PWS 2025 VA Bay Pines CBOCs.docx

Performance Work Statement (PWS)

FOR

PEST CONTROL SERVICES

DESCRIPTION OF SERVICES. The contractor shall provide all management, licenses, laboratory testing, tools, supplies, equipment, transportation, and labor to develop and implement the standards & requirements set forth in the Department of Veterans Affairs provided Integrated Pest Management (IPM) plan for the nine Veteran Affairs Health Care System (VAHCS) Bay Pines Community-Based Outpatient Clinic (CBOC's) in a manner that will ensure the health and general well-being of all medical facility personnel/patients. The contractor Shall also be fully cognizant of the fact that this contract is for the control of all pests within and immediately outside of a hospital/patient care facility. They shall take all necessary steps and precautions to ensure full and complete care for employees/patient safety in the selection and application of all chemicals. Two CBOC’s Facilities had incidents that have been reported. The Lee County CBCOC has Bed Bugs that were treated in the last month and were inspected to indicate no bed bugs in the facility. Sebring had sugar ants reported inside the facility that was treated. Customer complaints should not exceed 4 per month per CBOC.

Typical household variety pests are not present. Rodents and other vermin are aggressively controlled. All pesticides are mixed off site. All Pesticides are disposed of properly at an Approved off-site disposal area.

The following types of pests are common on these installations, and their abatement should be specifically addressed in the IPM and used to determine workload:

i. General structural pests (i.e., cockroaches, ants, carpet beetles, spiders.

ii. Bed bugs – with follow ups

iii. Carpenter ants, carpenter bees, etc.)

iv. Flying insect pests (i.e., housefly, stable fly, blowflies, etc.).

v. Predatory pests (i.e., lice, bedbugs, fleas, mites, ticks, bees, wasps, mosquitoes,)

vi. Stored product pests (i.e. saw tooth grain beetle, red/confused flour beetles, trogoderma beetles, grain moths, etc.),

vii. Mice and rats (i.e., house mouse, field mouse, roof rat, Norway rat, etc.)

viii. Vertebrate pests (i.e., bats, gophers, moles, snakes, rabbits, raccoons, opossums, etc.)

ix. Periodic termite inspections when warranted or requested.

x. Occasional Inspection by Bed Bug K-9 if warranted.

a. Warranted Pest Control Measures:

Certain pest control actions—such as termite inspections, bed bug K-9 sweeps, or other specialized treatments—shall be performed when deemed warranted. A warranted approach is defined as any pest control intervention that is justified based on observed pest activity, environmental risk factors, or recurring complaints. The determination of whether such measures are warranted shall be made by the Contracting Officer’s Representative (COR) or Facility Coordinator (FC), based on documented evidence such as pest logs, inspection reports, or customer feedback. The contractor may also recommend warranted actions based on professional judgment; however, no such services shall be performed without prior approval from the COR or FC

1. Use of Bait Boxes. Frequency of bait box service shall depend upon the level of rodent infestation. All bait boxes shall be maintained in accordance with Environmental Protection Agency (EPA) regulations, with an emphasis on the safety of non-target organisms. The Contractor shall adhere to the following five points:

1. All bait boxes shall be placed out of the general view, in locations where they will not be disturbed by routine operations. Tamper-resistant rodent bait stations shall be added as needed, based on pest activity levels and in accordance with EPA regulations and the VAHCS Bay Pines Integrated Pest Management (IPM) plan. All stations must be labeled, dated, and securely anchored per VA and manufacturer guidelines

2. The lids of all bait boxes shall be securely locked or fastened shut.

3. All bait boxes shall be securely attached or anchored to the floor, ground, wall, or

a. another immovable surface, so that the box cannot be picked up or moved.

4. Bait shall always be placed in the baffle-protected feeding chamber of the box and

a. never in the runway of the box.

5. All bait boxes shall be labeled on the inside with the Contractor's business name and

a. address and dated by the contractor's technician at the time of installation and each service.

2. BASIC SERVICES. The contractor shall use the attached VAHCS Bay Pines IPM plan and submit a listing of all chemicals to be used under this contract for approval prior to use. The IPM approach should use targeted (effective, environmentally sound) methods including habitat/facility modification, biological/genetic/cultural control, mechanical/physical control, and where necessary, the judicious use of least hazardous pesticides. The IPM plan provided complies with all applicable Environmental Protection Agency (EPA), Occupational Safety and Health Administration (OSHA), state/local regulatory guidance on pesticide storage, disposal and applications and the National Pest Control Association's good practice statements.

3. GOVERNMENT FURNISHED PROPERTY AND SERVICES. None.

4. GENERAL INFORMATION.

Performance standards Typical household variety pests are not present. Rodents and other vermin are aggressively controlled. All pesticides are mixed off site. All Pesticides are disposed of properly at an Approved off-site disposal area.

GOVERNMENT FURNISHED PROPERTY AND SERVICES. None.

GENERAL INFORMATION.

QUALITY CONTROL. The contractor shall develop and maintain a quality control program to ensure systematic inspection of facilities and grounds for pests, a customer service call/emergency response system for pest removal, and a continuous pest prevention education program for facility managers, food handling managers and facility occupants. The contractor shall develop and implement procedures to identify and prevent defective services from reoccurring. As a minimum, the contractor shall develop quality control procedures that address the areas identified in paragraph 2, Service Delivery Summary. The Contracting Officer Representative (COR) must have a specific quality control inspector to notify in case of customer complaints.

