Download Infestation - Progress Industries

Progress Industries
Standard Policies
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Infestation Procedure
Health
President & CEO
Infestation Policy
11-10
3-12, 3-13, 1-14, 3-15, 4-16, 1-17
The following guidance offers practical advice relating to the recognition and treatment of head lice,
body lice, crab lice, scabies, and bed bugs. This is applicable to all P.I. building sites where
individuals frequent or stay overnight. In any situation where staff believes an infestation of any
size exists, they should immediately contact their supervisor. The supervisor is responsible for
notifying P.I. Management Team who will determine the appropriate course of action to remedy the
situation. Treatment for infestations of pests will always be done in communication and coordination
with appropriate medical and/or community professional pest control experts.
HEADLICE (Pediculous Humanus Capitus)
The adult head is very small measuring .118 inches in length, the female being slightly larger than
the males. Lice live close to the scalp where the surface temperature is 87F or greater. They do not
voluntarily leave this warm environment. They match as closely as possible the color of the host’s
hair as do the un-hatched eggs being the same color as the scalp. All reactions to lice take time to
show, as it takes repeated bites for a person to become sensitized and start to itch.
Head lice are indiscriminate in their selection of suitable hosts, and can affect anyone. Contrary to
popular myth they are not associated with uncleanliness but in fact they thrive on clean hair. Head
lice can only transfer from one head to another during head to head contact. Lice do not fly, jump or
swim but wriggle and climb between the hairs. Head lice are thus more likely to be transmitted
between people who know each other very well, i.e. within a family rather than at school. Any louse
not in its ideal situation, i.e. close to the head will die. Any lice not found on the host are probably
old or damaged and are likely to have become detached during combing.
Warning Signs of Possible Head Lice Infection
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Louse Faeces – black gritty powder can be seen on pillows or collars.
Cast Skins – these look similar to lice and may be found on chair backs, combs, pillows, etc., (it
is probably the cast skins that have in the main part given rise to the myth that lice can be spread
by such items).
Close Friends/Neighbors mentioning an infection within their family.
An infection at school.
Treatment of Head Lice
Treatment should follow the recommendations of the Local Medical Doctor, Pharmacist, or
Community Nurse. Treatment should start as soon as the lice have been found and everyone who
needs to be treated should be treated at the same time with head louse lotion, not shampoo.
Shampoos are not recommended as they tend not to be as effective at killing lice as the lotions:
 Make sure you obtain enough lotion to treat everyone who needs it.
 You need one small bottle per head – more if the hair is thick.
 Follow the manufacturer’s instructions carefully.
 If you have been swimming in chlorinated water in the last two days you should wash your hair
well, using your normal shampoo. Dry hair thoroughly before applying the lotion or follow
instructions.
 Place a towel around the shoulders of the person being treated. Ask them to hold a protective
pad over the eyes because the lotion may sting if it affects the eyes.
 The entire scalp and the first few inches of hair should be soaked. You do not need to apply for
the whole length of hair as lice are only found close to the scalp.
 The hair should be left to dry naturally in a well ventilated room away from the open heat, e.g.
wall fires, bathroom radiant bars, etc. Do not dry with a hair dryer.
 On NO ACCOUNT should the head be exposed to any naked flame, e.g. fire or cigarettes:
some of the lotions are alcohol based and therefore flammable.
 After 12 hours (preferably overnight) wash the hair with an ordinary shampoo in the usual way,
rinse thoroughly and leave to dry naturally. Do not use a hair dryer. The next time you wash
your hair, you may use a hair dryer. (Some lotions may differ and need to be left on for a
shorter period of time- follow the instructions very carefully).
 DO NOT go swimming in a chlorinated swimming pool or have your hair bleached, colored or
permed for at least two days after using the lotion. These chemicals may stop the lotion from
working.
 Repeat the treatment after seven (7) days if instructions advise that it is necessary to do so.
BODY LICE (Pediculosis Corporis)
The body louse lives in clothing, only moving onto the body to feed. Each louse feeds by sucking
blood from its host four or five times a day. The parasite is grey in color preferring to secrete itself
in seams of clothing, and so is easily missed especially as it is mostly found in underclothing.
