICE OF NEVADA INFESTIONS 13  Soles of the feet

Treatment

*Bathing and over-the-counter preparations won't eliminate scabies. **Use of insecticide sprays and fumigants is not recommended

 It is important to remember that the first time a person gets scabies they usually have no symptoms during the first 2 to 6 weeks they are infested; however they can still spread scabies during this time.

 Treatment should be given to both the infested person and to household members and sexual contacts, particularly those who have had prolonged direct skin-to-skin contact with the infested person.

 Both sexual and close personal contacts who have had direct prolonged skin- to-skin contact with an infested person within the preceding month should be examined and treated.

 All persons should be treated at the same time to prevent reinfestation. Scabies may sometimes be sexually-acquired in adults, but is rarely sexually- acquired in children.

 Bedding, clothing, and towels used by infested persons or their household, sexual, and close contacts (as defined above) anytime during the three days before treatment should be decontaminated by washing in hot water and drying in a hot dryer, by dry-cleaning, or by sealing in a plastic bag for at least 72 hours.

 Scabies mites generally do not survive more than 2 to 3 days away from human skin.

Medications Used to Treat Scabies; Products used to treat scabies are called scabicides because they kill scabies mites; are available only with a doctor’s prescription. No “over-the-counter” (non-prescription) products have been tested and approved to treat scabies.

Scabicide should be applied to all areas of the body from the neck down to the feet and toes. In addition, when treating infants and young children, scabicide also should be applied to their entire head and neck because scabies can affect their face, RM VANDEE RN MSN 2015 13 PROCARE HOSPICE OF NEVADA scalp, and neck, as well as the rest of their body. Apply to a clean body and left on for the recommended time before washing it off. Clean clothing should be worn after treatment. Retreatment may be needed if symptoms are present 7-14 days after.

Tunneling of scabies

Reference

Head lice a treatment guide 2011, Minnesota Department of Health, from Head Lice (Pediculosis): A Treatment Guide from,http://www.health.state.mn.us/divs/idepc/diseases/headlice/treatment.html

How do I know if I have bed bugs? 2015. Bedbugsguide.com from;http://www.bedbugsguide.com/identifying-bed-bugs.htm

Scabies 2015 Mayo Clinic http://www.mayoclinic.org/diseases- conditions/scabies/basics/definition/CON-20023488

Infestations Post Test : To earn two hours of continuing nursing education please answer the following questions correctly: a passing score of 80% is required. True or False

Circle True or False 1. Lice is only found in families who are dirty, with poor hygiene. True False

2. As long as I wash my child hair with RID the lice will be gone True False 3. My entire home needs to be cleaned and fumigated if there is lice. True False

4. Entire family should be treated for lice True False 5. Home remedies like Vaseline may suffocate the lice True False

Chose the correct answer:

6. Bedbugs are becoming a growing problem because A) People do not clean their homes B)People buy used mattresses C.) Pesticides that once killed them are no longer used in the United States.

7. How can you prevent carrying bedbugs home with you when you visit a patient? A) Do not set your bag down on couch or near baseboard B) Do not visit home while the home is infested C) Discharge the patient from services

8. How do you know if you have bedbugs? A) Look for their waste under mattress or baseboards B) shine a light in the middle of the night and look for tiny bugs that look like

little cockroaches C)Unexplained little red bug bites on your body D. All of the above

RM VANDEE RN,MSN 2015 PROCARE HOSPICE OF NEVADA INFESTIONS 17 9. Can bedbugs cause serious illness? True or False 10. Do bedbugs bite during the day? True or False

11. Can scabies cause a serious illness? True or False 12. Can fumigating your home get rid of scabies? True or False

13. What is the distinguishing mark of a scabies bite? (Circle correct answer)

purplish bite with red bulls eye round cluster of blisters tiny red bumps

tiny blisters that form a tunnel large blisters pustules 14. Can scabies be treated with over the counter medications? True or False

15. Why are health care workers afraid to go into infested homes? Please write your answer below

16. Should a patient be refused service because of an infestation? True or False? 17. What should you do if you see a patient with one of the above conditions?

A) Notify your health care team B. Immediately notify your manager, go home wash clothes in hot water, and take hot shower.

C. Immediately notify your manager, go home wash clothes in hot water, and take hot shower. And have your co-worker check you periodically for lice if applicable. 18. How do you approach a family with a lice infection without hurting their feelings? A) Explain to family that it is common that the cleanest family can get lice. B)Never act repulsed by infection or living condition of family. C. Show empathy, caring a smile goes a long way D. All of the above

19. Have you every had an experience with a family with one of these conditions? If so do you feel you handled it professionally? Do you feel you could have handled it better? ______

20. Has this education handout help you better understand lice, bedbugs and scabies? Yes No

Name: Print ______Date ______Educator Rose Marie VanDee RN MSN ______Score ______

NV000672

RM VANDEE RN,MSN 2015