QUALITY ASSURANCE. The government will periodically evaluate the contractor's performance in Accordance with the Quality Assurance Surveillance Plan (QASP).

GOVERNMENT REMEDIES. The contracting officer shall use all relevant clauses within the contract to ensure performance is at a threshold for the Acceptable Quality Level (AQL).

HOURS OF OPERATION. Normal business hours are 8 a.m. to 4:30 p.m., Monday through Friday, excluding Federal holidays. Some contract tasks may require work to be performed after normal business hours. Work outside of normal business hours shall be coordinated with the COR/Facility Coordinator (FC) prior to commencement. An FC can be reached on the phone number provided for each CBOC. The COR will update FC’s every 90 days and when a replacement is identified.

4.5 FACILITY ACCESS: Upon arrival at various CBOC's, Contractor employees shall immediately report to the FC and sign into the logbook and provide an itinerary and approval from the FC prior to start of operations. Access to the CBOC will be coordinated with the COR/FC prior to arrival on-site. An FC can be reached on the phone number provided for each CBOC. The COR will update FC’s every 90 days and when a replacement is identified.

4.6 SPECIAL QUALIFICATIONS. The contractor will have a licensed pest control manager specifically assigned to support this contract and available within 24 hours to meet with government personnel. Moreover, all contract employees that apply pesticides must have a Florida pesticide application certificate/license. The contractor shall be responsible for ensuring that the licenses/certificates and training of contractor personnel are kept current. In addition, all mixing and storage of pesticides shall be performed off the installation. If the contractor spills or releases any hazardous substances (example, substances listed in 40 CFR 302), the contractor should immediately take steps to safely remediate the spill and notify the COR and the FC

PERFORMANCE REQUIREMENT SUMMARY

The contractor service requirements are summarized into performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimum acceptable levels of service required for each requirement. These thresholds are critical to mission success.

Performance Objective

Method of Surveillance

PRS #1

The contractor shall provide pest control services with certified, trained and licensed pest control operators.

All pest control measures will require no less than one follow-up inspection to ensure pest problems have been eliminated.

98%

Periodic Surveillance

PRS #2

The contractor is available within 7 hours after receipt of notification for routine service calls.

Contractor responds within 7 hours.

95%

Customer Feedback

PRS #3

Pest Control Technician is available for emergency services within 2 hours of notification

Contractor responds within 2 hours.

95%

Customer Feedback

PRS #4

Reports submitted on time

All reports contain correct information and submit on time

99%

Direct Observation

Emergency calls are covered under PWS and are considered as below:

a. Definition of Emergency Calls Emergency service calls are covered under this Statement of Work (SOW) and shall include, but are not limited to, the following situations:

· Presence of Pests in Patient Care Areas

· Presence of Biting or Stinging pests

· Presence of Pests in Sterile or Critical care areas

b. Determination of Emergency Calls All Emergency Service Calls shall be determined by the Contracting Officer’s Representative (COR). The COR shall also identify, and designate areas considered Patient Care Areas, which may require prioritized response and follow-up.

c. Patient Safety and Confidence Maintaining a pest-free environment in Patient Care Areas is essential to ensuring patient safety and staff confidence. The presence of pests in these areas can compromise the perception of cleanliness and safety. Therefore, it is critical that pest control services are performed in a manner that assures healthcare personnel and patients that the environment is safe, sanitary, and free of pest activity.

d. Follow-Up Requirements Each emergency service call shall require no fewer than one documented follow-up visit. The purpose of the follow-up is to verify that the issue has been fully resolved and that no recurrence has occurred.

e. Coordination and Documentation The contractor shall coordinate all emergency follow-up visits with the COR or the designated Facility Coordinator. The findings from each follow-up visit shall be clearly documented and included in the corresponding service report.

REPORTING REQUIREMENTS. The Contractor shall furnish to the COR/FC, prior to the initial application of pesticides, the Material Safety Data Sheets (MSDS) on all chemical products to include trade names, chemical names, and a label showing the contents and the use strength of the chemical as applied and antidote thereto. The Contractor shall furnish this information each time there are changes in chemicals or products used in the performance of this contract. A Pest Control Log is maintained by the FC which documents incidents of pest infestation and customer complaints. The Contractor shall verify complaint entries in the Pest Control Log during each visit and address the issue as required. All IPM services performed during the work shift will be documented by the Contractor on the Pest Management Maintenance Record that may be reviewed by the COR/FC at any time, and the Contractor shall leave a signed and dated notice with COR/FC stating the area treated, conditions found, and the treatment rendered. When service has been completed, Contractor must inform COR electronically or by telephone the results of service call. Additionally, the Contractor is responsible for supplying, completing, and submitting all reports required or requested by Federal, State, or local ordinances that pertain to any duties contained in the IPM plan

Appendices – Table of Contents

· Appendix A – Schedule of Buildings and Special Notes

· Appendix B – VAHCS Bay Pines Integrated Pest Management (IPM) Plan

· Appendix C – Bed Bug Prevention and Control Protocol

· Appendix D – Pest Control Reference Charts

· Appendix E – Patient and Provider Education Materials

· Appendix A – Schedule of Buildings and Special Notes Includes CBOC addresses, points of contact, and facility-specific notes.