Elongated inflamed areas of the body often following the outline seams of an under vest or other
clothing provide an indication or the presence of lice.
When the clothing is removed, the lice fall onto the floor. They constitute little or not risk as the lice
are weak, incapable of invasion and soon die. Those remaining in the clothing do, however,
constitute some risk and care should be taken to avoid contact with infected clothing. Aprons and
gloves are recommended when removing clothing and, because the lice only transfer in the dark, the
procedure should be carried out in a well lit room.
BODY LICE
ON CLOTHES
Infected Clothing
 Washable fabrics e.g. underclothes – lice and eggs are destroyed in a 140F wash.
 For heat labile fabrics – place clothing, unwashed, in a normal or domestic tumble dryer
(because dry clothing does not cool itself by evaporation of water, a temperature lethal to the
louse is soon attained throughout the clothing) 30 minutes at 122F. The items can be washed at
the normal temperature.
 Non-washable fabrics – dry cleaning of clothes is effective against lice and eggs.
Prevention of Body Lice
Staff must ensure that patients newly cured of lice possess two sets of clothing so that both sets can
be effectively laundered.
CRAB LICE (Pthirus Pubis)
The crab louse lives on coarse body hair as well as the pubic area; this can include beards, eyelashes,
chest and leg hair. In infants the lice occur occasionally in eyelashes and around the edges of head
hair. They can assume a color which blends with that of the skin. Eggs that hatch in around eight
(8) days are glued to the hair. The louse is less mobile than other lice and is therefore, less likely to
transfer to healthcare workers.
Spread of Crab Lice
While the host is active, the crab lice remains firmly attached to the hairs of the host’s body,
flattened against the skin. However, once the host is resting, apart from unconscious scratching, the
risks to the active lice are few. Thus the lice can set about disseminating themselves around the
host’s body seeking mates or even new hosts. Spread is by contact but not necessarily sexual. The
first signs of crab lice may be intense itching coupled with specks of black powder in underwear.
These specks are louse faeces. If this is the first infection, the patient may have had the crab lice for
some time.
Treatment of Crab Lice
An aqueous malathion lotion is the treatment of choice. In view of the frequent involvement of other
hair areas of the body, in addition to the pubic region, it is advisable to treat the whole of the trunk
and limbs. Eyelashes can be treated by wiping them with aqueous malathion and leaving for twelve
(12) hours, however, this should only be undertake if absolutely necessary and under medical
supervision. Treatment should be repeated after one (1) week. Contacts will need to be warned and
sexual partners advised to treat themselves with a recommended insecticide.
SCABIES (Sarcoptes Scabiei)
Human scabies is a parasitic disease of the skin caused by infection with the mite Sarcoptes Scabiei
and the ensuing allergic response to the presence of the mites dead or alive and their eggs or faeces.
The microscopic mite penetrates the epidermis causing the tiny
characteristic linear burrows that are seen in the skin. Eggs are
laid in the epidermis and hatch after three to four (3-4) days.
The emerging larvae then appear on the surface of the skin
before excavating neat tunnels. In general, a burrow can be
described as a discolored irregular track that may be paler than
the surrounding skin (especially near the entrance to the burrow).
Incubation Period
The mites multiply rapidly in the skin but there are no symptoms, the incubation period is two to six
(2-6) weeks before the onset of itching in those infected for the first time by symptoms may occur
one to four (1-4) days after re-exposure.
Itching, often intense, may affect all parts of the body except the head and middle of the back. The
itching is frequently more intense at night particularly soon after retiring to bed. In 80% of cases,
the mites are confined to the skin of the hands or wrists. Very few are found elsewhere but if so are
most likely on the breasts of women and genitalia of both sexes. Burrows are very hard to see in
people such as healthcare workers who wash their hands frequently, because skin replacement is so
rapid that the burrows are very short.
Consultation with a Dermatologist or Dermatology Nurse Specialist is recommended.
Contact and Contact Tracing
Scabies is always caught by personal contact. No special precautions need to be taken with clothing,
bedding or household effects, with the exception of Crusted (Norwegian) scabies which is extremely
rare and does require items that may transmit Scabies to be treated. Mattresses, pillows, other soft
furnishing and floors will need to be vacuumed. Bedding and clothing must be laundered separately
on a hot cycle or dry cleaned.
