Troubleshooter: Patient covered in bed bugs visits dental office
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QUESTION: We had a patient recently who was infested with bed bugs. No joke! I saw a bug on her and told her, but she didn't even seem alarmed, and my boss killed it. Throughout the procedure I saw 18 more! I was assisting from at least two feet away when I noticed. I told the office manager when we were done, and then I found a live bed bug on the floor! Of course, we had someone treat the whole office, but it was the worst appointment of my life!
My concerns are, do we need to inform other patients? Can we legally ask this woman not to return to our office unless she’s treated for bed bugs? Needless to say, this is the first time this has happened in our office and I’m hoping we’ve done all the correct follow-up. It freaked us out!
ANSWER FROM NOEL KELSCH, RDHAP, founder of Hy-Ginx dental hygiene education:
First and foremost, bed bugs (Cimex lectularius) do not ordinarily carry disease. But boy, can they “bug” you! Itching and scratching are side effects of the bugs sucking your blood. You can get secondary infections from the excessive itching and scratching. You can often see bite marks (pruriginous macules or papules) where the bugs have been, and some people are seriously allergic to them. The protein in the bug’s saliva causes the marks and any allergic reactions. If exposure continues the person can end up with fever and anemia.
These flat, small reddish brown bugs range in size from 1 mm to 7 mm. They do not fly or flitter around. They are parasitic and feed off people and animals as they sleep. Much like cockroaches, they can live without food for months. They are not a sign of being dirty and can occur in even the poshest hotels.
Infestations tend to occur around where people sleep. During the day, the bugs hide in places like the seams of mattresses or cluttered areas. Typically, bed bugs do not live in or on humans. They feed on them mainly at night. Bed bugs like dark hidden places. There is little chance that anyone would “spread” bed bugs to other patients. Bed bugs generally do not like to stay on humans because they like to be in dark places.
In outpatient settings, such as emergency rooms and dental offices, the Centers for Disease Control states that the key is prevention and patients need to be seen immediately. To prevent establishment of bed bugs, avoid wood furniture and fabric-covered furniture in the lobby. Use plastic encasement (barrier protection) for pillows, chairs, etc.
You will need to check your waiting room furniture and your operatory chairs for the following signs:
- The bed bugs’ exoskeletons after molting
- Bed bugs in the folds of chairs
- Rusty-colored blood spots due to the bugs’ blood-filled fecal material that they excrete on furniture
- A sweet, musty odor
If these signs are present you will need to get more help from the exterminator. Bed bugs are very resistant to pesticides. It’s important to have a professional address them, possibly more than once. They will first identify if the bug is a bed bug and apply the necessary steps to rid the office of them.
Your questions about being able to turn the patient away takes a few directions:
1. What are the patient’s real needs? Your compassion and humane attitude may change someone’s life. You might be the person who makes a difference to them. If someone is walking around with bed bugs on their body, they have a need that goes well beyond the dental chair. This person could be dealing with everything from fever to anemia. Clearly, they do not have the ability to address their own needs. This is where we come in. This is a case that might need to be referred to adult protective services. Referral for appropriate assistance and follow-up are a part of our role as providers.
2. Was the patient at the office for urgent treatment that needed to be addressed immediately? If the treatment was urgent then there are appropriate steps that can be taken to minimize contamination.
3. If after you have taken all steps to meet the needs of the patient and referred if the patient does not follow through, you can dismiss the patient. There are many legal ramifications for dismissal of a patient. You have to follow your state dental practice act regulations for dismissing someone from your practice. You need to consult your attorney and liability company before you dismiss someone. This can differ from state to state. It is important that you dismiss without abandonment, giving reasonable notice to allow a patient to secure care, and providing care for the allotted amount of time your state requires.
Our jobs include meeting both the oral health needs and issues that impact the oral health needs of our patients. When a patient clearly does not have the ability to meet his or her own basic human needs, we need to be there to advocate for them.
The CDC has a great resource page for bed bugs at cdc.gov/parasites/bedbugs/add_resources.html.
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