· Appendix B – VAHCS Bay Pines Integrated Pest Management (IPM) Plan Covers pest control policy, responsibilities, definitions, and procedures.

· Appendix C – Bed Bug Prevention and Control Protocol Detailed procedures for identifying, reporting, and managing bed bug infestations in inpatient, outpatient, and home care settings.

· Appendix D – Pest Control Reference Charts Includes identification, symptoms, life cycles, treatment, and control measures for pests like bed bugs, lice, scabies, etc.

· Appendix E – Patient and Provider Education Materials Educational content and visuals for staff and Veterans on pest awareness and prevention.

CBOC Site information

APPENDIX A

Schedule of Buildings and Special Notes

SCHEDULE OF BUILDINGS

Rodney Arnold

Naples, Fl 34102- Rodney Arnold

Port Charlotte, FL 33952 Rodney Arnold and Martina Moon

Sebring, FL 33870 Rodney Arnold

Sarasota, FL 34233 Carolyn Bieniasz

Bradenton, FL 34208 William Welch

Largo, FL 33771 Holly Ahl

St Petersburg, FL 33705 Ken McTier

Palm Harbor, FL 33761 Lynn McKinney Wilson

The Contractor is advised of the following:

a. Food Handling Areas: Treatment of these areas is limited to times when food is not being held, processed, prepared, or serviced, and while not occupied by facility employees. The Contractor personnel shall at no time enter facility elevators that are occupied by food service equipment while in the possession of pesticides or application equipment.

b. Patient Occupied Areas: Contractor personnel shall utilize pesticides with as low volatility and as odor free as possible in order to keep odor levels from affecting patients in these areas.

c. Critical Areas: The following areas have been designated by VAMC Bay Pines as "Critical Areas":

· Pharmacy

· Food & Nutrition Service Areas

· Operating Areas

· Intensive Care Units

· Rest Room Areas

· Exam Area

· Respiratory Care Areas

· Sterile Processing Department (SPD)

· Canteen Kitchen Area

The planned use of pesticides in these areas requires prior approval from the COR/FC and the recognition of the attendant hazards to occupants, supplies, equipment and · surfaces. When space treatment is required and has been approved by the COR/FC in these areas, the Ultra-Low Volume (ULV) Method of pesticide application shall be utilized. All hard traps need to be placed so as not to be seen by patients or staff.

d. Interference to Function: Contractor personnel may be required to be interrupted at any time, so as not to interfere with the normal functioning of the facility, including utility services, fire protection, and passage of facility patients, personnel, equipment, and carts.

e. All Contractor’s employees must wear a proper face covering when on property until the end of COVID-19 and follow all Center for Disease Control regulations.

SECURITY

1. VA Police will issue photo identification badges directly to contractors’ and sub-contractors’ superintendents and foremen. These ID badges must be worn by these individuals at all times while on VA property (If applicable).

2. The contractor shall be required to comply with all security policies/requirements of Bay Pines, VAHCS. All security policies/requirements must be met, and employees cleared up prior to the contractor performing work under this contract. Employees that cannot meet the security and clearance requirements shall not be allowed to perform work under this contract.

3. It is the responsibility of the contractor’s personnel to park in the appropriately designated parking areas. Parking information shall be coordinated by each Facility Coordinator.

4. Bay Pines, VAHCS, does not validate or make reimbursement for parking violations of the contractor’s personnel under any circumstance.

5. ID badges must be worn by the contracted employees at all times while on VA property.

6. Background investigation will be performed if necessary.

7. The contractor will be responsible for the actions of all individuals provided to work for the VA under this contract. In the event that damages arise from work performed by contractor provided personnel, under the auspices of this contract, “the contractor will be responsible for all resources necessary to remedy the incident.”

CONFIDENTIALITY AND NONDISCLOSURE

It is agreed that:

1. The preliminary and final deliverables and all associated working papers, application source code, and other material deemed relevant by the VA which have been generated by the contractor in the performance of this task order are the exclusive property of the U.S. Government and shall be submitted to the Contracting Officer (CO) at the conclusion of the task order.

2. The CO will be the sole authorized official to release verbally or in writing, any data, the draft deliverables, the final deliverables, or any other written or printed materials pertaining to this task order. No information shall be released by the contractor. Any request for information relating to the order presented to the contractor shall be submitted to the CO for response.

3. Press releases, marketing material or any other printed or electronic documentation related to this project, shall not be publicized without the written approval of the CO.

Organizational Conflict of Interest:

Contractor and subcontractor personnel performing work under this contract may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create a current or subsequent Organizational Conflict of Interests (OCI) as defined in FAR Subpart 9.5. The Contractor shall notify the Contracting Officer immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the Contracting Officer to avoid or mitigate any such OCI. The Contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the Contracting Officer and in the event the Contracting Officer unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the Contracting Officer may affect other remedies as he or she deems necessary, including prohibiting the Contractor from participation in subsequent contracted requirements which may be affected by the OCI.

Invoices:

All invoicing by the Contractor for this contract will be submitted to:

HTTP://WWW.TUNGSTEN-NETWORK.COM/US/EN/VE

INTEGRATED PEST MANAGEMENT

1. PURPOSE: This Bay Pines VA Healthcare System (BPVAHCS) Memorandum establishes policy pertaining to the responsibility and procedures for the administration of an effective pest management program. This policy applies to all organizational elements.