Once treatment is completed, the patient may return to work or school. A thoroughly treated patient
is not infectious.
Recommended Instructions for the Treatment of Scabies
Classical Scabies – The whole body surface from the neck down including the soles of the feet, pay
particular attention to the hands. The treatment should be applied underneath fingers and toe nails
using a brush or cotton bud. In children and elderly patients the face, head and especially the post
auricular fold (behind the ears) should be included.
Ensure the Following Points are Followed for the Treatment of Scabies
 The quantity of treatment material required depends on the size of the patient and the product
used. Approximately half of a 6 ounce bottle of liquid treats an adult, most adults requiring at
least 2x1 oz. tubes of cream, some people may need more especially if the head is being treated.
 Timing of the treatment – often the most convenient time is before retiring to bed.
 In all cases, a patient will require the assistance of somebody else to apply the treatment
especially to the back.
 The treatment should be applied to cool, dry skin – there is no need for a pretreatment bath as
this may lead to a reduction in efficiency of the treatment.
 Whether a cream or a liquid, the treatment must be applied evenly to the skin using hands
(gloves, not applying to yourself), a small disposable sponge. The treatment should be allowed
to dry before patients redress.
 Only a thin film of treatment product is necessary but not a centimeter of skin must be missed!
 If hands or any other body part are washed during treatment period – reapplication is required.
 The treatment must be left on the skin for the prescribed number of hours.
 For most patients, a single application is sufficient.
 Treatment should be washed off with cool water, without soap.
Most problems with Scabies treatment arise because (1) it is applied incorrectly in some way, (2) the
treatment is washed off too soon and (3) parts of the body are not treated.
Arm infested
with Scabies.
Post Treatment Itch
Patients should be made aware that following a successful treatment, itching may increase due to the
release of the allergen as the mites are killed. Antihistimine tablets or topical preparations can be
used to alleviate the itching. Consultation with a Dermatologist or Dermatology Nurse Specialist
may be necessary.
Review
Every patient should be reviewed after seven to ten (7-10) days. Consequently, a sketch map should
be made of the distribution of the lesions before treatment for comparison at the time of review. If
the treatment is successful, the old lesions mostly shrivel and dry, many resolve completely in a
week but if new pustules or papules are present a second treatment is required that should include
the head, especially behind the ears.
BED BUGS
Bed bugs are oval, flattened, brown and wingless insects approximately 1/4 to 3/8 inch long. They
are similar in appearance to a ‘wood’ tick. After the bug has taken a blood meal, its color will
change from brown to purplish-red. Also, after feeding, it is larger and more cigar-shaped making it
appear like a different insect. Young bed bugs are much smaller (1/16 inch long when they first
hatch) and nearly colorless except after feeding, but resemble the adult in general shape. You may
also find cast skins, which are empty shells of bugs as they grow from one stage to the next. After a
blood meal, bed bugs deposit fecal spots (composed of digested blood) in areas adjacent to the
feeding site or back at their hiding places.
Bed bugs are active at night and hide during the day. After mating, females lay white, oval eggs
(1/16 inch long) into cracks and crevices. An individual bed bug can lay 200–250 eggs in her
lifetime.
Bed bugs are parasites that feed on the blood of people and certain animals, and they require these
blood meals to grow and reproduce. They live close to areas where people typically sleep, rest or sit
for long periods. Hungry bugs will move out from their hiding places, in search of exposed skin.
Typically, the head and neck are bitten, but bed bugs will also bit bare arms, hands and legs. When
searching for a place to feed, these bugs can move very quickly. Once an appropriate site is found,
they feed for 2-5 minutes until full, and then move quickly away from the person.
In addition to bed bugs moving towards a person when they are least likely to be noticed, the result
of their bites may also go unnoticed, or can be mistaken for the bites of other pests. All people are
not equally sensitive to bed bug bites, so while some victims break out in rashes from the bites, other
people may not display symptoms. When a reaction does occur, the results of feeding can be mild (a
simple red spot) to severe (rash or even hives). The reaction caused by feeding might be mistaken
for other problems. Fleas, mosquitoes and other biting insects, sensitization to detergents and soaps,
and irritants (e.g. poison ivy) are some of the conditions of victims of bed bugs thought they were
dealing with.
Detection of Bed Bugs
Pay special attention to complaints of insect bites and of persons itching and scratching. If reported,
examine the person(s) for the presence of bed bug bites. If bites are present, proceed to examining
the residence.
Bed bugs typically cluster together in favorable harborage areas. However, some bed bugs will live
by themselves, away from the majority of the infestation. The best way to determine if you have an
infestation is to look for bed bugs where you sleep (or rest) and where you typically set down
luggage (or bags) when you enter the residence. Your luggage and places where your luggage may
be stored are also some of the first areas to look. In bedrooms, look particularly around boxsprings,
mattresses, bed frames, tufts, folds, and buttons on mattresses, furniture, such as desks and chairs,
behind wall paper, clocks and pictures, cracks in wood floors, and under the edge of carpet. While
bed bugs are most commonly found in bedrooms, infestations can also occur in other rooms,
including: bathrooms, living rooms, and laundry rooms.
Dark blood spots on sheets and bedding may indicate bed bug feeding. Bed bugs will sometimes
excrete while they are feeding. This results in darker (reddish or brownish) spots or smears placed
on bed sheets, pillowcases and mattresses, or in nearby areas. This material is composed mostly of
digested blood and the stains care very characteristic.
Remember these insects are small (1/16 to 1/4 inch) and very flat, so they can move into very tight
corners and cracks. In some infestations, they were found under picture frames, in between the glass
and the frame! Be prepared to do some close inspection and when in doubt, consider having the
inspection done by a pest control service.
Bed bugs on the underside of a box spring .
BED BUGS
Bed bugs along a mattress seam.
Bed bugs on a metal bedframe.
Control of Bed Bugs
Assistance from a professional pest control company is highly recommended. A licensed
professional can conduct a free inspection, establish a remedial plan and guarantee eradication. If
Polk County Health Services houses are involved, P.I. will contact Polk County Health Services
directly. In Jasper County, P.I. is served by Schendel Pest Control, who can provide remediation
services. Controlling an infestation requires very detailed work and much moved (and disassembly)
of furniture. Careful inspections must be completed in conjunction with non-chemical controls (such
as heating premises and contents to a desired temperature, vacuuming, and steam treatments) and
insecticide treatments. The insecticides available are commercial products requiring special
equipment and training that is not readily available in “over-the-counter” products. During any
treatment services, closely follow the directions of the licensed professional.
Containment
Limit incoming and outgoing traffic through the location as much as possible. Staff who are
assigned to work at the location should spray their clothing from the waist down with a product
containing a high concentration of DEET (known to be effective in the containment of bed bugs)
before entry and upon leaving the location. This assures that no bed bugs are transferred in or out of
the location by discouraging bugs from settling on staff clothes. Protective aprons and footies
should also be made available, if recommended by the licensed professional.
All renters clothing, bedding, etc. should be put directly into bags and taken off-site to be dried for
one cycle on high heat to kill any bed bugs that might reside there. To minimize the potential for
cross-contamination, restrictions should be placed on traffic in and out of affected areas of the house.
Company cars should be used to transport renters. Mattress covers can be purchased and marked
“bed bug proof”.
Prevention of Bed Bugs
The greatest risk for encountering bed bugs appears to be while people are traveling. Regardless of
the type of accommodations you stay at, it is a good precaution to check your room. Please refer to
the section “How can I detect an infestation?”, and check around the headboard and adjacent area of
the bed. Also inspect luggage stands or other areas where suitcases are typically set down. Be
aware of any unexplained bites you may find in the morning; that could be the result of bed bugs.
Also watch for fecal spots, which could occur on bed sheets or nearby areas. Inspect your luggage
when you get home after a trip for any bed bugs that may have escaped your earlier attention.
Other sources may be associated with the scavenging of used furniture. Residents and Tenants are
strongly cautioned against “scavenging” beds and furniture that have seemingly been discarded
and left by the curb for disposal, or behind places of business. Bed bug infestations are not limited
to beds and mattresses, and they can be found on tables, drawers, and even electronics if these items
were located in a bedroom or other place that could support an infestation.