2. POLICY: To maintain a pest-free environment through prevention of infestation or re-infestation and through control or elimination of infestations already in existence throughout the health care system. BPVAHCS will comply with all applicable Federal, State and City regulations in the usage and disposal of all products used in the control of pests. This includes proper storage, mixing, and application of products.

3. ACTION:

a. Responsibilities

(1) Chief, Environmental Management Service (EMS) (137). Designated as the health care system Pest Control Officer. EMS overall have the responsibility for the administration of the pest control program. The Assistant Chief, Service Operations section, monitors the application of products and pest control measures.

(2) Service Chiefs. Responsible for seeing that all personnel under their supervision are made aware of and adhere to the requirements of this memorandum.

(3) Chief, Acquisition and Material Management Service; Chief, Nutrition & Food Service; and contractor Officer. Arrange for protecting all food preparation, assembly and serving material during treatment. Prior to fogging, all horizontal surfaces will be covered, and all items cleaned prior to the next food service activity. We no longer fog within a food preparation area.

(4) Pest Control Technician. The person assigned to pest control operations, (EMS) is in charge of the pest control operations at this Ehealth care system. He/she is responsible for the following.

(a) Safe applications of all products. The products used in the interior pest control program are of low odor and low toxicity. Responsible care should be taken in handling, storing and dispensing these items. A list of antidotes for all products used on this station will be maintained by both the Pharmacy Service and the Occupational Health physician.

(b) Safe storage and proper disposal of all products and their residue in accordance with VA Integrated Pest Management Program 1850.02.

(c) Inspection of BPVAHCS on a scheduled basis, and maintenance of appropriate documentation. Ensuring that all record keeping required is accomplished in a timely manner and kept as required for inspection purposes.

(d) Answering all questions and serving as consultant regarding pest management.

(e) Pest Control Technician will provide twenty-four (24) hour notification to services for routine application of product and immediate notification for emergent needs.

(f) Provide Safety Data Sheet (SDS) to staff notified if requested.

(g) Apply products outside of normal business hours.

b. Definitions

(1) Pest. Any insect, rodent or nematode, or any form of terrestrial or aquatic plant commonly considered being detrimental to man or animal.

(2) Products. Any substance or mixture of substances intended primarily to prevent, destroy, repel or regulate reproduction. For the sake of brevity in this memorandum, rodenticide, both chemical and mechanical, will be referred to under the broad classification of products.

c. General Provisions. The presence of pests within the health care system buildings creates an unsightly, as well as unsanitary setting for patient wellbeing. It is the responsibility of each employee to aid in this program by doing the following.

(1) Nursing personnel will make periodic inspections of bedside lockers to ensure that food items, unwrapped candy, etc. are not stored in these lockers.

(2) Spillage of food, liquid urine, and feces must be cleaned up as soon as possible by assigned area personnel when housekeeping personnel are not available.

(3) Food items will not be stored in desks, cabinets, etc. Food is to be consumed only in authorized dining areas. Keep all office areas free of debris and clean up all food items.

(4) No live plants in offices, or in-patient care areas, for this causes harborage and infestation of pests.

(5) Report any sightings of pests, i.e., ants, roaches, silverfish, mice, etc., to EMS One Call at extension 17636. Give the building number, floor, room number, contact number, name of person calling. and specific details. Do not attempt to apply product treatment yourself.

(6) The application of products will be restricted to licensed technicians or people working under direct supervision of a licensed technician.

(7) The Pest Control Technician will maintain a log of all areas treated. Patient care and administrative areas will receive treatments needed in conjunction with the integrated pest management program. Patient care areas expected to be treated will be notified in advance.

(8) Infestations reported to Pest Control Technician will be inspected prior to treatment. Sanitation problems noted must be corrected before treatment is accomplished. Improper storage of materials will be brought to the attention of the appropriate Service Chief.

(9) Application of products will generally be of the pin stream, crack and crevice variety, having at least a 30-day residual effect.

(10) Food preparation area, critical care, and surgical suites will receive inspection and treatment if needed in accordance with the integrated pest management program or on a monthly basis.

4. REFERENCES: M-1, Part III, G-3, Interior Pest Control for Hospital. VHA Program Guide1850.s, Integrated Pest Management (IPM).

5. RESPONSIBILITY: Chief, Environmental Management Service (137).

6. RESCISSION: VAHCS Memorandum 516-137-001, Integrated Pest Management dated November 2023.

Paul Russo Director, Bay Pines VA Healthcare

BED BUGS: PREVENTION & CONTROL OF INFESTATIONS

1. Background

a. Bed bugs were essentially eradicated in the United States (U.S.) in the 1940s after widespread use of broad-spectrum synthetic insecticides. However, in the past 10 years, there has been a resurgence of bed bug infestations in a number of countries, including the United States.

b. Bed bug infestations in the U.S. primarily are caused by the common bed bug, Cimex lectularis. Adult bed bugs are about one-quarter inch long and wingless, with flat, oval, segmented, brown or reddish-brown bodies.

c. The bed bug feeds only on blood. The main source for blood meals, or “bed bug bites,” is humans. The bed bug is attracted to the host by detecting body heat and carbon dioxide. A blood meal is required for the female to produce eggs, and for progression of nymphs to each of the five developmental stages. However, an adult bed bug can survive for a year between feedings.

d. Bed bugs are nocturnal and hide during the day unless extremely hungry. Preferred harborages are relatively close to the host, such as mattress seams and folds. However, bed bugs can travel several feet from a host and have been known to conceal themselves in wall outlets, window and door frames, bed frames, drapery, baseboards, floor and wall cracks, drawers, electrical boxes, telephones, furniture, wall-to-wall carpeting, loose wallpaper, and behind wall hangings and headboards.

e. Bed bugs are not known to transmit any significant diseases. However, they are a clear nuisance.

f. Bed bugs typically feed at night. Their elongated mouthpart is used to get a blood meal, which takes about 10 minutes. Bed bug bites often occur on the arms, shoulders, neck, and legs. The bed bug injects the site with salivary fluid that has both anesthetic and anti-coagulative properties to facilitate feeding. The bed bug leaves the host once feeding is complete, so one will not typically see bugs on a person whose environment is infested. Bed bugs typically stay within 5 to 20 feet of their food source, but can travel significant distances within person’s clothing, luggage, and other personal items.

2. Procedures for Handling an Infestation: Environmental Control: If a bed bug infestation is suspected in the health care facility, the following environmental procedures are recommended.

a. Secure room or area from use and immediately notify EMS One Call at extension 17636.

b. EMS One Call extension 17636 will notify EMS assigned area supervisors and call Pest Control.

c. Leave the room intact without cleaning or removal of items, e.g., linens, furniture, drapes, to facilitate determination of the extent of the infestation and to prevent the spread of bugs to other areas.

d. The timeframe for the room closure can vary from 4 hours to 72 hours, which is determined by the severity of the infestation, and extermination methods used; this will be determined by Pest Control.

e. If possible, EMS or Nursing staff will capture a bed bug and place it in a sealed container to assist pest control in their assessment. The specimen will be taken to the Pest Controllers for inspection.

f. EMS trained in pest management will conduct a detailed inspection of the area. The inspection needs to verify any detected evidence of a bed bug infestation and estimate the magnitude of the infestation by examining all potential harborages.

g. Rooms adjacent to the affected area on either side or any location the patient inhabited (i.e., clinic, canteen) will be examined as a precautionary method.

h. A multifaceted integrated pest management approach to exterminate the infestation will be necessary given the varying susceptibility of bed bug life states to different control measures. The intervention strategy will likely necessitate participation of EMS, Nursing and Infection Control.

i. Once control measures have been implemented and Pest Control has done their inspection or eradication, they will contact Nursing to come in and double bag up the patient’s personal belongings, sending linen to the laundry in designated linen bags tied with an overhand knot in the container provided by laundry (the bags will have the patients name, last four Social Security Number (SSN), and room number on it).

j. Nursing will make an inventory of the patient's belongings, place them in a plastic bag which is tied off. Not to be opened till patient has left the building.

k. Routine follow-up inspections are required to monitor the effectiveness of treatments. The first follow-up will be within 24 hours after the initial pest control treatment. Pest Control will provide a report to EMS and communicate findings with the Charge Nurse, Nurse Manager or Nursing Supervisor.

l. Pest Control will provide a report to EMS and communicate findings with the Charge Nurse, Nurse Manager or Nursing Supervisor.

3. Staff Procedures (admitted patients): Procedure for suspected or diagnosed infestation for a new admission to any bedded unit (Building 100, Domiciliary, Acute Psychiatry, CLC): If a patient is suspected of being infected with bed bugs, the following actions are to be taken (refer to algorithm on Appendix A):

a. Briefly discuss the concern with the patient and ascertain whether the patient is aware of any issues with bed bugs or other insects.

b. Contact Infection Control or the Nursing supervisor immediately for further guidance regarding patient placement and containment. If other patients reside in the same room, a decision on where to move those patients will need to be made as well.

c. Secure room or area from use and immediately notify EMS One Call at extension 17636. The EMS supervisors and Pest Control will then be notified.

d. The potentially affected room will be left intact without cleaning or removal of items (e.g. linens, furniture) to facilitate determination of the extent of the infestation and to prevent the spread of bugs to other areas. A “Room Closed” sign will be placed by EMS at the entrance to the affected space.

e. EMS will perform an investigation to determine the likelihood of insects contaminating space.

f. The patient needs to shower, be issued a hospital-laundered change of clothing, and be moved to a new room. Patients will be examined for evidence of bug bites and documents in record.

g. Any other patients residing in the same room will be examined for bug bites, showered if appropriate, and moved to another room.

h. Place all the patient’s clothing and other belongings (except toiletries) into a sealed plastic bag. Wear appropriate PPE of gloves and gowns to avoid potential exposure. Avoid sending home a patient’s personal belongings that may be harboring bed bugs or bed bug eggs without some form of inspection and treatment to prevent the re-introduction of the insects into the patient’s residence.

i. Patient’s belongings such as wallets, books, passports will be placed in a double plastic bag which is securely tied off and kept intact until the patient is discharged or sent home. Recommended that Nursing staff and Social services communicate with patients about Appendix B.

4. Staff Procedures (Bay Pines outpatient): If the patient is in the medical center for a clinical appointment or activity (outpatient) and is found to have bed bugs, the following actions need to occur:

a. After the patient leaves the room or area, close the affected area for use with a “Room Closed” sign. Call the One Call at 17636 for pest control and EMS. Until the area has been assessed by pest control for bed bugs and an intervention strategy is completed. Once this is completed, the room can be returned back to service.

5. Community Based Outpatient Clinics (CBOCs): In a suspected case, the clinic will notify the One Call center at 17636. Nursing will follow Appendix “B”.

6. Home Care Procedures: Programs that provide care in the patient’s home (e.g., home-based primary care, home care, mental health, physical therapy) must prevent the transfer of bed bugs from any patient homes to the health care facility or employee residences.

a. only necessary bags or equipment into the patient’s home.

b. Avoid placing bags, equipment & coats on/next to beds, upholstered furniture, or walls.

c. Provide information on bed bug prevention and interventions, if there is evidence of an infestation in the patient’s home. Provide the patient with the “Bed Bugs: Identification and Control” brochure (Appendix A) and/or Patient and Provider Education Sheet (Appendix A).

7. Prevention of Bed Bug Infestations: Risk areas are designated as follows and inspected by the EMS supervisor or Pest Control.

a. High Risk: Inspected monthly in coordination with units.

(1) Domiciliary

(2) Emergency Department

b. Medium Risk: Inspected every other month in coordination with units.

(1) CLC

(2) Mental Health inpatient care units

c. Low Risk: Inspected quarterly

(1) Inpatient wards

(2) Outpatient clinics

8. Prevention is focused on avoiding the transfer of bed bugs to the facility and reducing potential places they harbor. Considerations for the prevention of an infestation include the following by EMS.

a. Periodically conduct a risk assessment of the facility to determine what areas may be particularly susceptible to infestation, especially the residential programs, e.g., community living center, inpatient psychiatric service, where people arrive for care with their own luggage or belongings.

b. Seal cracks and crevices in the rooms and repair torn wallpaper.

c. Replace torn furniture and mattresses.

d. Routinely inspect common bed bug harborages during terminal cleaning process.

e. Check linens when removing from beds for dark spots, bugs, or other bed bug signs. Early detection can facilitate mitigation activities.

f. Avoid mattresses that have excessive piping or seams.

g. Avoid the use of box springs since bed bugs can easily hide inside; alternatively, put covers on the box springs to prevent access by bed bugs.

h. Move beds away from direct contact with the wall.

i. Avoid the use of headboards that are attached to the wall.

9. Education: Education will require a multidisciplinary approach to include EMS, Nursing, and Infection Control. Education will be provided to patients and staff. An educational brochure and algorithm will be developed to assist with education. For staff members education will include bed bug behaviors and signs of an infestation as well as how to implement prevention and control measures. For patients’ education will include bed bug detection, prevention and control issues (see Appendix A).

10. References

a. Under Secretary for Health’s Information Letter (IL) on Beg Bugs, IL 10-2008-011, August 8, 2008.

b. http://www.afpmb.org/pubs/tims/TG44/TG44.htm

c. Laukhuf K. Bed Bugs: An Old Menace Bites Back, RN 70(5):29-32; 2007.

Bugs are found on the patient, their belongings or in their room.

If possible, capture a bed bug and place in a sealed container and contact Pest Control at extension 17636 Contact EMS at extension 17636 and inform them of all areas that the patient has visited.

Secure patient and their belongings in room/area and close room: post “Room Closed” sign provided by EMS.

Charge Nurse will notify Infection Control at extension 15949 and the Nurse Supervisor.

Have patient shower and change into clean pajamas; place patient in a clean room.

Pest Control will process room and inform Nursing to bag patient belongings.

Pest control will provide updates on surveillance and additional treatments required as necessary to Nursing.

Area items machine washable Pest Control or EMS will notify and Nurse Manager of treatment and length of time the room will be out of Service.

Nursing will inventory and double bag patients personal clothing using an overhand knot; label the bag with the patient’s last 4 of SSN and room number.

Personal items such as jewelry, books, or wallet will be heat treated if available.

Contact Laundry at extension 14474. Laundry will pick up bagged washable items and return them. after cleaning.

Belongings returned to patient

Yes No

How to Identify and Control Bed Bugs

Adult Nymph

Bed bugs are now found around the world, not just in developing nations. They have spread to the United States, Canada, England, and Europe. Bed bugs do not spread disease, but their bites can cause itching, allergies, stress, and loss of sleep.

Bed bugs come out at night to feed on a blood meal, so they are found where people sleep in their homes, apartments, shelters, buses, cruise ships, trains, and even in five-star hotels. During the day bed bugs hide in mattress seams, box springs, pillows, bed frames, furniture, books, clutter, clothing, boxes, electronics, luggage, cracks, and behind wallpaper and electrical plates. These wingless bugs live within eight feet of sleeping areas but can travel over 100 feet in a night.

Bed bugs are small, flat insects that only feed on the blood of humans and animals. Every day the adult female lays 4-5 eggs (the color of a sesame seed and the size of a poppy seed.) The eggs hatch in 4-12 days. The newly hatched nymph is very pale until it feeds on blood, then it looks like a tiny drop of blood. Adults are about the size and shape of an apple seed, and dark red to brown in color. At night, the bugs crawl at a steady pace. These bugs live up to one year and can last many months without a blood meal.

Prevent bed bugs from taking over your home. Inspect bed bugs regularly. Do not wait until you get bitten. Look for bed bugs and the eggs in their usual hiding places, and for clusters of small red or dark stains or bumps, drops of dried blood, or fecal droppings. Look for their amber-colored outer skin, which is shed as they grow. With a large number of bugs, there is a sweet musty odor. The best time to spot a crawling bed bug is in the middle of the night. Bed bugs can crawl between the walls of rooms and apartments. Try to collect a sample to make sure they are bed bugs. Consult a pest control expert with skill in treating bed bugs. Save time, money and stress. Start treatment right away.

Bed bugs hide in mattresses, bed frames, pillows, luggage, electronics, clothing, boxes, and furniture. Check used and new items for signs of bed bugs before bringing them into your home.

Shelters, hospitals, behavioral health facilities, nursing, and other group homes have to be extra careful. These places need to check new people and their clothing and personal belongings when they are admitted. People who have bed bugs should shower, change into clean bug-free clothes, and return to a different room. The original room should be checked for bed bugs and the bugs killed before anyone else stays in the room. If these steps are not taken, bed bugs can spread throughout the entire building and may even require tent fumigation to kill all of the bed bugs.

Seal infested clothing and items in a plastic bag tied with a "goose neck" (overhand) knot. Wash items in hot water (140° F) and dry on the highest heat setting for at least 20 minutes. Non-washable items can be sealed in bug proof plastic for a year.

PATIENT & PROVIDER EDUCATION

1. BED BUGS: What you need to know?

a. Bed bugs have been around for thousands of years.

b. They are a human parasite which thrives worldwide.

c. Like mosquitoes and bed bugs feed only on blood.

d. They are small but visible to the naked eye, wingless, yellow to reddish brown in color, oval shaped, and have prominent eyes (Figure 1).

e. They can hide in the cracks and crevices of mattresses, in box springs, on the backboards of beds, and behind loose wallpaper baseboards.

f. They can travel in furniture, luggage, clothing, and other personal belongings. Travel, immigration, and resistance to insecticides have contributed to resurgence in reports of infestations with these insects in developed countries.

g. The stigma commonly associated with bed bugs is mostly unwarranted because infestation is not necessarily attributable to lack of hygiene.

h. Bed bugs are predominantly night feeders, attracted to warm-blooded animals, including humans. There is currently no scientific evidence that these blood-sucking insects spread diseases.

2. SIGNS AND SYMPTOMS:

a. In many cases there is no reaction and barely any visible evidence of a puncture from a bite.

b. The most common reaction is the development of small, inflamed itchy bumps where each bite occurred. These usually resolve in a week or two weeks.

c. Frequently, people sleeping in areas with bed bugs may find small spots of blood where they were bitten and on their sheets in the morning.

d. An allergic reaction to the bed bug bite can cause a reaction that may result in urticaria (welts) at the site of the bite. This may evolve into more widespread blisters over the subsequent days and may become complicated by secondary bacterial infections. This type of reaction is uncommon.

3. TREATMENT:

a. There is no specific medical treatment for bed bugs.

b. Symptomatic relief for itchy bites can be obtained using over-the-counter topical antihistamines or topical corticosteroids.

4. PREVENTION:

a. Bed bugs are difficult to eliminate.

b. Proper identification by thorough inspection of areas thought to be at risk of infestation including hotel rooms or other unfamiliar locations.

Items like mattresses, box springs, and bedding purchased from resale shops should be carefully inspected before bringing them into the home. Be cautious when considering bringing used furniture home. In particular, furniture left curbside (“street furniture”) or discarded are at greater risk for being infested with bed bugs.

c. Vacuuming mattresses and box springs may help. Covering mattresses and box springs with encasements that prevent escape of bed bugs may help.

d. If your home is infested, showering and changing into freshly cleaned clothes will help to minimize the risk of bringing bed bugs to other areas. Insecticides in the same class as those used to prevent malaria transmitted by mosquitoes in tropical countries have been moderately effective, but bed bugs are developing resistance to these and there is some concern about the health effects of these insecticides on humans.

b a

Figure 1. a) Adult and larval bed bugs- note the difference in size and color. Size significantly varies not only with stage of maturity but also whether they have recently fed. b) Close-up image of an adult bed bug.

Clean infested rooms well. Scrub infested surfaces with a stiff brush or scraper to dislodge eggs and use a strong vacuum to remove bed bugs from cracks. Take bed frames and headboards apart. Remove drawers. Turn over furniture. Inspect and clean all surfaces. Remove all signs of bed bugs. At home, wrap mattresses and box springs in a sealed mattress bag. Repair holes or tears with permanent tape. Trapped bugs die within a year.

Take special steps when you travel. Remove the sheets and inspect the mattress and seams, and both sides of the headboard. Bugs in these areas are probably bed bugs. Report this to hotel management. If you carry your own pillow, put it in a bug-proof sealed pillowcase. Keep your luggage, radio, and other items as far from the bed as you can.

A penny of prevention is worth a pound of cure!

Watch for signs of bed bugs. Keep your place neat and clean. Report bites and bugs as soon as you see them so that proper steps will be taken before the problem gets out of hand.

Bed bug bites may itch and become painful or infected. Bed bugs inject saliva with an anesthetic and blood thinner. Itching and welts may not appear for two days or even two weeks. Some people have painful welts and severe allergies from bed bugs, while others do not notice any reactions. Do not scratch, as this can lead to skin breaks and infections. The Centers for Disease Control and Prevention says if you have bug bites to keep the area clean, use antiseptic creams or lotions, and take an antihistamine.

For more information, contact:

Bay Pines VA Healthcare System Bay Pines, FL Infection Control Section Phone: (727) 398-6661, ext. 15949 Toll-free: (888) 820-0230, ext. 15949

Algorithm for the Evaluation of Veterans Presenting with Suspected Bed Bugs to CBOC’s and Clinic’sEscort Veteran to exam room for assessment of bedbugs or other insect infestation

· Complete assessment and visually confirm bug

· Contain suspected bedbug in a Ziploc bag or specimen cup to present to EMS or Pest Control Contractor to confirm bedbug identification

· Take picture of bug, if applicable

· Explain bed bug protocol to Veteran explaining the necessity to be confined to that exam room. Minimize disruption of patients clothing. If removal of infested clothing should occur, it should be done over a large plastic trash bag when possible. Clothes should be placed in a sealed plastic bag and given to Veteran to take home and provide alternative clothing which is not to be returned back to clinic.

· When Veteran is discharged from clinic, a “Room Closed” sign will be placed on door, until the area has been assessed by pest control for bugs and intervention strategy is completed.

· Once the room has been assessed by pest control for bugs and an intervention strategy is completed; EMS will determine when “Room Closure” is lifted.

· Identify other locations where Veteran has been. Assess adjoining rooms for bugs.

· If Veteran is scheduled for multiple appointments on the same day, those appointment areas will be notified by nursing or HAS as designated by Leadership on duty. Assistant Nurse Manager/Nurse Manager in collaboration with Lead Provider and Chief Nurse to make the determination to cancel additional appointments.

· Veteran is educated as needed for treatment and follow up required

· Social Worker to be notified to provide resources to Veteran for bedbug elimination, if indicated

Notify Assistant Nurse Manager/Nurse Manager or HAS Supervisor of suspected case of bedbugs

Assistant Nurse Manager/Nurse Manager or HAS Supervisor to Notify EMS Pest Management Southern CBOC’s call EMS Supervisor (239) 940-5380 & Pest Manager cell (727) 580-5990 or extension 17755 & CBOC Facilities Coordinator (727) 365-1990 Northern CBOC’s call EMS Call ext. 17636 or Pest Manager cell (727) 580-5990 or extension 17755 & CBOC Facilities Coordinator (727) 365-1990

Assistant Nurse Manager/Nurse Manager or HAS Supervisor to Notify EMS Pest Management Southern CBOC’s call EMS Supervisor (239) 940-5380 & Pest Manager cell (727) 580-5990 or extension 17755 & CBOC Facilities Coordinator (727) 365-1990 Northern CBOC’s call EMS Call ext. 17636 or Pest Manager cell (727) 580-5990 or extension 17755 & CBOC Facilities Coordinator (727) 365-1990

Assistant Nurse Manager/Nurse Manager or HAS Supervisor to Notify EMS Pest Management Southern CBOC’s call EMS Supervisor (239) 940-5380 & Pest Manager cell (727) 580-5990 or extension 17755 & CBOC Facilities Coordinator (727) 365-1990 Northern CBOC’s call EMS Call ext. 17636 or Pest Manager cell (727) 580-5990 or extension 17755 & CBOC Facilities Coordinator (727) 365-1990

EMS Pest Management to call Pest Control Contractor for inspection of area, identification and extermination of bedbugs

· EMS Pest Management will contact the Contractor Officers Representative (COR) Ext. 15131 for contracted housekeeping services to terminally clean.

· Once surfaces have been cleaned, Housekeeping will determine when “Room Closure” is lifted and communicate to the Supervisory staff.

PEST CONTROL REFERENCE CHART

Bed Bugs (Cimex lectularius)

· ¼” length (apple seed)

· Wingless

· Flat & oval shaped

· Segmented

· Reddish- Brown in color

· Visible to the naked eye

· Bed bugs usually feed at night when people are sleeping. (Nocturnal)

· The only evidence that a person was bitten may be itchy welts that appear as soon as a few days or up to 14 days later.

Evidence of bed bug infestation:

· Presence of the bed bugs or their exoskeletons

· Blood spots/stains on bedding, walls, or upholstered furniture

· Can survive without a blood meal for 1 year.

· Bed bugs hide in the environment.

i.e. in cracks, crevices and seams near where humans and pets sleep or rest.

· Bed bugs live clothes, backpacks, in books, furniture (couches, chairs, dressers, and night tables, picture frames, behind wallpaper), & electronic devices (alarm clocks, radios, CPAP machine, IVP pump & computers)

· Infestations of bed bugs are not limited to hotels/bedrooms;

they can be found in public transportation, hospitals, and long-term care facilities.

Treat the environment!

Bed bugs do not spread disease but are a nuisance and infestations should be controlled by Pest Control.

For Inpatient or Clinic Infestations contact EMS

INPATIENT:

1. The Contractor Shall Capture a bug and place in a sealed container, live if possible.

2. Secure room or area from use and Contact EMS One Call ext. 17636.